HIV & Aging: Journal Articles

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.

A cross-sectional study assessed 3258 adults (2248 MSM, 373 heterosexual men, and 637 women) with HIV in the UK. Median age was 45, 56% reported physical symptoms of distress; 27% depression; 22% anxiety; 38% functional problems. They found that the prevalence of depression and anxiety decreased with age while functional problems increased with age. There was no association between age and physical symptoms of distress. Longer duration of living with HIV infection was strongly associated with higher prevalence of physical distress symptoms, depression, anxiety, and functional problems.

This study assessed 29 HIV-positive adults over the age of 50 living in U.S. rural counties. Using thematic content analysis, they examined the nexus of aging and HIV to identify factors that affects overall health, engagement in care, and medication adherence These older adults were more concerned with health conditions other than HIV. Lack of concern for HIV were attributed to fewer HIV-related complications, degree of comfortability and the number of years living with HIV.

National surveys were used to assess the distribution and characteristics of malignancy-related deaths among HIV patients in 2010, and compared them to 2000 and 2005. Cancer is the leading cause of mortality in the HIV-infected patients studied. The risk of malignancies, including non-AIDS-related cancers, is higher in HIV patients than in the general population. Smoking is reported to be the primary risk factor in non-AIDS-related cancer, particularly lung cancer.

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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.