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.
Many people living with HIV use complementary and alternative medicine (CAM) to manage symptoms, chronic medical conditions, or to optimize health. This study looked at different types of CAM among people living with HIV who were also taking ART. The study also compared characteristics of people who used CAM compared to those who did not. The data are from veterans who participated in the Veterans Aging Cohort Study between 2012-2015.
Depression is known to be frequent in adults with HIV and to complicate management. However, what is not so clear is how the length of depression status over time can affect outcomes. In a study of almost 6000 patients, median age 44, with 2 or more depression assessments in the period 2005 to 2015, it was possible to address this question.
The National Cancer Institute projects that the proportion of adult persons with HIV in the US aged 65 years and older will increase from 8.5% to 21.4% in 2030. There will be a decrease in age-specific cancer rates for Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer, lung cancer, Hodgkin lymphoma and other cancer types combined through 2030. However, absolute numbers of lung cancer will increase. Also, prostate cancer rates and numbers are projected to increase during this time period.
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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.