HIV & Aging: Journal Articles

Because of the increase in life expectancy in older adults with HIV, the frequency of polypharmacy and drug-drug interaction is increasing. Among 242 50-year-old patients on antiretroviral treatment 148 (61%) were receiving other medications. There were 243 potential drug interactions detected with 197 considered moderate and 46 severe, affecting 110 patients. Generally, the blood levels of the non-HIV medications were higher with this interaction. Statins and inhaled corticosteroids were the most common medications. Interactions with boosted protease inhibitors were more frequent.

AIDS-related causes of death have decreased with better HIV treatment, and non-AIDS related causes of death have increased. A study of 5285 Italians aged 15-74 years with diagnosed AIDS was conducted from 2006-2011. Among this group 1220 individuals were found to be deceased, and their death certificates were reviewed for all causes associated with death. Cardiovascular disease and diabetes were mentioned on death certificates, both with 13 fold higher frequencies when compared to a 2,019 age-sex matched sample derived from 952,019 deceased non-AIDS persons.

Persons 50 years and older tend to have late HIV diagnoses, which complicates management and also serve as a source for HIV transmission. The factors that lead to this situation are not clear. Interviews about possible reasons were completed on 20 persons who had a late HIV diagnosis. The results suggest that older persons do not see themselves at risk for HIV.

There is a concern among older adults with HIV about cognitive impairment and related changes in the brain. A longitudinal study of 123 virologically-suppressed HIV patients (median age 56 years) and 78 similar HIV-negative individuals (median age 57 years) used neuropsychological assessment and brain imaging at baseline and 2 years later to address this question. At baseline the people with HIV had poorer cognitive performance, lower gray matter volume with higher white matter intensity and abnormal striation than the comparison group.

As part of stroke prevention, especially with vascular symptoms, carotid endarterectomy or carotid stenting are often performed. With apparent increased strokes in adults with HIV, a question arises about the frequency and age of such surgical procedures. Using a very large sample of hospital admissions from the Healthcare Cost and Utilization Project, the age, sex, other demographics, comorbidities, and other related variables were collected from medical records on adults with HIV (HIV+) and without HIV (HIV-) over a 10-year period (2004-2014).

Increased vascular stiffness has been found in adults with HIV. A key question is if the vascular stiffness is related to cognitive decline. This issue was investigated in the Women’s Interagency HIV Study, which includes 1662 women with 72% HIV positive and the remainder, similar in demographics, but who are HIV negative. Carotid ultrasound at a single baseline visit was used as a measure of stiffness and longitudinal neuropsychological test results as a measure of cognitive status were determined from 2004-2016.

With mortality from HIV reduced there are more older persons living with HIV. The concern is that diseases and conditions associated with aging will become frequent and result in multimorbidity (MM) in this subgroup. A number of reports, including the one featured above, have reported this increase in MM. However, investigators from Switzerland present a literature review and suggest a possible recent reduction in the frequency of various comorbidities.

The question addressed by this report is whether the frequency of multimorbidity (MM) is increasing over time as persons with HIV continue to age. A large cohort of adults with HIV (22,969) gathered from various sites in the US under the auspices of NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) was used to investigate the cross sectional frequencies of MM by year from 2000 to 2009. Most of the participants in this study were white men with a baseline age of 40 years.

An important question is the effect of unmet basic needs, such as food security and stable housing, on persons with HIV. A study to address this question is reported using a cohort of 496 adults with HIV living in Ontario, Canada. Needs were determined by questions, such as: In the last 12 months have you experienced difficulty in buying enough food? and How difficult is it for you to meet monthly housing costs? The outcome variables were derived from the Medical Outcomes Study HIV Health Survey and measured physical health and mental health.

The lead author, a geriatrician, and her colleagues make a strong case in a recent IAS journal publication that geriatric approaches used with very old persons should be adapted and applied to the care of older adults with HIV. The high frequency of multimorbidity and associated polypharmacy found in the older adult with HIV supports this view. “Comprehensive Geriatric Assessment” (CGA) is commonly used by geriatricians. It assesses medical, social, functional, psychiatric, and other domains. The CGA provides a more comprehensive picture of needs of the older adult with HIV.

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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.

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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.