HIV & Aging: Case Studies

Case Histories

By 2015 half of US population with HIV will be age 50 and older. The Academy recognized the emerging challenges associated with the graying of the epidemic when it published Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV, in 2011.

We now have a unique on-line resource at HIV-Age.org. It provides, editorials and commentary, up to date Journal Articles and references, updated chapters from the Recommended Treatment Strategies document, all in this interactive blog.

We aim to make HIV-Age.org the “go to” resource for clinicians, researchers, clients, media and the public.

This project has been funded by a generous gift to the Academy from the Archstone Foundation.

Along with our partners, ACRIA (AIDS Community Research Initiative of America) and the American Geriatrics Society (AGS), we have launched this website and look forward to your participation on it.

One of the segments of the blog will be an opportunity to share case histories of especially challenging treatment issues regarding older HIV patients. There will be a featured case history each month. Blog readers will have the opportunity to comment, offer suggestions and have an online discussion of each of these cases.

This note is to offer you the opportunity to submit a case history for use on the blog site. Please note our criteria:

  • Patients names will not be used, offer a fictitious patient name.
     
  • The patient must be over 50 yrs of age.
     
  • Provide a brief history including pertinent HIV history, medications, co-morbidities.
     
  • Pose a clinical question—may be a difficult management issue in an older patient with HIV, or may illustrate an example of the complexities of caring for this population.
     
  • Limit the case history to 500 words.
     
  • The Academy may make copy edits of the document.
     
  • Please tell us if you would like your name associated with the case history or not.
     
  • Send case history to ken@aahivm.org.
     

Thank you for helping make this new resource a valuable addition to our programs as we continue advancing excellence in HIV care.


Mr. Wander is a 61-year-old gentleman with past stroke without sequelae, hepatitis C virus (HCV) infection not on treatment, HIV diagnosed at age 37 on efavirenz, tenofovir and emtricitabine, who presents to the emergency room stating “a man who takes care of horses” gave him a pill which made him ill. He denies other specific complaints or symptoms. He reports that he takes “approximately 4 medications daily” but is unable to elaborate the name, dosage and timing of any of his medications. His last CD4 is 170 cells/mm3 and his viral load is undetectable. He has prior meningoencephalitis due to toxoplasmosis.

Ms. Fracture is a 50-year-old woman with past intravenous drug abuse, chronic obstructive pulmonary disease (COPD) from tobacco abuse, HIV well-controlled on ART who presents to your clinic to establish care. Her current medications include prednisone 10 mg daily, methadone 100 mg daily, ritonavir, atazanavir, tenofovir and emtricitabine daily. Her last CD4 count is 200 cells/mm3, and her viral load is undetectable.

Mr. Creatinine is a 55-year-old African American man who just moved to your town and comes to establish care at your clinic. He was diagnosed with HIV many years ago but did not follow up with his HIV provider due to complicated social issues. Now that he moved to live with his daughter and things are more stable, he looks forward to taking care of his HIV. He has never been on ART. Otherwise, he has a history of hypertension, diabetes and hepatitis C. He is not taking any medications since he has not seen a doctor for a while.

Mrs. Surprise is a 55-year-old woman with a 48-pack-year smoking history but no significant past medical history who develops progressively worsening dyspnea on exertion over 2 weeks. She received prescription for inhalers and steroid taper from an outpatient clinic last month, but symptoms returned after the steroid taper was completed.

Mrs. Pill is a 70-year-old woman with chronic HIV infection who recently moved to your town and comes with her daughter to establish care with you as her new HIV provider. She has a history of non-traumatic hip fracture, hypertension, hyperlipidemia, coronary artery disease s/p stent placement 5 years ago, and chronic kidney disease (CKD) stage II (creatinine clearance (CrCl) of 65 mL/min).

Mr. Heart is a 70-year-old man who comes to your office to establish care. He has a history of HIV. His last CD4 was 500 cells/mm3 with an undetectable viral load. He takes atazanavir, ritonavir, emtricitabine and tenofovir. Otherwise, he has a history of hypertension, hyperlipidemia, and diabetes. His other medications include lisinopril 20 mg daily, simvastatin 20 mg daily, and metformin 1000 mg daily.

Mrs. Feeble is a 70-year-old woman with end-stage-renal disease (ESRD) from hypertension on dialysis, chronic obstructive pulmonary disease (COPD) on 2L oxygen with recurrent pulmonary Mycobacterium Avium Intracellulare (MAI) infection failing past therapies, coronary artery disease s/p stent placement 1 year prior with congestive heart failure (ejection fraction of 40%), right hip osteoarthritis and HIV well-controlled on ART. Patient is in your clinic with her daughter who is her health care proxy for a pre-operative assessment of an elective ventral hernia repair. The daughter tells you the surgeon mentioned that Mrs. Feeble looks frail and wants her optimized before the surgery.

Purpose of this Program: The AAHIVM, ACRIA and AGS (collectively, the “Sponsors,” “we” or “us”) are sponsors of this Website and through it seek to address the unique needs and challenges that older adults of diverse populations living with HIV face as they age. However, the information in this Website is not meant to supplant the advice provided in a doctor-patient relationship.

General Disclaimer: HIV-Age.org is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through HIV-Age.org should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.

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The American Academy of HIV Medicine is a professional organization that supports the HIV practitioner and promotes accessible, quality care for all Americans living with HIV disease. Our membership of HIV practitioners and credentialed HIV Specialists™, HIV Experts™, and HIV Pharmacists™ provide direct care to the majority of HIV patients in the US.