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Cumulative Affects of Aging & HIV: mental & physical affects Reported at 2018 aging Workshop - 'mental & physical functional Disabilities'
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20-40 years of living with HIV & being Over 65 Years old & its cumulative affects results in older HIV+ over 65 with .....
(1) 60% over 65 YO having frailty,
(2) 55% poor physical function/pain & moderate to severe bad quality of life & too many medications - polyphramcy - increases risk for cognitive impairment/falls & fractures,
(3) 50% with cognitiveAging & impairment ,
(4) women suffer aging consequences worse than men,
(5) 50% over 60 had falls in MACS - falls & fractures are double in prevalence in older HIV+ over 60 compared to HIV-neg,
(6) 64% are lonely / high rates of social isolation & being homebound - unable to shop for food,
(7) 40% may have fatty liver that is fatty liver disease without having HCV or HBV, "non-viral liver disease",
(8) at UCSD HIV clinic they saw a 1000% increase in HIV+ clients over 65.
(9) THE last session at the workshop was devoted to an open panel discussion on policy changes needed to provide support services for these disabled older HIV+ & how to get there because so far these needs are not getting the attention it deserves......its projected that 60% with HIV in the USA will be over 50 very soon & then to 75% with 80% having CVD & 30% malignancy - housing, food, becoming homebound & accessing healthcare will become very challenging for many older aging HIV+ who suffer disability which will be a highpercent of those aging and older, increasing as years go by.
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Aging Workshop Summary Reports / Coverage by NATAP:
BRIEF TAKE-Home Messages
1- exhausted immune system in HIV+ contributes to premature aging;
2 - 64% lonely; 50% unable to physically function & poor quality of life, and exhausted,
3- 10 Years Accelerated Aging in Frail >55 years old HIV+ demonstrated by DNA methylation
4 - MACS men HAD Double the rate of falls compared to HIV-neg / >60 Years Old - 50% had a fall or more than 1 fall - in HIV-neg 20% of men 60-69 had a fall with 10% experiencing injury & 5% a fracture: increased risk with detectable viral load, efavirenz, neuropathy, fatigue, diabetes, poor balance/physical function, curbs, poor balance confidence
5.. structured exercise routines improved physical functioning
6 - "Invisible vs Visible" disabilities in older HIV+ - they had higher rates of "visible" disabilities meaning physical function decline was clear & greater after 60 years old
7- older HIV+ experiencing signs of premature muscle aging
8 - Canadian study found only 14% of older HIV+ were "aging well"
9 - 64% of HIV+ were lonely & social isolation a critical problem. Clearly many older HIV+ experience the cumulative affect of 20-30 years with HIV - physical & mental fatigue, cumulative stigma & self stigma having the affect of limited mobility & desire NOT to engage socially !
10- HIV+ WOMEN& Aging - women appear to age worse than men. Several studies report on this. Menopause in HIV+ occurs prematurely and has a greater negative affect on HIV+ women, they experience more adverse effects of menopause & at earlier ages.
11- In ACTG HAILO Cohort - 25% of HIV+ 60 years of age or older experienced a Fall or more, if they were FRAIL 50% experienced a Fall or more.
- In Spain/Italy Study - Older HIV+ women over 50 - they had WORSE Quality of Life & Worse Physical Function than older HIV+ Men: 42% of women vs 30% of men were exhausted at least 1-2 days a week. 40% of both men & women had sarcopenia. 25% of women & 16% of men reported moderate to severely bad quality of life. Comorbidity rates were reported & they were high & common.
- 63% Frail at 65 Years Old-Itlalian Study/NEW HIV Index+Protective Index / HIV-related and social frailty predictors and protectors in 1612-person Italian cohort - (09/19/18)
12- Cognitive Aging in HIV - Leah Rubin delivered plenary talk: WIHS mid-life age HIV+ women had double the mood disorders, associated with Post Traumatic Stress. The presence of comorbidities worsened the affect. METABOLIC SYNDROME associated with worse cognitive performance. 50% with HIV have cognitive impairment, despite viral suppression.
13; "Deprescribing" was a big discussion point at Workshop. Older HIV+ are given too many medications & some of which actually can cause cognitive impairment, many clinicians appear not to understand this & these drugs can increase risk for cognitive impairment, falls & fractures. so "deprescribing" needs to be considered.
The Impact of Number of Medications on Falls in Aging Persons Living with HIV - every increase in 1 medication increased risk by 10% for a fall - "50, the new 65?" - (09/17/18)
14 - 40% had fatty liver in HIV+
15 - 60% frailty, fractures & falls occur more often in HIV+ and intensifies in older aging HIV+ this will hasten mortality & disability, premature muscle aging, mood disorders, metabolic syndrome,
16 - 1000% increase in over 65 in HIV clinic, depression & comorbidities linked. dental care not even discussed: a hidden comorbidity; 17 - taking non-ARVs that might cause cognitive impairment in HIV+; polypharmacy linked with cognitive impairment - "deprescribing" suggested; fatty liver a new comorbidity for older aging HIV+; muscle mitochondria damage by old and contemporary nukes.
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9th International Workshop on HIV and Aging
13 and 14 September 2018
New York City, NY
REPORTS....
