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Aging & HIV - an unaddressed
timebomb waiting to explode - slide presentation by Jules Levin, NATAP
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Download the PDF here
Older Aging HIV+ over 60-65 years old often have on average 5 comorbidities & are taking 12-15 medications a day not even including their HIV ART regimen, they are suffering premature aging / geriatric syndrome, which includes premature frailty causing disability & are thusly unable to perform daily normal activities - bone disease: falls, fracture follow, cardiovascular disease, cognitive impairment & neurologic disease, disabling neuropathy, cancers, diabetes. Support services are needed, education for clinicians & clinics, patients and service providers - a network between these groups are needed to address thus, the most important problem facing HIV-infected individuals: 80% in NY & other major cities are over 45, 50% over 50, and 20% over 60 - this will only get worse.
Decreased Life Expectancy in HIV+
Aging with HIV: Emerging importance of chronic comorbidities in patients over 75
Trends in hospital deaths among human immunodeficiency virus-infected patients during the antiretroviral therapy era, 1995 to 2011..... Comorbidities Death Rates Doubled AIDS-Related death Rates: 70% of Deaths were due to Non-AIDS Related Cause, COMORBIDITIES, while only 29.5% were AIDS-related - (09/24/15)..... Clinicians can no longer remain focused on AIDS-defining opportunistic infections and need to recognize the emerging importance of chronic comorbidities when developing a differential diagnosis, and the higher risk of death due to non-AIDS infectious causes
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.....http://www.natap.org/2015/HIV/052015_04.htm
Alarmingly High Comorbidity Rates Among HIV+ - (09/24/15).....cardiovascular events 15.9% up from 9.6% in 2003; chronic kidney disease 16% up from 5% in 2003; renal impairment 20% up from 9.2% in 2003; hypertension 65% up from 34% in 2003; diabetes 31% up from 20% in 2003; hyperlipidemia 47.4% up from 12.1% in 2003; fractures or osteoporosis 11.2% up from 6.7% in 2003...HCV is 13% in medicaid in 2013
Veterans Aging Cohort Study (VACS) Index, Functional Status, and Other Patient Reported Outcomes in Older HIV-positive (HIV+) Adults in SF.....Poor Outcomes in HIV+ Aging age 53-61
80% of HIV+ Are Over 45 / 20% over 60 /50% Over 50 in NY, SF, Boston, Florida - (01/27/17)
Aging in US - Worse Still To Come - polypharmacy, multiple comorbidities, decreased survival, impaired daily activities functioning http://www.natap.org/2016/HIV/122116_05.htm
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)......"HIV+ beneficiaries were approximately twice as likely as those without HIV infection to have chronic condition flags indicating hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, or diabetes (Table 2)."
Cost of Care in Older Aging patients with Increased Comorbidities ... Aging, Worse Still to Come?
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