HIV/AIDS in Puerto Rican Patients 50 Years or Older

1
HIV/AIDS in Puerto Rican Patients 50 Years or
Older

• Alejandro Amill, MPH María Gómez, Ph.D. Doris
  Báez, MSc Miriam Velásquez, MSc Diana M
  Fernandez, MSc Eddy Ríos, Ph.D., MPH and Robert
  F. Hunter, MD, FACP.
• Universidad Central del Caribe, Bayamón, Puerto
  Rico
• Retrovirus Research Center

2
Background

• 11 (86,875) of the AIDS cases reported in the
  United States and 12 (3513) of the cases in
  Puerto Rico are from individuals 50 years or
  older. (CDC, 2002 PR Health Department, 2003)
• Elders are usually perceived as not being at risk
  for HIV infection and usually excluded from
  targeted prevention programs. (Chiao, Ries
  Sande, 1999)
• Health care providers are slow to diagnose HIV in
  older people. (Kasper Cavalieri, 1999)

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Objectives

• To characterize and describe HIV/AIDS infected
  patients 50 years or older of age in terms of
  their socio-demographic, risk and clinical
  profile , and compare them with a younger sample
  counterpart.

4
Research Design

• Prospective cohorts (IRB approved) HIV Central
  Registry (HCR), Adult Spectrum of Disease (ASD).
• Data collection started on May 1992.
• Setting Hospital Universitario Ramón Ruiz Arnau
  and Immunology Clinic.
• Data sources Interview, medical records
  abstraction and laboratory blood samples.
• Participants Age 18 years, HIV/AIDS.

5
Research Design
Puerto Ricos Health Regions.
Source Department of Health in Puerto Rico.
6
Methods

• Study design Cross-sectional study from a
  longitudinal cohort. Data from 3151 study
  participants was collected between May 1992 and
  December 2002.
• Study Sample 288 (9.1 of the total study
  population) HIV/AIDS with age 50 years.
• Bivariate analysis Mantel-Haenszel Chi-Square
  (M-H X2) and Wilcoxon Rank Sum test .
  Significance level set at plt 0.05.
• Variables were evaluated at year of patient
  enrollment.
• Packages SAS Windows V8, SPSS 11.0 Windows

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Results
Proportion of confirmed AIDS cases 50 years or
older, in Puerto Rico. PR Health Department
(2004).
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Results
Table 1. Socio-demographic parameters, n288
Parameters Frequency
Study enrollment
Hospital 111 38.5
Immunology clinic 177 61.5
Origin
Puerto Rico 279 96.9
US 2 0.7
Other 7 2.4
Gender
Females 66 22.9
Males 222 77.1
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Results
Table 2. Other socio-demographic parameters.
Parameters n Frequency
Civil status 273 88 32.2
Housing status 188
Alone 29 15.4
With family 138 73.4
Institutionalized 15 8
Homeless 6 3.2
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Results
High school diploma or higher degree between the
groups of age, n2802
Age distribution by categories, n288.

OR0.489 C.I. (0.357, 0.671) P value lt 0.0001
Median 54 years
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Results
Table 3. Reported risky practices.

Parameters n OR C.I. p
Sex with HIV patient 2564 1.61 1.22, 2.10 lt.0001
Sex with injecting drug user 2502 .715 .516, .990 .047
Overall heterosexual contact 3151 2.18 1.71, 2.80 lt.0001
IVD user 3111 .383 .296, .496 lt.0001
No risk Identified 3151 2.34 1.45, 3.76 lt.0001
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Results
Aids diagnosis at study entry, N3151.

OR1.48, C.I. (1.15, 1.89), p 0.0017
13
Results
Type of Aids diagnosis at study entry, n1582.

OR0.694, C.I. (0.423, 0.965), p 0.048
14
Results
Table 4. Other clinical parameters.

Parameters OR C.I. P value
Chronic conditions
Diabetes mellitus 3.78 2.52, 5.67 lt.0001
Cardiovascular disease 3.59 2.48, 5.20 lt.0001
Renal insufficiency 2.05 1.22, 3.46 .0058
Thyroid dysfunction 3.34 1.07, 10.4 lt.0273
HAART at study entry 3.08 1.46, 6.52 .0020
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Results
Table 5. Immunology markers in patients
without AIDS diagnosis.
Parameters n Median P value
CD4 cell count (cell/mm3)
18-49 years 885 442 .771
gt50 years 71 448
CD4
18-49 years 836 26 .011
gt50 years 65 22
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Results
Table 6. Immunology markers in patients
with AIDS diagnosis.
Parameters n Median P value
CD4 cell count (cell/mm3)
18-49 years 1155 63 .120
gt50 years 139 90
CD4
18-49 years 1098 8 .331
gt50 years 130 7
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Results
Survival function for patients with AIDS
diagnosis at last follow up, n 2168.
   
Median of survival 18-49 (2.16 years), gt50
(1.85 years) P gt0.05

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Conclusions

• Elderly patients are less likely to have
  completed a high school education that their
  younger counterparts.
• Elderly adults are more likely to exposed to
  heterosexual contact, specifically with a person
  with AIDS or HIV infection documented.
• Elderly patients are seeking health care with a
  later stage of the disease and with several
  co-morbid chronic conditions.

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Limitations and Recommendations

• Non probabilistic sample of all 50 years or older
  patients with HIV/AIDS in Puerto Rico.
• More research from population base prospective
  data is needed in order to generate models for
  risky behaviors prediction and clinical outcomes.
• HIV/AIDS health interventions and programs for
  prevention base on this data could result in
  reduction of risk exposures and morbidity
  outcomes among elders in Puerto Rico.

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Acknowledgements

• RCMI/NIH grant G12RR03035
• CDC/ASD grant U62/CCU206209
• Consultants Dr. St. Lawrence, Dr.
  Bandigwala, Dr. Thomas
• System Specialist Magaly Torres
• Data Abstractors Gisela I. Cestero, Glenda L.
  Ortiz, Heidy Ortiz.
• Data Entry Wanda Marín.