Human immunodeficiency infection in the elderly: a retrospective analysis of 20 patients.
Int Conf AIDS 1989 Jun 4-9; 5:169 (abstract no. A.553) Thompson J, Kapila R, Tecson F; New Jersey Medical School and VA Hospital, East Orange, N.J., USA
From January 1985 to June 1988 twenty (20) patients over the age 60 years were diagnosed with HIV infection/AIDS according to CDC criteria group I-IV. Their ages ranged from 60-85 years with a mean of 66.1. The group included 18 men and 2 women. The risk factors for the men were Homosexuality, 6/18 (33%), IVDA 3/18 (15%), Heterosexual contact 1/18 (6%), both IVDA and sexual contact 2/18 (11%), blood transfusion 2/18 (11%), unknown risk factor 4/18 (22%). The risk factor for both females was heterosexual contact. The initial presentation of AIDS in the men was opportunistic infection. Pneumocystis (PCP) 9/18 (50%), Mycobacterium Tuberculosis (MIB) 3/18 (11%). concomitant PCP and MIB, 1/18 (6%) and fatal bacterial sepsis 2/18 (11%). Two males had malignant lesions; one with Kaposi's Sarcoma and the other with Multiple Myeloma. On of the two women had PCP and the other was an asymptomatic carrier. 50% of both males and females presented with oral thrush and 45% had a history of Herpes Zoster. Several significant differences were noted in contrast to younger patients (YP) less than the age of 60. 1. The course of the disease was more aggressive. Only 1 of 10 patients with PCP (100% with Adult Respiratory Distress Syndrome) survived the initial episode. 2. 75% of elderly patients died within 3 months of diagnosis, compared to an average life span of 18-24 months in YP. PCP was often confused with exacerbation of Chronic Lung Disease and Congestive Heart Failure. 4. Cryptococcal Meningitis, Cerebral Toxoplasmosis and HIV Encephalitis were often confused with organic brain syndrome, cerebral arteriosclerosis and alcohol related brain injury, with initial manifestations of mental deterioration and fatigue. 5. Drug toxicity including Azidothymidine was extremely common (up to 70% in the elderly HIV population compared to only 30% in YP). In conclusion elderly patients with HIV usually have a typical presentation, increased severity and prognosis of HIV related illness and greater drug toxicity.
Keywords: AEGIS, Retrospective Studies, Infection, Acquired Immunodeficiency Syndrome, HIV Infections, Risk Factors, Opportunistic Infections, Zidovudine, Substance Abuse, Intravenous, Aged, 80 and over, Heterosexuality, Centers for Disease Control and Prevention (U.S.), Toxoplasmosis, Cerebral, Meningitis, Cryptococcal, Neoplasms, United States, Aged, Human, Male, Female, Adult, Infant, Newborn, complications, analysis, ICA5