AGE: CD4 effector memory T cells connected to death in veterans living with HIV..... "suggest an accelerated aging of the immune system, and an increase in this particular risk factor for death" - (09/26/18)
AGE: Association between cognitive reserve and cognitive performance in people with HIV: a systematic review and meta-analysis - (09/26/18)
AGE: The Impact of Structured Exercise on Brain Health in Individuals with HIV: A Pilot Study from the Brain Positive Health Now Cohort (BHN).....Improved Physical Function - (09/26/18)
AGE: Falls Among Older Men With or at Risk for HIV Infection - (09/25/18)
AGE: Detectable viral load quadruples odds of recurrent falls in older men with HIV - Mark Mascolini (09/25/18)
AGE: 75% Projected to Be Over 50. 85% of HIV+ projected to Have Cadiovascular Disease in USA, 30% malignancy, 23% diabetes. Care Costs Increase by 40% due to Comobidities. - (09/25/18)
AGE: Frailty Phenotype in Canadian Men and Women with HIV. from Jules: Fried Frailty test is too simple in HIV - (09/25/18)
AGE: How Different Are Invisible and Visible Disabilities in HIV? Over 60 functioning Very Limited - Important Report: mental & physical limitations in Aging HIV+ - (09/25/18)
AGE: Efficacy and Safety of Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Treatment-experienced, Virologically Suppressed (EMERALD) and Treatment-naïve (AMBER) Patients: Week 48 Subgroup Analysis by Age - (09/25/18)
AGE: Acute Exercise-Induced Inflammatory Response among Older Adults with and without HIV - (09/25/18)
AGE: Exercise-Induced Inflammatory Changes among Older Adults with and without HIV.... from Jules: look at slides at end showing improved functioning due to exercise with high intensity exercise appearing to show more benefits, and decreased CRP with high intensity. - (09/25/18)
AGE: HIV and the "Geri-ome": Linking Gut Dysbiosis to Inflammation - (09/25/18)
AGE: 'Premature Muscle Aging In Middle-Aged HIV+ men & women' - (09/25/18)
AGE: Aging with HIV? I'm fine, thanks for asking! - 14% Age Well in Canada Cohort - (09/21/18)
o
o AGE: Associations of loneliness with cognitive function and quality of life (QoL) among older adults living with HIV - (09/19/18) 64% lonely
AGE: Considerations for The HIV Positive Woman during menopause - (09/19/18)
AGE: Frailty and the Risk of Falls in HIV-Infected Older Adults in the ACTG A5322 Study - (09/19/18)
AGE: Advance Directives and Medical Power of Attorney Assignment in Individuals with HIV - low rates: only 30%-50% or less leave advance directives or power of attorney before death - (09/19/18)
AGE: Cognitive aging in the era of effective antiretrovirals - (09/19/18)
AGE: More than 40% of HIV group has hepatic steatosis, regardless of age - Mark Mascolini (09/19/18)
AGE: Associations of loneliness with cognitive function and quality of life (QoL) among older adults living with HIV - 18% lonely quite often - Mark Mascolini (09/19/18)
AGE: Aging HIV+ Brain - The relationship between synaptodendritic neuropathology and HIV-associated neurocognitive disorders is moderated by age - (09/19/18)
AGE: Muscle mitochondrial function and contemporary anti-retroviral therapy - (09/19/18)
AGE: Physical function worse in older women than men with HIV, despite better CD4 recovery 55% of men & women with poor physical functioning, exhaustion, pain - Mark Mascolini (09/19/18)
AGE: Metabolic syndrome tied to neurocognitive deficit with (but not without) HIV - Mark Mascolini (09/19/18)
AGE: Older age raises odds of amnestic mild cognitive impairment (but not HAND) with HIV - by 5% per year of aging - Mark Mascolini (09/19/18)
AGE: 63% Frail at 65 Years Old-Itlalian Study/NEW HIV Index+Protective Index / HIV-related and social frailty predictors and protectors in 1612-person Italian cohort - (09/19/18)
AGE: HIV and frailty predict first fracture in middle-aged US women's cohort - doubled fracture rates - Mark Mascolini (09/19/18)
AGE: Frailty Phenotype: A Clinical Marker of Age Acceleration in the older HIV-Infected Population - (09/18/18) DEMONSTRATES 10 Years Accelerated Aging
Exhausted & Depleted T Cells in HIV+ Cause Premature Aging & Comorbidities & Frailty Memory loss: T cell subsets associated with mortality in HIV+ and HIV- veterans - (09/18/18)
Effects of Comorbidity Burden and Age on Brain Integrity in HIV - (09/17/18)
The Impact of Number of Medications on Falls in Aging Persons Living with HIV - every increase in 1 medication increased risk by 10% for a fall - "50, the new 65?" - (09/17/18)
Frailty Predicts Fractures Among HIV-infected and Uninfected Women: Results from the Women's Interagency HIV Study - (09/17/18)
People taking more medications and women have higher fall risk in older HIV group - written by Mark Mascolini - (09/17/18)
Exercise-induced inflammatory changes among older adults with and without HIV Inflammation does not drop more with HIV after 24 weeks of exercise - written by Mark Mascolini - (09/17/18)
AGE: Only 42% in HIV group have an advance directive immediately before death - written by Mark Mascolini - (09/17/18)
AGE: "Aging well 14%" more frequent than frailty in Canadian HIV group - written by Mark Mascolini - (09/17/18)
AGE: People taking more medications and women have higher fall risk in older HIV group - written by Mark Mascolini - (09/14/18)
AGE: Big HIV clinic sees more than 1000% jump in patients 65 and older - written by Mark Mascolini - (09/14/18)
AGE:Depression, bipolar disorder tied to noncommunicable disease risk with HIV - written by Mark Mascolini - (09/14/18)
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