Is age a negative prognostic indicator in HIV infection or AIDS?

To better understand disease progression in older persons with human immunodeficiency virus (HIV infection or acquired immunodeficiency syndrome (AIDS), we studied patients aged 50 years and older hospitalized with a diagnosis of HIV infection or AIDS between January 1985 and October 1995. Data collected included demographics, opportunistic infections, comorbid disease, neurologic dysfunction, and antiretroviral therapy. A total of 86 patients with a mean age of 54.3 years was identified. Pneumocystis carinii pneumonia was the most frequent opportunistic infection (43%). Hypertension was the most common previous medical condition (38%). Other comorbid disease was present in less than 15% of the subjects. Fifty-seven patients (66%) had neurologic impairment, with 30 requiring treatment for delirium. In these 30, 23 (77%) had anemia, infection, or both. The median length of survival following the diagnosis of AIDS was 18.5 months, for HIV it was 48 months. The median survival following the diagnosis of AIDS in patients who received antiretroviral therapy was 22 months compared with 11 months for those who did not receive antiretroviral therapy (p<0.0004). Multivariable analysis found that antiretroviral therapy was the only independent predictor of survival after the diagnosis of AIDS. In contrast to previous studies, the present findings suggest that older age may not necessarily be associated with more rapid disease progression and reduced survival times in persons with HIV infection or AIDS. In those patients with delirium, many may have readily treatable conditions (anemia and/or infection). The absence of significant comorbid disease and the access to antiretroviral therapy may be in part responsible for the longer survival times obtained in this cohort compared to that reported previously.