Browse by Topic

Aging

Thanks to the effectiveness of combination Antiretroviral Therapy (cART), people are aging with HIV, and in many cases doing so successfully. Although we still struggle without a cure, this remains an exciting period in combating this epidemic in that prognosis and life spans are greatly improved. Yet, challenges remain as we observe either accelerated or accentuated aging in many with this disease in several areas (i.e., cardiovascular, renal, and metabolic disease; systemic inflammation); however, one area has received particular attention – brain health, specifically cognition.

Overlapping geriatric syndromes such as “frailty”, “disability”, “multimorbidity”, and “polypharmacy” require adaptation for those aging with HIV infection to account for the ongoing role of HIV infection and its treatment in modifying the aging process. Several complementary approaches to the measurement of frailty have evolved within the geriatric literature and these have been variably applied among those aging with HIV. The approach most often employed in the HIV literature, uses a triad of wasting, slowing, and weakness and is characterized by the frailty phenotype and the frailty related phenotype (Desquilbet et al, 2011; Fried et al., 2001). Another approach focuses on cumulative deficits across multiple physiologic systems (Clegg et al., 2013), but it requires 30 separate measures and has been deemed less feasible for routine care. Rockwood et al have proposed a reduction in the number of measures from 30 to 10. Some have suggested that a single measure of function, such as grip strength or the six minute walk test, might serve.

“In this study population over age 50 50% of participants had frailty or pre-frailty at higher frequencies than HIV-negatives…..49% had been exposed to zidovudine, stavudine or didanosine. Subjects had a median of 4 (IQR 3-6) co-morbidities.” Pre-frailty and difficulty with IADLs were the most frequent syndromes, occurring in 50% of participants.

Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine.

HIV providers in the current era contend with tremendous variability in the health of older persons with HIV/AIDS. Many of us care for HIV-infected patients in their 70’s who are robust, have had an excellent response to antiretroviral therapy (ART), and are living active and fruitful lives. For many of these patients, HIV infection is their only health problem, and not much of a problem at that. At the same time, we care for HIV-infected patients in their 50’s with substantial multi-morbidity including cognitive and/or functional disability.

The Quick Reference Card for Managing Older Adults with HIV was developed out of the New York State Dept. of Health AIDS Institute Office Of The Medical Director. To obtain a copy, access www.hivguidelines.org. The AIDS Institute determined HIV and Aging as a priority over ten years ago. The number of people with HIV infection who are over 50 years of age is climbing. HIV Primary Care Specialists have demonstrated success in the integration of primary care into their practices for more than a decade.

In the US the HIV population is aging. By 2015 half of the over 1.4 million people infected with HIV will be age 50 and older. Each day 80 more people become part of this older adult group. And, 1 in every 6 new HIV diagnoses occurs in the age 50 and older population. This graying of the epidemic is mostly a result of effective HIV treatment (ART). This intersection of HIV and Aging requires a shift in how optimal care is provided.

Latinos are the largest and fastest growing ethnic group in the US, and comprise 17% of the population. They are often viewed as a monolithic group by mainstream culture. However, the term Latino, referring to people of Mexican, Central American, and South American origins, encompasses great diversity with regard to nationality, immigration history, language use, educational and occupational opportunities, and socio-economic position. 

Case Western Reserve University researchers were surprised to learn that people younger than 50 years old with HIV feel more isolated and stressed than older people with the disease.

They expected their study to reveal just the opposite.

“The younger, newly diagnosed individual may not know anyone in their peer group with a chronic illness, much less HIV,” said Allison Webel, PhD, RN, assistant professor at Case Western Reserve’s Frances Payne Bolton School of Nursing.

On Sept. 18 the United States government observes National HIV/AIDS and Aging Awareness Day. This commemoration is the latest addition to a series of such HIV-related remembrances and is one that has particular salience given the ever-evolving demographic landscape of the HIV-infected population in the U.S.

Neurology

Thanks to the effectiveness of combination Antiretroviral Therapy (cART), people are aging with HIV, and in many cases doing so successfully. Although we still struggle without a cure, this remains an exciting period in combating this epidemic in that prognosis and life spans are greatly improved. Yet, challenges remain as we observe either accelerated or accentuated aging in many with this disease in several areas (i.e., cardiovascular, renal, and metabolic disease; systemic inflammation); however, one area has received particular attention – brain health, specifically cognition.

Frailty

Overlapping geriatric syndromes such as “frailty”, “disability”, “multimorbidity”, and “polypharmacy” require adaptation for those aging with HIV infection to account for the ongoing role of HIV infection and its treatment in modifying the aging process. Several complementary approaches to the measurement of frailty have evolved within the geriatric literature and these have been variably applied among those aging with HIV. The approach most often employed in the HIV literature, uses a triad of wasting, slowing, and weakness and is characterized by the frailty phenotype and the frailty related phenotype (Desquilbet et al, 2011; Fried et al., 2001). Another approach focuses on cumulative deficits across multiple physiologic systems (Clegg et al., 2013), but it requires 30 separate measures and has been deemed less feasible for routine care. Rockwood et al have proposed a reduction in the number of measures from 30 to 10. Some have suggested that a single measure of function, such as grip strength or the six minute walk test, might serve.

Cardiovascular Disease

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine.

Depression

Latinos are the largest and fastest growing ethnic group in the US, and comprise 17% of the population. They are often viewed as a monolithic group by mainstream culture. However, the term Latino, referring to people of Mexican, Central American, and South American origins, encompasses great diversity with regard to nationality, immigration history, language use, educational and occupational opportunities, and socio-economic position. 

Stress

Case Western Reserve University researchers were surprised to learn that people younger than 50 years old with HIV feel more isolated and stressed than older people with the disease.

They expected their study to reveal just the opposite.

“The younger, newly diagnosed individual may not know anyone in their peer group with a chronic illness, much less HIV,” said Allison Webel, PhD, RN, assistant professor at Case Western Reserve’s Frances Payne Bolton School of Nursing.

Pages

Connect

Phone: 202-659-0699
Fax: 202-659-0976

Contact

AAHIVM National Office
1705 DeSales Street NW, Suite 700
Washington, D.C. 20036

About

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.