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HIV-infected adults aged over 50 years in South Africa are increasing. This study explored differences between baseline characteristics and 12-month outcomes of younger and older HIV-infected adults initiated on antiretroviral therapy (ART). Additionally, associations with outcomes within the older group were sought.    Methods  We retrospectively reviewed treatment-naive HIV-infected adult patients at ART initiation. Patients aged 18.0–39.9 years were compared to patients aged over 50 years using log-binomial regression for baseline characteristics and 12-month outcomes. Within the older group, outcome associations were found using multivariate regression.    Results  The older cohort ( n  = 1635) compared to the younger cohort ( n  = 10726) comprised more males (47.2% vs. 35.4%, PR 1.52,  p  < 0.05), smokers (12.9% vs. 9.7%, PR 1.32,  p  < 0.05) and overweight patients (26.0% vs. 20.0%, PR 1.32,  p  < 0.05). Fewer older patients had tuberculosis (10.2% vs. 15.3%, PR 0.67,  p  < 0.05), other opportunistic infections (16.9% vs. 23.3%, PR 0.70,  p  < 0.05), World Health Organization stage 3/4 disease (39.9% vs. 43.2%, PR 0.89,  p  < 0.05), anaemia (22.8% vs. 28.4%, PR 0.77,  p  < 0.05), liver dysfunction (17.1% vs. 21.3%, PR 0.83,  p  < 0.05) or low CD4+ count < 100 cells/mm 3  (56.3% vs. 59.9%, PR 0.71,  p  < 0.05).  Mortality was higher in the older cohort (11.3% vs. 7.5%, PR 1.48,  p  < 0.05). Virological suppression was greater in the older cohort (89.5% vs. 86.5%, PR 1.28,  p  < 0.05) but CD4+ restitution was lower (62.8% vs. 75.0%, PR 0.61,  p  < 0.05). There was no difference in treatment complications between the groups.  Within the older cohort, associations with death were as follows: age > 55 years (PR 1.47,  p  < 0.05), an AIDS-defining condition (PR 2.28,  p  < 0.05), raised ALT (PR 1.53,  p  < 0.05) and CD4+ < 100 cells/mm 3  (PR 2.15,  p  < 0.05). Associations with favourable treatment response at 12 months were unemployment (PR 1.18,  p  < 0.05) and raised ALT (PR 1.19,  p  < 0.05). Associations with a treatment complication at 12 months were unemployment (PR 1.12,  p  < 0.05), smoking (PR 1.20,  p  < 0.05) and nevirapine use (PR 1.36,  p  < 0.05) but secondary education was protective (PR 0.87,  p  < 0.05).    Conclusion  HIV-infected South African adults aged over 50 years differ in characteristics and outcomes compared to their younger counterparts and justify specialised management within HIV treatment facilities.

Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa