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Aging and HIV
Identifying Care Needs

  Reported by Jules Levin, NATAP.
These are all recently reported studies at Aging Workshops in the past few weeks in NYC & Washington DC. Federal HIV/AIDs officials at the NIH and the White House are essentially ignoring the daily living needs of older aging patients related to their impaired daily functioning, support services needs and training for clinicians & patients. This is a global issue that is emerging first here in US, next is Westen Europe, then the rest of the world. In NY & SF already 50% of HIV are over 50 & soon will be over 60. HCV is part of the problem too because HCV increases inflammation & immune activation leading to increased risk for comorbidities, immune depletion & dysfunction, including bone disease, kidney disease, cardiovascular disease. So the longer a patient has HCV without successful treatment the greater the risk that HCV will increase these risks. The fact that the federal government is denying access to HCV treatment though restrictions for so many increases the risk for morbidity & mortality for these patients. History of cocaine, heroin, injection drug use are all associated increased inflammation & increased risk for comorbidities including kidney & bone disease.


Frailty 50% Now, Predicted to be 75% in Older Aging HIV in 14 years, requiring a large number of patients, perhaps 40%, to be confined in old age homes because they will not be able to function
Frailty / Aging Projections in Italy - Future challenges for clinical care of an ageing population infected with HIV: a "geriatric -HIV" modelling study -
Diet & Exercise are the best antidotes for aging of course in addition to appropriate medical care:
Strong Leg Muscles Improve Brain Functioning - 2 studies report - (09/28/16)
Less Physical Activity, Less Education Tied to Daily Living Impairments [Disabilities] in Older HIV Group - ACTG5322 -
CMV is associated with inflammation & thereby contributing to increased risk for comorbiities in HIV+
Higher CMV Antibody Concentrations are Associated with Older Age and Worse Neurocognitive Performance in Adults Living with HIV Disease - (10/08/16)
HIV+ on Medicare are experiencing more comorbidities & Blacks & Latinos experience greater numbers of comorbidities:
HIV+ >65 on Medicare Have 2 Times More Comorbidities vs HIV-neg AND Blacks & Latinos Have 4-Fold Increased Risk for the 5 Comorbidities Examined vs Whites - CDC Report Chronic health conditions in medicare beneficiaries 65 years and older with HIV infection. - (10/08/16)
Planning & special care for older aging HIV+ is necessary, special Geriatric HIV Care Centers in NY & SF but more are needed:
Caring for Older Adults [aging] with the Human Immunodeficiency Virus....."advance care planning is essential in older adults with HIV"
Non-HIV care provider....Aging, Worse Still to Come?....Aging Clinic at Weill-Cornell, NYC; aging $costs in HIV skyrocket - (09/29/16)
Geriatric Syndromes are Common Among Older HIV-Infected Adults
45% reported difficulty with daily living activities (IADLs) ... At the SF aging clinic HIV+ at average age 57 are experiencing - 4 (IQR 3-6) co-morbidities and were taking a median of 9 (IQR 5-12) non-antiretroviral medications. 86% of subjects had at least one geriatric syndrome and 54% had 2 or more syndromes. 38 subjects (27%) reported at least one fall, 36 (25%) reported urinary incontinence, and 64 (45%) reported difficulty with at least 1 instrumental activity of daily living. 12 (9%) subjects met the full criteria for frailty, while 79 (56%) met criteria for pre-frailty
Older HIV+ are experiencing increased falls & consequent fractures as a result of frailty, cognitive impairment & osteoporosis; fractures in the general public are associated with increased risk for premature mortality:
Frailty and the Risk of Falls in HIV-Infected Older Adults in the ACTG A5322 Study



Aging and HIV
Identifying Care Needs

Aging & HIV Workshop, Wash DC Sept 26 2016
Cynthia L. Gibert, MD, MSc
Professor of Medicine, George Washington University School of Medicine and Health Sciences Washington DC Veterans Affairs Medical Center