HIV & Aging: Journal Articles

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.

This is a retrospective controlled cohort study of deaths in the ART era (1996-2012) in British Columbia. The mortality rate of HIV-infected patients has declined by 96% but remains about 3 times higher than in the HIV-uninfected population. Deaths due to non-HIV related causes now account for about 75% of all deaths in the HIV infected population. Cancers remain the largest cause of death in this HIV-infected cohort.

HIV infection itself is a risk factor for kidney disease in the older HIV-infected patient compared to matched HIV-uninfected patients. The HIV-infected group was twice as likely to have a decline in renal function and 6 times as likely to have proteinuria. Interestingly, another strong predictor of worsening kidney disease was not having ART modified at the onset of renal dysfunction. This finding illustrates how important it is for clinicians to carefully monitor kidney function in virologically stable older patients, and to consider modifying ART with changes in renal markers.

In this well-designed case-cohort study of age-matched HIV-infected and -uninfected older adults with HIV from the MACS group, a measurable decline in cognitive function was seen in older infected patients. Five domains of cognition were measured and all were affected with increasing age compared to the uninfected controls. Older subjects with late-stage HIV-infection showed severe declines in the two domains of episodic memory and motor function.

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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.