The epidemiology of the human immunodeficiency virus (HIV) infection has evolved to affect all ages, genders, and races. There is a growing proportion of HIV-infected individuals over the age of 50. The cumulative number of AIDS (acquired immunodeficiency syndrome) cases in adult aged of 50 years or older has increased 5-fold between 1990 and 2001, growing from 16,288 to 90,513. New AIDS cases among people over the age of 50 have been steadily increasing during that period and are now approaching 20%, while those among people from age 30 to 39 are decreasing. In 2004, an estimated 23% of persons living with HIV or AIDS were over the age of 50. With increasing numbers of new cases among older people and improved survival in HIV-infected individual with effective antiretroviral treatment, it is projected that by the year 2015, the proportion of those infected with HIV older than age 50 will increase to 50%. Although aging among HIV-infected patients has rarely been the focus of research in developing countries, the number of older HIV-infected patients is likely to increase in those areas as antiretroviral treatment becomes more available over the next few decades.
Older HIV-infected patients are often underrepresented in clinical trials evaluating antiretroviral agents. Although the study inclusion criteria may not incorporate an age restriction, the median age of the treatment-naive subjects in recently published clinical trials is mostly in the mid to late 30s. This makes it difficult to generalize the efficacy and safety data for older HIV-infected patients.
This review will focus on issues related to the use of antiretroviral agents in older HIV-infected patients and various factors that may be associated with altered pharmacokinetics in older individuals.
The epidemiology of the human immunodeficiency virus (HIV) infection has evolved to affect all ages, genders, and races. There is a growing proportion of HIV-infected individuals over the age of 50. The cumulative number of AIDS (acquired immunodeficiency syndrome) cases in adult aged of 50 years or older has increased 5-fold between 1990 and 2001, growing from 16,288 to 90,513. New AIDS cases among people over the age of 50 have been steadily increasing during that period and are now approaching 20%, while those among people from age 30 to 39 are decreasing. In 2004, an estimated 23% of persons living with HIV or AIDS were over the age of 50. With increasing numbers of new cases among older people and improved survival in HIV-infected individual with effective antiretroviral treatment, it is projected that by the year 2015, the proportion of those infected with HIV older than age 50 will increase to 50%. Although aging among HIV-infected patients has rarely been the focus of research in developing countries, the number of older HIV-infected patients is likely to increase in those areas as antiretroviral treatment becomes more available over the next few decades.
Older HIV-infected patients are often underrepresented in clinical trials evaluating antiretroviral agents. Although the study inclusion criteria may not incorporate an age restriction, the median age of the treatment-naive subjects in recently published clinical trials is mostly in the mid to late 30s. This makes it difficult to generalize the efficacy and safety data for older HIV-infected patients.
This review will focus on issues related to the use of antiretroviral agents in older HIV-infected patients and various factors that may be associated with altered pharmacokinetics in older individuals.
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