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Geriatric Conditions Common in Older HIV+ (UCSF SCOPE, CROI)
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"Our study supports findings from other HIV cohorts that have found evidence of clinical aging in adults who were younger than the typical "geriatric" population (65 years and older)"......"we found that falls were present in 1 quarter of participants, supporting data from a published study of falls in older HIV-infected adults, which showed a 30% fall rate"......"These data suggest that HIV-infected adults may experience similar rates of geriatric syndromes at relatively younger ages and emphasize the critical need for appropriate HIV-negative comparison groups to put these findings into further context........the association with comorbidities and lower CD4 nadir suggests possible targets of intervention. Our results are consistent with a study of HIV status, age, and daily function, which also demonstrated an association of CD4 nadir and comorbidities with functional impairment" [from Jules: the immediately previous study I emailed that studied mortality & when to begin ART did not examine this - that nadir CD4 increases comorbidities & functional impairment!!!!]
Geriatric Syndromes in Older HIV-Infected Adults...at 57 age...Participants had a median of 4 (IQR: 3-6) comorbidities & were taking a median of 9 (6-12) nonantiretroviral medications & (53.6%) had 2 or more geriatric syndromes - (05/20/15) - AIDS June 1 2015, Greene, Meredith MD et al.
presented at CROI - CROI: Geriatric Syndromes are Common Among Older HIV-Infected Adults - (03/16/15)
'The most frequent conditions were prefrailty (n = 87, 56.1%), difficulty with 1 or more IADLs (72, 46.5%), and cognitive impairment (72, 46.5%). Prefrailty (1 or 2 of the Fried criteria) was found in 56.1%"
'Consideration of how to incorporate assessment of geriatric syndromes into HIV care and development of targeted interventions for risk factors of geriatric syndromes is needed as the HIV-infected population continues to age."
"The development of geriatric syndromes, multifactorial health conditions that impact morbidity, mortality, and utilization of services, is one of the fundamental clinical manifestations of aging. A combination of risk factors for geriatric syndromes including psychosocial factors, such as social isolation and substance use, multimorbidity and polypharmacy, and chronic inflammation, is common among older HIV-infected adults,41-44 which has raised concern about how to decrease age-related complications in this population.5 Based on these concerns and findings from other studies identifying increased risk for frailty,17,19 we undertook a comprehensive study of geriatric syndromes in middle-aged and older antiretroviral-treated adults. As hypothesized, we identified a frequent occurrence of geriatric syndromes, with prefrailty, difficulty with IADLs, and cognitive impairment particularly common even among participants with well-controlled HIV. A combination of both HIV-related factors (CD4 nadir) and non-HIV-related factors (comorbidities, non-white race) was associated with increased risk of having more geriatric syndromes."
"Our findings suggest that even in middle-aged HIV-infected adults with well-controlled HIV, the burden of geriatric syndromes is important and will need to be addressed clinically to minimize age-related complications for this population. The association with lower CD4 nadir suggests that earlier antiretroviral treatment initiation may help to prevent aging-related complications, and the association with increasing number of comorbidities suggests that treatment and prevention of other comorbid conditions are equally important to the management of HIV in the aging HIV population. Consideration of how to incorporate assessment of geriatric syndromes into HIV care and development of targeted interventions for risk factors of geriatric syndromes is needed as the HIV-infected population continues to age."
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