HIV & Aging: Journal Articles

Almost a third of transgender women in the USA test positive for HIV (CDC). This study aimed to show the CVD profile of transgender women. Data was derived from the Partners Healthcare System (PHS) in Boston. The study found that transgender women with HIV showed a significantly increased prevalence of anemia, as well as lower hemoglobin levels when compared to men with HIV. Both groups had a mean age of 51. There was no difference for traditional CVD risk factors such as prevalence of hyperlipidemia or hypertension.

There is a paucity of research and published literature on older transgender individuals. This article provides a comprehensive review of the literature relevant to providing optimal mental health care to older trans adults. It reviews terminology, highlights health disparities, and reviews ways for mental health professionals to support the aging transgender client. The older the transgender adult, the more likely the individual grew up in a historical context when there was greater social stigma towards their gender identity, even among mental health professionals.

HIV-positive veterans (n=42,441) and demographically matched uninfected veterans (n=104,712) from (1999-2015) were followed for 16 years in this study–98% were men. Long-term viral suppression was associated with a reduction in the increased risk by more than 90% for ADC (AIDS defining cancers). There was a 23% reduction for virus-related NADC (non–AIDS-defining cancer), but absent for NADC not caused by virus. For the first two groups, 60% of the risk reduction was attributed to early suppression.

Data on 876 Canadian patients diagnosed with HIV before 1996 were analyzed. This sample was able to be followed for more than 20 years on average. The researchers defined the socio-demographic, clinical, and health care utilization characteristics of these long-term HIV/AIDS survivors. The study purpose was to understand what factors could account for those who survived to 1/1/2016. Of 876 patients, 49.5% died, 30.3% moved, 20.3% remained in active care for a median of 23.4 years.

Moderate to high-intensity aerobic exercise increases cardiorespiratory fitness (VO2peak) in younger adults with HIV. There are few studies that show any benefit from varying types of exercise in older adults with HIV. In a pilot study using 22 older men with HIV, half were randomly assigned to one of two groups – moderate-intensity aerobic exercise (Mod-AEX) or high-intensity aerobic exercise (High-AEX). In the High-AEX group, exercise consisted of using a motorized treadmill with occasional substitution using an elliptical machine as needed for joint pain.

Patients’ perceive their ART as crucial for their living. Is their attitude similar for those medications they take for comorbid conditions? To assess this, a sample of 150 patients from the Swiss HIV Cohort Study (SHCS) was assessed. Adherence for ART, and for treatments of comorbid conditions, was defined as not missing any dose or missing one dose of the treatment in the past 4 weeks. The final sample has a mean age of 54 with 70% being male. Of these, 83% were adherent to ART and 71% were adherent to their co-treatments (P=0.0001).

A qualitative study of twelve focus groups of older adults with HIV was used to study those elements of healthcare that are perceived as being most valued. A majority of the respondents expressed a preference for all care delivery occurring in HIV focused clinics/practices. This preference was highest among those who had the most years living with HIV and comorbidities. Participants placed high value on care-coordination and communication between specialists.

A Veterans Aging Cohort Study (VACS) was undertaken to determine if changes in alcohol use would be reflected in changes in HIV severity. Using C-AUDIT screens, among almost 44,000 PLWH, AUDIT-C changes were non-linear and associated with changes in CD4 counts and log Viral Load data. Most study participants had non- or low-level drinking and stable alcohol use over time. Improvement in HIV severity was greatest among those with stable AUDIT-C scores (those who initially did not drink or drank at low rates).

Using a sample of almost 23,000 PLWHA, a longitudinal assessment (2000-2009) of the occurrence of age-related comorbid conditions was conducted. Multimorbidity was defined by having 2 or more of the following: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Among the nearly 23,000 adults, 79% were male, 36% black, with a median baseline age of 40 years. Multimorbidity increased from 8.2% to 22.4% (p<.001) and remained significant after adjusting for age.

The risk for being obese or overweight was assessed using a sample of 862 patients in France (median age 51 years; 68% male; on ART for 16.7 years median; 91% had undetectable viral loads; 73% had CD4 counts of 500 or greater; 31% had HCV serology with 13% having detectable HCV-RNA; 60% were smokers). Obesity (>/=30 kg/m) was observed in 5% of the sample, and overweight (>/ 25= kg/m; <30 kg/m) affected 22% of the patients. Almost 36% had at least one comorbidity. Of these almost 53% were overweight or obese.

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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.