Sex, Race and Health Risks in Elderly HIV Patients
Sex, Race and Health Risks in Elderly HIV Patients
A total of 132 patients (28 women and 104 men) were included in the study. Median age for the study cohort was 63 years (women 62 years and men 63 years) and 62.6% were African American (women 89.3%, men 55.3%). Non-African Americans were universally Caucasian. The subpopulation of older patients was not statistically different compared to the HOP clinic population <59 years of age in regard to sex and racial proportions. In all, 31% of the men had a risk category of male to male (MSM) sex and 5 of the men with an MSM risk were injection drug users (IDUs). Thirteen patients (9 women and 4 men) were categorized as having a heterosexual risk. Two men, but no women, were at risk because of a blood transfusion or transplant. Forty-two patients (11 women, 31 men) had their risk categorized as unknown or other (including risks not otherwise specified).
Substance use other than IDU was common. Proportions of the population using legal and illicit substances at baseline or during the study period were as follows: cigarettes (49.2%), alcohol binges (18.9%), crack cocaine (8.3%), and marijuana (11.4%). Fifteen patients had a history of IDU (3 women and 12 men). No patient was identified as using crystal metamphetamines. The total number of older patients who used any type of illicit substances during the study period was 25 (19.7%). Sex and race were not associated with the use of any substance.
The study population baseline immunity was relatively well preserved as reflected by the relatively high mean CD4 counts, but African Americans had a significantly lower mean count compared to non-African Americans (P < .005). The proportion of patients having an HIV RNA level <400 copies at baseline was 28.8%. This study did not evaluate virologic response to ARV medications, but all patients ever on ARV medications during the study period had a nondetectable HIV RNA level (<400 copies) at least once. Women had a lower baseline mean hemoglobin compared to men, but levels were consistent with normal ranges. African Americans had a significantly lower mean baseline hemoglobin and serum albumin compared to non-African Americans (P < .05), which may have reflected a more advanced HIV disease status. Renal function was similar between men and women, but African Americans had both a lower baseline creatinine clearance and a higher prevalence of proteinuria compared to non-African Americans. However, these differences did not reach statistical significance. Only 4 patients in our study population had chronic renal failure.
The mean serum aspartate amino transferase (AST) was slightly elevated for the entire cohort and was modestly higher among women and African Americans compared to men and non-African Americans, respectively. Hepatitis C infection was the only variable significantly associated with increased AST levels (P < .001, Table 1).
Frequent medical or mental health conditions present either at baseline or diagnosed during the study period are shown in Table 2. Of the 43 patients with liver disease, 37 had chronic hepatitis C infection and 5 were hepatitis B surface antigen positive. Women were more depressed compared to men, but there were no significant associations between sex and any other condition. African Americans were more likely to be diagnosed with mild liver disease, hepatitis C infection, and diabetes and less likely to be diagnosed with depression and other mental health conditions compared to non-African Americans. However, after adjusting for age, sex, and baseline body mass index (BMI), race was not associated with diabetes.
Both sex and race were independently associated with depression. Female sex (odds ratio [OR] = 3.7, P = .012) and non-AfricanAmerican race (OR = 4.8, P = .001) had a significant associationwith depression, and independent of their age and sex, African Americans (OR = 2.3, P < .001) and IDUs (OR = 1.4, P < .04) were most likely to be diagnosed with hepatitis C.
Of the study cohort, 94% was ever on ARV medications. In addition to medications for underlying medical conditions, patients were often on pain medications during the study period (22% ever opiates, 20% ever gabapentin, and 16% nonsteroidal anti-inflammatory agents). Sex and race were not associated with either opiate or pain medication use.
Seventeen patients suffered mobility impairment including the use an aide for walking (3.0%), the use a wheelchair (2.3%), or ever having a fall (7.6%) during the study period. Results showed that age, sex, and race were not associated with all combined categories of mobility impairment outcomes described above. However, having a diagnosis of diabetes showed a trend toward significance association with the presence of mobility impairment (OR= 3.2, P = .06). A total of 48 persons were hospitalized during the study period. Multivariate analysis showed that African American race (OR = 10.4, P = .0001), cardiovascular disease (OR = 3.6, P = .003), and late HIV diagnosis (>59 years of age; OR: 4.1, P = .02) were independently associated with hospitalization. Other rare outcomes not statistically analyzed included 4 cases that were placed in a nursing home and 1 death.
