Tamar Kahn
24 July 2007
Sydney, Australia — While HIV-positive patients now lived longer thanks to antiretroviral drugs, they faced a higher risk of a host of agerelated illnesses such as cardiovascular disease and dementia, delegates at the fourth International Aids Society Conference on HIV pathogenesis, treatment and prevention heard yesterday.
As SA's government expanded its treatment programme for people infected with HIV, these age-associated illnesses were set to become more problematic.
State clinics and hospitals treated about 280000 people and 110000 got the drugs privately, said Dr Nomonde Xundu, the health department's head of HIV/Aids. The figures were due to rise sharply as the government aimed to reach 80% of those in need by 2011.
Dr Brian Gazzard, founder of the British HIV Association, told delegates yesterday that HIV, the virus causing Aids, appeared to accelerate several naturally occurring molecular changes as people aged, increasing the risks of a host of "geriatric giants" such as dementia, osteoporosis and cardiovascular disease. Ageing and HIV had received scant attention from the international research community, and the few studies to date all focused on the developed world, he said.
Southern African HIV Clinicians' Society president Dr Francois Venter said many South African health facilities had a significant number of older patients on their books: at Johannesburg General Hospital for example, half the patients were older than 38 and about a fifth older than 70.
Older patients also often had more side effects from their medication than younger people, he said. "Treating older patients is much more complicated because they often have underlying kidney or liver disease," he said. These conditions meant patients were at greater risk of serious side -effects, and might have difficulty absorbing antiretrovirals.
Older adults were rarely included in clinical trials of new medicines so there was little published data on age-specific drug actions, interactions with other medication, or side effects. There were guidelines for treating children but no such guidance on older adults.
A disproportionate number of older HIV-positive patients in SA were men, said Venter. HIV prevalence among South Africans over 50 was 5,7% in 2005, according to the Human Sciences Research Council. HIV prevalence among men aged 50-54 was 14,2%, almost double the 7,5% prevalence among women. A similar pattern was seen in the 55-59 group, with male and female HIV prevalence of 6,4% and 3% respectively.
The conference highlighted the fact that many South African HIV-positive patients began antiretroviral treatment only when they were extremely ill with opportunistic infections. SA's guidelines say treatment should begin when a patient's CD4 count (a measure of the strength of the immune system) falls below 200, but delegates heard that the average CD4 count of South African patients starting antiretroviral therapy was only 87.
Xundu said she planned to call a meeting of experts next month to discuss ways of getting people to test earlier. The meeting would also consider the latest World Health Organisation treatment guidelines, which recommend commencing treatment when CD4 counts fell below 350.
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