Page 331 - HIVMED_v21_i1.indb

Page 2 of 5 Original Research

Although there is a growing body of research on HIV and after 3 months, then treatment is instituted. Hypertension is
ageing, evidence from low- and middle-income countries defined as two blood pressure readings > 140/90 millimetre
that bear the highest burden of HIV infection is scarce. 10,11 The of mercury (mmHg) at least 6 h apart. Chronic kidney
expectations and management of elderly PLWH differ from disease (CKD) is defined as a serum creatinine clearance of
those of younger patients and may change over time. In this < 60 milligrams per deciliter (mg/dL) confirmed with a
study, we profiled the demographic and clinical characteristics second result within 3–6 months. All cancers ever diagnosed
of elderly patients receiving comprehensive HIV care at were included in the analysis and the pre-cancer conditions
Newlands Clinic (NC), Harare, Zimbabwe, as of 01 October of vulva and cervical intra-epithelial neoplasia (VIN and
2019. There is evidence that the distribution of comorbidities CIN) were included as well.
may differ by sex ; therefore, we analysed and reported our
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results by sex. Weight and height measurements were performed by nurses
in the consulting rooms using Seca 752 or Seca 952 scales and
Methods wall-mounted height measure tapes, respectively. Before
being weighed, patients removed shoes, jackets and emptied
Study design their pockets. Samples for blood glucose measurement were
This study utilised a cross-sectional analysis of routinely collected into 4-mL BD Vacutainer Plus plastic tubes with
collected electronic clinic data. 10 mg sodium fluoride and 8 mg potassium oxalate additives.
Blood samples for creatinine measurement were collected
into 4-mL BD Vacutainer Plus plastic serum tubes with clot
Study setting activator and silicone-coated interior. Glucose and creatinine
The study was conducted at Newlands Clinic, Harare, measurements were conducted at the on-site laboratory on a
Zimbabwe. Newlands Clinic, operated by the Ruedi Luethy COBAS Integra 400 plus instrument using the hexokinase and
Foundation, is a model public–private partnership with the Jaffe reaction methods, respectively.
Ministry of Health and Child Care. Since 2004 the clinic has
offered comprehensive HIV treatment and care to individuals Ethical consideration
living with HIV. Operations of the clinic have been previously
described. The clinic’s electronic database captures patient- Permission to carry out the study was granted by the
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level data on laboratory test results, diagnoses, medications Newlands Clinic local research board. Ethical approval was
and demographic variables. granted by the Medical Research Council of Zimbabwe,
approval number: A1336. Participants consented to publication
as part of the informed consent process.
Sampling

Patients ≥ 50 years were defined as elderly. All patients who Results
were 50 years and older as on 01 October 2019 were included
in the analysis. The study had no exclusion criteria for Of the 6543 patients in care at NC, 1688 (25.8%) were above
enrolment. the age of 50 years (Table 1). The median age at analysis was
56 years (IQR: 52–61), with 72.2% of elderly patients aged
between 50 and 60 years, and no difference by sex. The
Data analysis median duration of ART was 10.9 years (IQR: 7.1–13). At

Routinely collected electronic patient data were abstracted enrolment into care, 51% were married, 32% widowed, 6%
from the clinic’s electronic database using custom structured divorced and 11% single. There was a far lower proportion of
language queries and exported to Excel. Records were married women than married men (31% vs. 82%). The most
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de-identified at abstraction and assigned numeric unique recent median CD4 cell count in this cohort was 464 cells/mm
identifiers. Stata version 13 was used for analysis. The most (IQR: 327–628), which was higher in females than males
recent CD4 cell count and HIV viral load (VL) were defined (526 vs. 377). Over 90% of all patients were virally suppressed,
as the last test result documented in the patient’s clinic with VLs below 50 copies/mL. Only 1.8% of patients had a
VL > 1000 copies/mL. No sex differences were observed in
notes taken within the preceding year. Weight categories the VL distribution. Almost half of the elderly patients were
were defined using body mass index (BMI) as follows: either overweight or obese and 8% were underweight.
underweight (BMI < 18 kilogram/square meter [kg/m ]), Women were more likely than men to be overweight and
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normal weight (BMI of 18 kg/m – 25 kg/m ), overweight obese (32% and 25% vs. 18% and 7%, respectively). Most
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(BMI > 25 kg/m – 30 kg/m ) and obese (BMI > 30 kg/m ). patients (64.1%) received the fixed dose ART combination of
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Baseline age was defined as age at the date of initiating tenofovir, lamivudine and dolutegravir.
ART. Descriptive statistics (medians, interquartile ranges
[IQRs] and proportions) were used to describe patient
demographic and clinical characteristics. Diagnosis of Comorbidities and pill burden
comorbidities was conducted based on the following existing Hypertension, arthritis and any malignancy were common
national guidelines: diabetes mellitus (DM) is defined as comorbidities differently distributed by sex (Table 2).
either fasting blood sugar ≥ 7.0 millimoles per litre (mmol/L) Hypertension was the most common comorbidity, with
or random blood sugar of ≥ 11 mmol/L, if it still remains high 704 (41.2%) patients having a documented diagnosis of
http://www.sajhivmed.org.za 323 Open Access