Results
A total of 132 patients (28 women and 104 men) were included in the study. Median age for the study cohort was 63 years (women 62 years and men 63 years) and 62.6% were African American (women 89.3%, men 55.3%). Non-African Americans were universally Caucasian. The subpopulation of older patients was not statistically different compared to the HOP clinic population <59 years of age in regard to sex and racial proportions. In all, 31% of the men had a risk category of male to male (MSM) sex and 5 of the men with an MSM risk were injection drug users (IDUs). Thirteen patients (9 women and 4 men) were categorized as having a heterosexual risk. Two men, but no women, were at risk because of a blood transfusion or transplant. Forty-two patients (11 women, 31 men) had their risk categorized as unknown or other (including risks not otherwise specified).
Substance use other than IDU was common. Proportions of the population using legal and illicit substances at baseline or during the study period were as follows: cigarettes (49.2%), alcohol binges (18.9%), crack cocaine (8.3%), and marijuana (11.4%). Fifteen patients had a history of IDU (3 women and 12 men). No patient was identified as using crystal metamphetamines. The total number of older patients who used any type of illicit substances during the study period was 25 (19.7%). Sex and race were not associated with the use of any substance.
The study population baseline immunity was relatively well preserved as reflected by the relatively high mean CD4 counts, but African Americans had a significantly lower mean count compared to non-African Americans (P < .005). The proportion of patients having an HIV RNA level <400 copies at baseline was 28.8%. This study did not evaluate virologic response to ARV medications, but all patients ever on ARV medications during the study period had a nondetectable HIV RNA level (<400 copies) at least once. Women had a lower baseline mean hemoglobin compared to men, but levels were consistent with normal ranges. African Americans had a significantly lower mean baseline hemoglobin and serum albumin compared to non-African Americans (P < .05), which may have reflected a more advanced HIV disease status. Renal function was similar between men and women, but African Americans had both a lower baseline creatinine clearance and a higher prevalence of proteinuria compared to non-African Americans. However, these differences did not reach statistical significance. Only 4 patients in our study population had chronic renal failure.
The mean serum aspartate amino transferase (AST) was slightly elevated for the entire cohort and was modestly higher among women and African Americans compared to men and non-African Americans, respectively. Hepatitis C infection was the only variable significantly associated with increased AST levels (P < .001, Table 1).
Frequent medical or mental health conditions present either at baseline or diagnosed during the study period are shown in Table 2. Of the 43 patients with liver disease, 37 had chronic hepatitis C infection and 5 were hepatitis B surface antigen positive. Women were more depressed compared to men, but there were no significant associations between sex and any other condition. African Americans were more likely to be diagnosed with mild liver disease, hepatitis C infection, and diabetes and less likely to be diagnosed with depression and other mental health conditions compared to non-African Americans. However, after adjusting for age, sex, and baseline body mass index (BMI), race was not associated with diabetes.
Both sex and race were independently associated with depression. Female sex (odds ratio [OR] = 3.7, P = .012) and non-AfricanAmerican race (OR = 4.8, P = .001) had a significant associationwith depression, and independent of their age and sex, African Americans (OR = 2.3, P < .001) and IDUs (OR = 1.4, P < .04) were most likely to be diagnosed with hepatitis C.
Of the study cohort, 94% was ever on ARV medications. In addition to medications for underlying medical conditions, patients were often on pain medications during the study period (22% ever opiates, 20% ever gabapentin, and 16% nonsteroidal anti-inflammatory agents). Sex and race were not associated with either opiate or pain medication use.
Seventeen patients suffered mobility impairment including the use an aide for walking (3.0%), the use a wheelchair (2.3%), or ever having a fall (7.6%) during the study period. Results showed that age, sex, and race were not associated with all combined categories of mobility impairment outcomes described above. However, having a diagnosis of diabetes showed a trend toward significance association with the presence of mobility impairment (OR= 3.2, P = .06). A total of 48 persons were hospitalized during the study period. Multivariate analysis showed that African American race (OR = 10.4, P = .0001), cardiovascular disease (OR = 3.6, P = .003), and late HIV diagnosis (>59 years of age; OR: 4.1, P = .02) were independently associated with hospitalization. Other rare outcomes not statistically analyzed included 4 cases that were placed in a nursing home and 1 death.
Source...