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Exercise

Many research reports identify cognitive impairment in adults with HIV. Tracing this impairment to HIV infection itself has been elusive. This paper investigates whether physical activity and associated cardiovascular risk may underlie these reported increased rates of cognitive impairment. The study used 988 participants (20% women) with well-controlled HIV infection at entry into the AIDS Clinical Trials Group (ACTG) Protocol A5322 (HAILO). The cardiometabolic risk profiles between women and men with HIV were assessed.

Neurocognitive

Using a sample of 122 PLWH (People Living With HIV) and 95 HIV negatives, ages 35-65, the study created a composite score that assessed trauma, economic hardship (food insecurity and low socioeconomic status), and a stress composite variable (TES). Study participants also completed a comprehensive neuropsychological battery and an assessment of activities of daily living (ADLs). The PLWH group had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress when compared to the uninfected group (p<0.0001).

Aging

During the period of 2004 to 2015 54,102 new HIV diagnoses in older adults (50 years and older) were tabulated from 31 European countries. A larger younger group (15-59 years) was collected for comparison. Also, information on age, sex, transmission route and CD4 count was obtained. During the 12-year study period for the entire group the average rate of new HIV diagnoses increased 2.6 per 100,000 in the population. The diagnoses increased significantly among older men, 2.2%, women, 1.3%, men who have sex with men, 5.8%, and injection drug users, 7.4%.

Cytokines are important players in the homeostasis of the immune system in those infected with HIV. A study of 50 newly-infected HIV patients and 50 controls was completed with a 12-month follow-up. Before the start of therapy pro-inflammatory cytokines: Tumor necrosis factor-alpha (TNF-a), Interleukin-6 (IL-6), and anti-inflammatory cytokines: Interleukins 4 and 10 (IL-4 and IL-10) as well as Transforming growth factor beta (TGF-b) were elevated.

Because older persons living with HIV are experiencing both age-associated and HIV-related problems, new care models to address this combined burden are necessary. Investigators in San Francisco sought out more first-hand information on needs from patients older than 50 years and their providers at an HIV clinic. They used surveys with 77 patients and 26 providers as well as separate focus groups with 31 older patients and 20 staff members. Transcripts were used to identify frequent themes.

As adults with HIV live longer they experience body changes and conditions often seen in older persons. An important question is whether these changes are occurring prematurely (accelerated) or are a manifestation of more changes occurring together (accentuated) but not necessarily earlier. A cross-sectional study of 134 HIV-treated adults, 45 yeas of age or older, were compared with 79 life-style similar individuals without HIV and 35 age-matched blood donors.

People with HIV are at an increased risk for both AIDS-defining and non-defining cancers. These can occur also after an initial cancer diagnosis as either first or second primary cancers. This study used the San Francisco HIV/AIDS Case Registry with data from 1990 to 2010. These data were matched with the California Cancer Registry, and 4545 incident primary cancers were identified. Standardized incidence rates were calculated to allow comparisons.

A possible mechanism related to neurocognitive impairment (NCI) was investigated in 52 people with HIV receiving stable antiretroviral therapy and a matched comparison group of 31 HIV-uninfected controls. Cytomegalovirus immunoglobulin (CMV-IgG) levels were measured, and a neurocognitive test battery was administered to both groups. NCI was defined as a global deficit scale score equal or greater than .5. NCI was detected in 30.8% of persons with HIV and had an odds ratio of 5.15 over the comparison group. CMV-IgG levels were not significantly related to total NCI scores.

Because of the increase in life expectancy in older adults with HIV, the frequency of polypharmacy and drug-drug interaction is increasing. Among 242 50-year-old patients on antiretroviral treatment 148 (61%) were receiving other medications. There were 243 potential drug interactions detected with 197 considered moderate and 46 severe, affecting 110 patients. Generally, the blood levels of the non-HIV medications were higher with this interaction. Statins and inhaled corticosteroids were the most common medications. Interactions with boosted protease inhibitors were more frequent.

AIDS-related causes of death have decreased with better HIV treatment, and non-AIDS related causes of death have increased. A study of 5285 Italians aged 15-74 years with diagnosed AIDS was conducted from 2006-2011. Among this group 1220 individuals were found to be deceased, and their death certificates were reviewed for all causes associated with death. Cardiovascular disease and diabetes were mentioned on death certificates, both with 13 fold higher frequencies when compared to a 2,019 age-sex matched sample derived from 952,019 deceased non-AIDS persons.

Europe

During the period of 2004 to 2015 54,102 new HIV diagnoses in older adults (50 years and older) were tabulated from 31 European countries. A larger younger group (15-59 years) was collected for comparison. Also, information on age, sex, transmission route and CD4 count was obtained. During the 12-year study period for the entire group the average rate of new HIV diagnoses increased 2.6 per 100,000 in the population. The diagnoses increased significantly among older men, 2.2%, women, 1.3%, men who have sex with men, 5.8%, and injection drug users, 7.4%.

Cytokines

Cytokines are important players in the homeostasis of the immune system in those infected with HIV. A study of 50 newly-infected HIV patients and 50 controls was completed with a 12-month follow-up. Before the start of therapy pro-inflammatory cytokines: Tumor necrosis factor-alpha (TNF-a), Interleukin-6 (IL-6), and anti-inflammatory cytokines: Interleukins 4 and 10 (IL-4 and IL-10) as well as Transforming growth factor beta (TGF-b) were elevated.

cancer

People with HIV are at an increased risk for both AIDS-defining and non-defining cancers. These can occur also after an initial cancer diagnosis as either first or second primary cancers. This study used the San Francisco HIV/AIDS Case Registry with data from 1990 to 2010. These data were matched with the California Cancer Registry, and 4545 incident primary cancers were identified. Standardized incidence rates were calculated to allow comparisons.

cytomegalovirus immunoglobulin

A possible mechanism related to neurocognitive impairment (NCI) was investigated in 52 people with HIV receiving stable antiretroviral therapy and a matched comparison group of 31 HIV-uninfected controls. Cytomegalovirus immunoglobulin (CMV-IgG) levels were measured, and a neurocognitive test battery was administered to both groups. NCI was defined as a global deficit scale score equal or greater than .5. NCI was detected in 30.8% of persons with HIV and had an odds ratio of 5.15 over the comparison group. CMV-IgG levels were not significantly related to total NCI scores.

Drug-Drug Interactions

Because of the increase in life expectancy in older adults with HIV, the frequency of polypharmacy and drug-drug interaction is increasing. Among 242 50-year-old patients on antiretroviral treatment 148 (61%) were receiving other medications. There were 243 potential drug interactions detected with 197 considered moderate and 46 severe, affecting 110 patients. Generally, the blood levels of the non-HIV medications were higher with this interaction. Statins and inhaled corticosteroids were the most common medications. Interactions with boosted protease inhibitors were more frequent.

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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.