The Impact of the Third Wave of the COVID-19 Pandemic on the Elderly and Very Elderly Population in a Tertiary Care Hospital in Portugal.

BACKGROUND:  COVID-19 poses a significantly more serious threat to adults aged 65 and above, with a higher mortality rate. This study aims to describe the outcome of COVID-19 patients in the elderly and very elderly population admitted to a tertiary care Portuguese hospital. The authors defined the elderly population (65 to 79 years) and the very elderly population (≥ 80 years). METHODS:  We conducted a retrospective observational single center study in the internal medicine ward of a tertiary hospital from November 1, 2020 to January 31, 2021. All COVID-19 patients aged over 65 years were enrolled. RESULTS:  Of the 824 patients with SARS-CoV-2 infection, 586 (71%) were aged above 65 years. Of them, 61.7% were very elderly and 32.9% were elderly. The hospital recorded 53 (27.5%) deaths in the elderly group and 182 (46.3%) in the over-80 group. In the elderly population, only 32 patients had critical illness compared to the 79 in the very elderly group. In addition to respiratory complications, acute kidney failure and liver dysfunction were noted. In both groups, mortality was higher when there was acute kidney injury (AKI). With respect to treatment, dexamethasone and azithromycin did not show a statistically significant difference between the groups. The need for oxygen therapy over 4L/min, high-flow therapy, and mechanical invasive ventilation was related to higher mortality in both groups. CONCLUSION:  The very elderly group had a higher number of deaths compared to the elderly group due to multiple comorbidities. Respiratory failure was the most frequently occurring complication. Surprisingly, dexamethasone and azithromycin therapy did not show a statistically significant effect in both age groups despite their current widespread usage in COVID-19 treatment worldwide.

Durability of first antiretroviral treatment in HIV chronically infected patients: why change and what are the outcomes?

INTRODUCTION: First antiretroviral therapy (ART) is often switched to simpler, more potent or better tolerated regimens (1, 2). Although discontinuation rates are frequently studied, the durability of regimens is rarely approached. MATERIALS AND METHODS: Retrospective study with the following objectives: analyze first ART schemes and their durability in naive patients with chronic HIV-1 and 2 infections, evaluate factors influencing ART change, second-line ART and consequent virologic and immunologic responses. Patients had follow-ups in a Central University Hospital, started ART between January 2007 and December 2012 and changed first regimens. Clinical data was obtained from medical records and analyzed using the Statistical Package for the Social Sciences (version 20). RESULTS: Of the 652 naive patients who started ART, 164 changed regimens. The majority had HIV-1 infection (n=158). The mean age was 43.9 years (standard deviation±14.3), with a male predominance of 57.9%. Regimens with efavirenz were the most common amongst HIV-1 patients (50%) followed by lopinavir/r (22%). In HIV-2 patients, lopinavir/r (n=3) regimens were most prevalent. First ART regimens had a mean duration of 12.1 months. There was no difference between NNRTI (59.8%) and protease inhibitor (40.2%) schemes regarding durability. Adverse reactions were the major cause of ART switching (55.5%) followed by therapy resistance (12.1%). Age was inversely related to durability (p=0.007 Mann-Whitney, Phi coefficient -0.161) and associated with the appearance of adverse reactions (p=0.04, Chi-square). Younger patients had a reduced risk of adverse reactions by 27%. Adverse reactions increased the risk of inferior durability by 40%. Psychiatric symptoms (28.4%) were the most prevalent, all attributed to efavirenz. The year of ART initiation was associated with different durability rates (p=0.005, Mann-Whitney). Patients started on ART before the year 2010 reduced the probability of inferior ART duration by 25.8%. After second-line ART regimens, TCD4+ counts>500 cell/µL were increased by 38% and favourable virologic outcome achieved in 84%. CONCLUSIONS: Adverse reactions were the main cause for ART switching, supporting a cautious approach when initiating regimens, particularly in older patients. All ART naive patients who changed initial therapy had favourable immunological and virologic responses.