Age-based outcomes of antiretroviral therapy for people living with HIV in current follow-up: a comparative retrospective cohort study, Ganzhou, China, 2001-2021.
Abstract
Background
The increasing population of elderly people living with HIV (PLHIV) presents new challenges for HIV management, while few studies have explored antiretroviral therapy (ART) effects in this population. This study aimed to compare ART outcomes across multiple physiological systems between young and elderly PLHIV.
Methods
A comparative retrospective cohort study was conducted among 2,178 young (18-49 years) and 1,495 elderly (≥50 years) PLHIV who received ART in Ganzhou, China, between 2001 and 2021. Temporal changes in multiple biomarkers related to virological, immunological, haematological, hepatic, renal, and metabolic functions were compared. Paired t tests and two-sample t tests were used for primary comparisons, and linear mixed-effects models were used for longitudinal analyses.
Results
Baseline assessments revealed significantly lower white blood cells (WBC), platelets (PLT), haemoglobin (Hb), and alanine aminotransferase, alongside higher glucose (Glu), total cholesterol (TC), and serum creatinine (Scr) in elderly individuals (P<0.05). Both groups demonstrated comparable ART benefits including reduced viral load, decreased CD8+ T cells and aspartate aminotransferase, along with increased CD4+ T cells (CD4+), WBC, PLT, and Hb (P<0.05). Linear mixed-effects models confirmed significant longitudinal changes in most biomarkers. No significant age-group interactions were observed for CD8+ T cells, viral load, WBC, PLT, triglycerides, TC, Glu, and aspartate aminotransferase, indicating similar trends. However, compared with young PLHIV, elderly PLHIV had smaller increases in CD4+ and Hb, larger decreases in Scr and alanine aminotransferase, and a greater increase in total bilirubin. Moreover, both groups shared three notable temporal patterns: early-stage bilirubin decline, late-stage Scr rebound, and persistent Glu, TC, and triglyceride elevation throughout treatment.
Conclusion
Despite baseline physiological disadvantages, elderly PLHIV attained virological suppression, immune reconstitution, and functional improvements across multiple organ systems that were comparable to those of young PLHIV. However, age-specific differences were observed, including smaller increases in CD4+ and Hb, and distinct renal, hepatic, and bilirubin trajectories in elderly PLHIV. These findings underscore the viability of ART in the elderly PLHIV and highlight the age-specific metabolic variations that demand clinical attention.