1667. Evaluation of Aging and HIV in a Rural Ugandan Cohort: Impact and Challenges
Session: Poster Abstract Session: HIV: Aging and HIV
Saturday, October 10, 2015
Room: Poster Hall
Background:

An estimated 3 million adults 50 years or older live with HIV infection in sub-Saharan Africa, and this number is expected to triple by 2040. Multiple studies have focused on HIV and aging in resource rich settings, addressing topics such as cognition and metabolic complications. There is a paucity of data concerning HIV and aging in Africa, especially as it impacts non-communicable diseases.

Methods:

Data was abstracted retrospectively from the charts of randomly selected HIV infected patients from Kayunga District Hospital in rural Uganda. Selection was age-stratified with 300 charts from those 50 years and older, and 150 from those 25-40 years. Variables included demographics, comorbidities, antiretroviral therapy (ART) history, non-ART medications, vital signs, hematology and chemistry results, as well as HIV outcomes. The data was analyzed using t-tests, Mann-Whitney U, χ2, or Fisher’s exact test as appropriate. All p-values were two sided and <0.05 was considered significant.

Results:  

The groups were similar regarding number of visits and symptoms recorded, ART status and adherence, rates of tuberculosis, and most laboratory parameters. Compared to those aged 25-40, the 50+ age group had been diagnosed and seen in the clinic longer, had a lower CD4 count, had a higher peak WHO stage, and were more likely to have a viral load <50 cp/mL and, at ART initiation, a CD4 count <350 cells/mL (p <0.05, each). Additionally, the older group had more non-ART medications, more comorbidities documented (specifically hypertension and helminthiasis), a higher creatinine (though no more renal disease), and higher rates of thrombocytopenia (p <0.05, each). Important data was absent from most charts, such as routine vital sign measurements and documentation of comorbidities (e.g., only 17% of the older and 0% of the younger group had any comorbidity documented, and of those with hypertension, 40% were missing any blood pressure measurement).

Conclusion:

Older HIV patients in this rural Ugandan setting have more advanced HIV disease, better virologic suppression, and more medical comorbidities and medications compared to the younger patients. In the context of effective HIV care, many non-HIV measures were not addressed. Our data underscore the need for health-care systems in resource-limited settings to adopt a comprehensive care model as the HIV population ages.

Nathanial K. Copeland, MD1, Francis Kiweewa, MBChB, MMed, MPH2, Victor G. Valcour, MD, PhD3, Alice Mambuya, RN2, Rosemary Namagembe, RN2, Hannah Kibuuka, MBChB, MMed, MPH2, Monica Millard, BSN, MPH4, Nelson L. Michael, MD, PhD4 and Julie Ake, MD, MSc5, (1)Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD, (2)Makerere University Walter Reed Project, Kampala, Uganda, (3)Department of Neurology, University of California San Francisco School of Medicine, San Francisco, CA, (4)U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, (5)US Military HIV Research Program (MHRP) at WRAIR, Silver Spring, MD

Disclosures:

N. K. Copeland, None

F. Kiweewa, None

V. G. Valcour, None

A. Mambuya, None

R. Namagembe, None

H. Kibuuka, None

M. Millard, None

N. L. Michael, None

J. Ake, None

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