603. Multi-morbidity and Impaired CD4/CD8 ratios in Older Adults with well controlled HIV.
Session: Poster Abstract Session: HIV: Management and Clinical Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWeek2018 CD4CD8poster.pdf (488.0 kB)
  • Background: Older age has been associated with impaired CD4 recovery and a low CD4:CD8 ratio is an independent predictor of non AIDS morbidity/mortality. In this study we describe the overall comorbidity burden and assess factors associated with CD4:CD8 <1 among HIV+ older adults 60years+ seen at CORE Center, Cook County Health and Hospital System; a safety-net health system.

    Methods: We evaluated demographic, clinical, and lab variables in all HIV+> 60years who had at least 1 primary care visit from January 01, 2016 to May 31,2017 at the RMR CORE center. Since HIV viremia is associated with CD4 recovery, analysis on CD4:CD8 ratios was restricted to the pts with viral suppression.

    Results: There were 809 Pts with a median age of 63 (range: 60-89) yrs. 75% were male, 74% black, 17% Hispanic and 8% white. Mean CD4 was 538 (+307) Cells/mm; 107 (13%) had CD4<200 and 675 (84%) had undetectable HIVRNA (<40 copies/ml). 38% were HCV Ab+. Common comorbidities were hypertension 62%, COPD 23%, Diabetes 22%, depression 17%, osteoarthritis 15%, neuropathy, chronic kidney disease (CKD) and Coronary artery disease (CAD) 13% each. 50% had 1-2 comorbidities and 31% had >3 co-morbidities. Of the 675 patients with suppressed viremia, 470pts (70%) had CD4:CD8 <1 and 245 (36%) had CD4:CD8< 0.5. Compared to pts with CD4:CD8> 1, Pts with CD4:CD8<1 had lower CD4 counts (451 vs 739 cells/mm3; p<0.001), were less likely to have CD4>500 (35% vs 75%; p<0.001 ), more likely to have CD4< 200 (13% vs 1%; p<0.001), be male (82% vs 60%; p<0.001), HCVab+ (39% vs 32%; p 0.05). They also trended to have more CAD 7% vs 4% (p=0.1) and more CKD 15% vs 11% (p=0.2).

    Conclusion: There was a high rate of multi-morbidity among older, predominantly ethnic minorities HIV infected adults with 56% having >2 comorbidities. In the setting of viral suppression, 70% still had a CD4:CD8 ratio <1 which likely reflects the effects of older age, and lower CD4 nadir. This impaired immune restoration and co-morbidity burden portend a higher risk of non-AIDS morbidity and mortality in these patients and highlights the need for comprehensive care in HIV clinic settings.

    Oluwatoyin Adeyemi, MD, Ruth M Rothstein CORE Center, Cook County Health and Hospitals System (CCHHS) and Rush University Medical Center, Chicago, IL and Lisa Diep, MPH, Cook County Health & Hospital System, Chicago, IL

    Disclosures:

    O. Adeyemi, None

    L. Diep, None

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