Optimal ARTs for Older Adults with HIV

Cheerful senior gentleman posing with an AIDS badge on his shirt isolated on white background. Photo by iStock

Recently, the HIV-Age.org website published the results of a review to identify the most effective, least toxic ART (antiretroviral therapy) regimen for treating older patients who are HIV-positive.
The population of Americans with HIV continues to age (an estimated 70% of PLHIV in the U.S. are over the age of fifty), but older HIV-positive adults have historically been excluded from or under-represented in pre-release studies of the effects of ART. This review, published for the benefit of physicians and clinicians treating older HIV patients, highlights the special considerations for the use of ART in older people with HIV. The study focused on toxicities associated with specific antiretroviral agents or drug classes and poses key research questions for future studies.

The review concluded that, “like all people newly diagnosed with HIV, older people with HIV should be started on ART as soon as possible, regardless of CD4 count, and with a regimen that includes an integrase strand transfer inhibitor (INSTI) and two nucleoside reverse transcriptase inhibitors. Important toxicities to consider when choosing an ART regimen include bone and renal effects related to tenofovir, weight gain related to INSTIs and tenofovir alafenamide, neurocognitive and neuropsychiatric toxicities related to efavirenz, and increased cardiovascular risk associated with abacavir and boosted protease inhibitors. With the ongoing importance of INSTIs as a component of preferred ART regimens, further characterization of INSTI-related weight gain is a critical current research priority in understanding ART toxicity.”

In short, the ART review produced multiple data-driven recommendations for medical personnel that can result in reduced ART toxicities associated with various diseases and conditions in HIV-positive older adults, including potential bone, renal, neurocognitive and neuropsychiatric toxicities, weight gain, and cardiovascular risk.
The abstract of the review can be read at: www.HIV-Age.org.

—Reporting by Hank Trout

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.