HIV & Aging: Journal Articles

Cytokines are important players in the homeostasis of the immune system in those infected with HIV. A study of 50 newly-infected HIV patients and 50 controls was completed with a 12-month follow-up. Before the start of therapy pro-inflammatory cytokines: Tumor necrosis factor-alpha (TNF-a), Interleukin-6 (IL-6), and anti-inflammatory cytokines: Interleukins 4 and 10 (IL-4 and IL-10) as well as Transforming growth factor beta (TGF-b) were elevated.

Because older persons living with HIV are experiencing both age-associated and HIV-related problems, new care models to address this combined burden are necessary. Investigators in San Francisco sought out more first-hand information on needs from patients older than 50 years and their providers at an HIV clinic. They used surveys with 77 patients and 26 providers as well as separate focus groups with 31 older patients and 20 staff members. Transcripts were used to identify frequent themes.

As adults with HIV live longer they experience body changes and conditions often seen in older persons. An important question is whether these changes are occurring prematurely (accelerated) or are a manifestation of more changes occurring together (accentuated) but not necessarily earlier. A cross-sectional study of 134 HIV-treated adults, 45 yeas of age or older, were compared with 79 life-style similar individuals without HIV and 35 age-matched blood donors.

People with HIV are at an increased risk for both AIDS-defining and non-defining cancers. These can occur also after an initial cancer diagnosis as either first or second primary cancers. This study used the San Francisco HIV/AIDS Case Registry with data from 1990 to 2010. These data were matched with the California Cancer Registry, and 4545 incident primary cancers were identified. Standardized incidence rates were calculated to allow comparisons.

A possible mechanism related to neurocognitive impairment (NCI) was investigated in 52 people with HIV receiving stable antiretroviral therapy and a matched comparison group of 31 HIV-uninfected controls. Cytomegalovirus immunoglobulin (CMV-IgG) levels were measured, and a neurocognitive test battery was administered to both groups. NCI was defined as a global deficit scale score equal or greater than .5. NCI was detected in 30.8% of persons with HIV and had an odds ratio of 5.15 over the comparison group. CMV-IgG levels were not significantly related to total NCI scores.

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).

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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.