HIV & Aging: Journal Articles

With better HIV treatment, the frequency of Herpes Zoster (HZ) in older adults with HIV has dropped but is still at least two to three times higher than in persons uninfected with HIV. Also, this subgroup is still vulnerable for complications when infected with HZ. So, many clinicians recommend use of the vaccine in HIV-positive adults 50 and older with an undetectable viral load and a CD4 count over 200. A study at 6 sites was implemented to determine the level of vaccine use at baseline and the effect of two regimens for improvement.

There is variability in reports about the presence of an increased frequency of diabetes mellitus (DM) in older persons with HIV. Most suggest an excess than in a comparison group, but the reasons for this increase are unclear. To address this issue, a longitudinal study of adults 50 years or older with HIV was mounted using data from a clinic in Vancouver, Canada. Data from 1065 patients were identified without DM who had a median of 13 years of follow-up. The onset of DM was identified from medical records using standard diagnostic criteria.

The latest (2016) HIV frequency estimate from CDC indicates that two thirds of infections have involved male-to-male sexual contact. From 2008 to 2016 the annual number of new cases in men who have sex with men (MSM) increased 3% per year in those 13-29 years (total of 106,258) and was stable for those 50 years and older (total of 29,034). Diagnoses did increase among Asians and Hispanic Latinos in the older subgroup. Blacks accounted for 25% of the diagnoses in the older group.

The FDA approved PrEP (tenofovir and emtricitabine) as a once a day single pill in 2012. Since 2014 the CDC has recommended this form of PrEP because it was found to be safe and very effective in the prevention of HIV in high-risk populations. The authors of this editorial review the realities of the current epidemic, address reasons for the underuse of this method and make suggestions for improvement.

The average age for older adults with HIV is increasing. There is interest in identifying predictors of mortality outcomes as a guide to better management and to identify possible reversible risk factors. A French study entitled Dat’AIDS has relevant data on 1415 persons 60 years and older with HIV from 12 French hospitals, including 5 year-mortality experience.

Because of increased survival of older persons with HIV, the frequency of comorbidities is expected to become higher in patients in the coming years.

The National Survey of Sexual Health and Behavior found that 5.1% of men over age 61 used condoms in the last ten vaginal intercourse behaviors. Over the last decade the CDC reports that between 16-17%, 1 in 6, of new HIV diagnoses occurs in adults age 50 and older. There has been no evidence of a decline in these percentages. A study of PCPs found general agreement that methodologies need to be put in place to increase testing for HIV of older adults. The PCPs believed that HIV testing must be inclusive of testing for all STI’s.

Significantly elevated rates of PTSD are observed with high frequency in PLWHA. Several coping behaviors have been identified that can ameliorate PTSD symptoms and associated spectrums of depression. In a study of almost 250 African American women (54% were age 45 and older) multiple factors were assessed for their protective association as evidenced by reduced PTSD symptoms. The variables studied were age, marital status, education, internalized HIV-related stigma, and social support. Older age showed a significant but small association with reduced PTSD symptoms.

About 400 men with and without HIV, median age 60 years, participating in a sub-study of the MACS (Multicenter AIDS Cohort Study), were evaluated for body composition (waist circumference, abdominal visceral and subcutaneous adipose tissue, sarcopenia, and osteopenia/osteoporosis) and presence of frailty (Fried definition). The frailty frequency was 16% for men with HIV and 8% for men without HIV (2.43 increased odds of frailty).

Utilizing an electronic medical record review in 250 adults (median age of 50 years) with HIV infection, substance dependence, or ever injection drug use, various categories of medication intake were determined. These categories included: overall systemically active; overall active but excluding antiretroviral (ARV); sedating, non-opioid sedating including gabapentin, trazodone, other anti-depressive medications; and opioids. The outcomes were self reported and included falls or accidents requiring medical attention and any fractures in the previous year.

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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.

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.