From the Journals

Growing old with HIV: What’s likely, and how can physicians help?

 

Key clinical point: Significant medical monitoring and intervention may be required to enable successful aging in the HIV-infected population.

Major finding: Aggressive use of antiretroviral therapy, primary prevention, and early diagnosis and treatment of comorbidities are key.

Study details: Literature review.

Disclosures: The review was not sponsored and the authors reported that they had no disclosures.

Source: Escota, J V et al. Int J Infect Dis. 2018;66:56-64.


 

FROM INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES

Individuals infected with HIV require early intervention with safe and effective antiretroviral therapy beyond the standard care required for successful aging. The long-term residual inflammation associated with fully suppressive ART must also be addressed, according to a review in the International Journal of Infectious Diseases.

The review was prompted by the increasing number of aging persons with HIV in the population, due to the advent of life-protecting drug treatments.

Gerome V. Escota, MD, and his colleagues at Washington University, St. Louis, assessed the factors faced by the normally aging population and then added an assessment of the path to successful aging given the unique aspects of the HIV infected population (Int J Infect Dis. 2018; 66:56-64).

For example, in San Francisco, 58% of the people with HIV were over 50 years of age by 2014, according to the authors, and those numbers will continue to increase. Such patients will not only be suffering the effects of the normal aging process, but also the potential burden of long-term antiretroviral drug use on their systems.

In addition, even the use of highly-effective antiretroviral therapy does not completely eliminate the inflammatory markers among HIV-infected individuals, and such markers have been associated with increased risk of cardiovascular and other problems. Of particular concern: “It remains unknown whether age-associated inflammation will aggravate residual HIV-associated inflammation in these patients over time,” the authors wrote.

Exacerbated comorbidities that may be a risk among the aging population infected with HIV include cardiovascular disease, osteoporosis, malignancies, chronic liver and kidney disease, and HIV-related neurocognitive disease.

An active senior man jogging ©Willie B. Thomas/iStockphoto
The “low-hanging fruit” for successful aging with HIV includes “improving the cascade of HIV care and addressing health disparity, increasing the proportion of HIV-infected persons who are receiving suppressive [antiretroviral therapy] and maintained in care, using safer antiretroviral medications, and improving the uptake of primary care preventative guidelines among HIV-infected persons.” Such preventative measures include statin therapy, lifestyle modification, smoking cessation, and the treatment of the various risk factors for both natural aging and aging with HIV, the reviewers concluded.

The review was not sponsored and the authors reported that they had no disclosures.

SOURCE: Escota, J V et al. Int J Infect Dis. 2018;66:56-64.

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