The ageing of HIV: Implications for geriatric medicine

ArticleinAge and Ageing 39(5):536-41 · September 2010with25 Reads
DOI: 10.1093/ageing/afq083 · Source: PubMed
Abstract
The prevalence of human immunodeficiency virus (HIV) in the over 50 age group is increasing as a consequence of younger adults ageing with HIV, in addition to new diagnoses in later life. We conducted searches in MEDLINE for English language studies published between January 1984 and January 2010 using search terms 'HIV', 'AIDS', 'HIV testing' and 'HIV complications' and selected articles relevant to adults aged 50 years and over. The prevalence, natural history and complications of HIV infection and treatment in older adults are reviewed. In 2007 the Centers for Disease Control and Prevention in the United States reported that 16.8% of new diagnoses of HIV that year were in individuals aged over 50 years. Older adults are vulnerable to late or missed diagnosis, and poorer treatment outcomes, due to the misconception that they are not at risk. A heightened awareness of HIV as a possible diagnosis in older adults is becoming increasingly important. As the HIV population ages, the emergence of disease and treatment complications such as cardiovascular disease, osteoporosis and dementia are evident. Management of older adults with HIV and multiple co-morbidities presents challenges to infectious diseases physicians and geriatricians alike. Inclusion of older adults in future HIV clinical trials will help design healthcare models to provide for this growing population.
    • "The study included a small number of HIV(+) patients, and HIV(+) patients not receiving HAART were absent owing to ethical considerations as current guidelines recommend the early introduction of HAART. A previous epidemiological study suggested that elderly patients were usually diagnosed in advanced stages of the disease and that they required immediate use of medications [15]. The selection of our control group may have been biased, as we recruited patients from a tertiary healthcare center and the risk of cardiovascular disease may have been higher in these patients than in the general population [32,33]. "
    Article · Jan 2016
    • "Liver disease is the second cause of death in HIV-infected patients after AIDS-related complications and the progression of chronic hepatitis C into cirrhosis is accelerated in HIV + patients [44]. In the Swiss HIV Cohort Study a fourfold increase in morbidity and mortality due to liver diseases has been reported in older patients and among 446 deaths between 2005 and 2009, 45 and 11 % were in coinfected patients with HCV and HBV, respectively. "
    Full-text · Article · Oct 2015
    A. CalcagnoA. CalcagnoS. NozzaS. NozzaC. MussiC. Mussi+1more author...[...]
    • "The resource implications of these changes are considerable, not only for the HIV services themselves, but also for the other chronic disease (e.g. oncology [41], cardiac [42], renal [43], and transplant services [44, 45]) and geriatric care [46] specialties that will be seeing more and more HIV-infected patients, and for the co-ordination of care across these multiple providers. While the changing age profile of HIV patients is the most obvious, and probably the most important, factor several of the other factors are also likely to change in the future, for example increasing health insurance coverage as a result of the affordable health care act in the USA [47], and increasing levels of urbanization [48]. "
    [Show abstract] [Hide abstract] ABSTRACT: The hepatitis C virus (HCV) NS3/4A serine protease inhibitors (PIs) boceprevir (BOC), telaprevir (TVR) and simeprevir (SMV) are approved for treatment of chronic hepatitis C virus infection in combination with pegylated interferon and ribavirin. The present study investigated the prevalence of HCV NS3 drug resistance mutations (DRMs) associated with HCV genotype 1-infected individuals at baseline and in viral breakthrough following BOC and TVR treatment. HCV genotype 1-infected individuals were enrolled in a multi-center, prospective outcomes study. The HCV NS3 viral protease was analyzed for DRMs at baseline (n=164) and at viral breakthrough (n=18) following BOC/TVR treatment. Viral NS3 protease subtype analysis showed 65.2% (107/164) were HCV subtype-1a and 34.8% (57/164) were HCV subtype-1b infections. Naturally-occurring PIs DRMs in NS3 (V36L, T54S, V55A, Q80K/R and I132V) were identified in 57.3% (94/164) cases at baseline. The NS3 Q80K polymorphism was found in 43/107 (40.2%) of HCV subtype-1a and exclusively in clade 1 (43/82; 52.4%) versus clade 2 viruses (0/25; 0%, P<10(-6)). The pre-treatment I132V variant was found in 78.9% (45/57) of subtype-1b. Of 18 patients who had viral breakthrough, the majority was subtype-1a (77.8%, 14/18). BOC/TVR-associated DRMs were detected in 94.4% (17/18), of which 64.7% (11/17) emerged on treatment. To ensure the most appropriate DAA-based treatment regimen is employed, baseline reporting of clade and resistance mutations for HCV subtype-1a using nucleotide sequence-based analysis is warranted prior to commencement of therapy.
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