HIV & Aging: Journal Articles

HIV Patients Place High Value on Care-Coordination and Sustained Confidentiality when Referred to Specialists

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.

Changes in Drinking Rates are Reflected in Increased Risk for Poor HIV Management

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).

Multimorbidity Increasing in US HIV Populations: Highest in Heterosexuals, No Gender Differences Found

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.

Hypertension, Diabetes, Neuropathy Higher in Overweight HIV Adult Patients

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.

75% of Deaths in Older Adults are Non-HIV

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.

How Important Are Those Kidney Tests Anyway?

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.

How Common Is Cognitive Decline in Older People with HIV?

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.

Years Living with HIV Infection Mediates Physical and Mental Health

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.

Intersection of Aging and HIV for Rural Older Adults Living with HIV

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.

Cancer Leading Cause of Death Among HIV-Infected Patients in France: 2000–2010

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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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.