Highly active antiretroviral therapy (HAART) has resulted in improved longevity in HIV-infected patients and a growing prevalence of HIV infection in people over the age of 50. Some preliminary data suggest that older patients may not respond as well to HAART as younger patients. Specifically, immune recovery may be less good, and both morbidity and mortality rates may be higher in older patients. As the HIV-infected population ages, there is a growing need to better define the natural history of the disease, the effectiveness of therapy, and the effect of age-related comorbidities on disease progression. We propose to conduct an observationalcohort study of 3,600 HIV-infected individuals (1,800 aged 50 years and over and 1,800 under age 50 years, matched on year of HAART initiation, pre-HAART CD4, and site of care) followed at 5 HIV primary care sites in the United States.
Specific aim 1 : evaluate virologic and immunologic response, HIV disease progression, and mortality in patients over 50 on HAART compared to younger patients on HAART. We hypothesize that older patients will achieve greater rates of virologic suppression, but less immunologic response and have worse HIV disease progression and mortality than younger patients. Our primary study outcome will be HIV disease progression. Secondary outcomes will include changes in CD4+ cell counts, viral load suppression, and death.
Specific Aim 2 : evaluate the incidence of adverse drug reactions (ADRs), particularly hepatotoxicity, nephrotoxicity, pancreatitis, diabetes, and lipid abnormalities in older HIV-infected patients, stratified by HAART class. We hypothesize that older patients on PI based HAART will have more ADR's requiring cessation of HAART than HIV+ older patients on NNRTI based HAART.
Specific Aim 3 : define incidence, prevalence, and mortality from comorbidities in HIV-infected patients over age 50 with a particular focus on (a) end-stage renal disease, (b) non-HIV related malignancies, (c) anemia and (d) cardiovascular disease. We hypothesize that older patients will have a greater incidence of these comorbidities than age matched HIV seronegative controls. Our primary outcomes will be incidence and prevalence of these comorbidities. Secondary outcomes will include cause-specific mortality. Our research team has an established history of collaboration in HIV and aging, and brings together a wealth of research expertise in HIV treatment outcomes, co-morbidities in the elderly, and novel biostatistical and epidemiological methodologies in cohort studies and longitudinal analyses of HIV disease and AIDS.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
3R01AG026250-01A2S1
Application #
7471106
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Nayfield, Susan G
Project Start
2006-09-30
Project End
2009-08-31
Budget Start
2007-08-01
Budget End
2009-08-31
Support Year
1
Fiscal Year
2007
Total Cost
$82,000
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Haines, Charles F; Fleishman, John A; Yehia, Baligh R et al. (2016) Closing the Gap in Antiretroviral Initiation and Viral Suppression: Time Trends and Racial Disparities. J Acquir Immune Defic Syndr 73:340-347
Haines, Charles F; Fleishman, John A; Yehia, Baligh R et al. (2014) Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era. J Acquir Immune Defic Syndr 67:84-90
Haines, Charles F; Moore, Richard D; Bartlett, John G et al. (2013) Clostridium difficile in a HIV-infected cohort: incidence, risk factors, and clinical outcomes. AIDS 27:2799-807
Justice, Amy C; Modur, Sharada P; Tate, Janet P et al. (2013) Predictive accuracy of the Veterans Aging Cohort Study index for mortality with HIV infection: a North American cross cohort analysis. J Acquir Immune Defic Syndr 62:149-63
Abraham, Alison G; D'Souza, Gypsyamber; Jing, Yuezhou et al. (2013) Invasive cervical cancer risk among HIV-infected women: a North American multicohort collaboration prospective study. J Acquir Immune Defic Syndr 62:405-13
Agwu, Allison L; Siberry, George K; Ellen, Jonathan et al. (2012) Predictors of highly active antiretroviral therapy utilization for behaviorally HIV-1-infected youth: impact of adult versus pediatric clinical care site. J Adolesc Health 50:471-7
Berry, Stephen A; Fleishman, John A; Moore, Richard D et al. (2012) Trends in reasons for hospitalization in a multisite United States cohort of persons living with HIV, 2001-2008. J Acquir Immune Defic Syndr 59:368-75
Silverberg, Michael J; Lau, Bryan; Justice, Amy C et al. (2012) Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis 54:1026-34
Agwu, Allison L; Jang, Susie S; Korthuis, P Todd et al. (2011) Pregnancy incidence and outcomes in vertically and behaviorally HIV-infected youth. JAMA 305:468-70
Agwu, Allison L; Fleishman, John A; Korthuis, P Todd et al. (2011) Disparities in antiretroviral treatment: a comparison of behaviorally HIV-infected youth and adults in the HIV Research Network. J Acquir Immune Defic Syndr 58:100-7

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