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HIV/Life Expectancy-Mental Health/Comorbidities-
Psychosocial-Lifestyle-Social Determinants
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Download the PDF here
Impact of smoking, hypertension, and cholesterol on myocardial infarction in HIV-infected adults...."hypertension, cholesterol & smoking are very strong drivers of MIs in HIV+"
Lowering high total cholesterol would prevent 43% of myocardial infarctions (MIs) in people with HIV, according to a 29,515-person analysis of the NA-ACCORD cohorts [1]. Avoiding hypertension would prevent 41% of MIs, and avoiding smoking would prevent 38%.
What Does Aging with HIV Mean for Nursing Homes?
Psychosocial, mental health, and behavioral issues of aging with HIV
individuals with greater minority burden (i.e., the number of minority statuses, including being gay or bisexual, nonwhite, disabled, low-income, foreign-born, and speaking English as a second language) experienced greater HIV-related stigma, which was associated with greater mental health burden
Life Expectancy, Inflammation, Comorbidities, Mental Comorbidities
in Keri Althoff's talk as part of plenary session at CROI - SYMPOSIUM: LIFE EXPECTANCY AT 25 - she showed these 2 slides, 1- showing prevalence of mental comorbidities in HIV+ vs general population bearing in mind the many diverse types of HIV+ populations within which the prevalence & affects of these mental comorbidities will vary. In slide just below this 1st one she discussed the affect of mental comorbidities on care saying numbers of days of depression relates to missed visit appointments & detectable viral load. Other studies have linked all these to viral load detectable & this leads to increased physical comorbidities. In the general population depression causes increased inflammation, result in stress hormone abnormalities and cause metabolic abnormalities; depression has been linked to a number of comorbidities as depicted in 3rd slide just below. Althoff urged that we include mental comorbidities in our studies - really! She went on to away how ART reduces comorbidities risk but rates of CVD & cancers are still higher even on ART in HIV vs general population. She turned to social isolation - see slide below - saying hoe in HIV+ social isolation is a killer and she went on to show how younger HIV+ adults may have as much if to greater social isolation
http://www.croiwebcasts.org/console/player/37257?mediaType=slideVideo&&crd_fl=1&ssmsrq=1521830953426&ctms=5000&csmsrq=871
And Caroline Sabin gave a talk on life expectancy where she showed this slide from the general population where PSS, perceived stress scale & increases mortality regardless of how many comorbidities a person has, and she discussed the importance of mental health in mortality . Then she showed slide below from UK CHIC where says it shows with HIV+ men & women with undetectable VL & CD4 achieved over 350 life expectancy "its expected" to be as good as the general population, which I do not believe, and she shows r=this in a slide: that life expectancy is based on modeling & historic date, which is why none of these life expectancy studies can be true because they are NOT eve trying to model in the affects of comorbidities & frailty, which is very difficult to accurately do.
http://www.croiwebcasts.org/console/player/37256?mediaType=slideVideo&&crd_fl=1&ssmsrq=1521834577754&ctms=5000&csmsrq=806
The bottom line is we are seeing much greater rates of CVD & cancers and other comorbidities in HIV+ in older people in particular, and frailty is setting in at earlier ages & at higher rates in older HIV+..
Jason Baker discussed inflammtion & showed this slide that the strength of the association of these inflammations markers & mortality is much stronger in HIV+ than the general population, from START 10 tears ago. He also lists the anti-inflammatories in research.
http://www.croiwebcasts.org/console/player/37258?mediaType=slideVideo&&crd_fl=1&ssmsrq=1521837572531&ctms=5000&csmsrq=938
Here is link to panel discussion about all of this is this session at CROI, where they discussed how to conduct clinical trials og=f anti-inflammatory medications & how the different inflammatory markers affects might affect outcomes. Frank Palella in the open discussion said & he is right of course - just finding an anti-inflammatory that improves IL-6 & D-Dimer may not be enough because there are multiple factors that go towards mortality outcomes & improving a comorbidity outcome; this includes mitochondrial damage & microcrobial translocation. - http://www.croiwebcasts.org/console/player/37259?mediaType=audio&&crd_fl=1&ssmsrq=1521836164921&ctms=5000&csmsrq=781
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