Comorbid Conditions, Treatment, and Health Maintenance in Older Persons with Human Immunodeficiency Virus Infection in New York City

Shah, Sanjiv S.; McGowan, Joseph P.; Smith, Cheryl C.; Blum, Steve; Klein, Robert S.

doi:10.1086/343048

Cited by 73 publications

(48 citation statements)

References 22 publications

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“…Gutiérrez et al 50 observed that the greater progression to AIDS events or death among older people persists after adjusting for CD4 lymphocyte count in patients on HAART and a sustained virological response. The increased mortality in older patients may be related to age as a predictor of disease progression, diagnostic delay, 30,32,[34][35][36][37][38] the presence of comorbidities, 17,18,29,30,51 or the presence of AIDS or not AIDS, 17,52,53 among others. Other authors have not found an association between mortality and age.…”

Section: Discussionmentioning

confidence: 99%

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

Blanco

Jarrín

Vallejo

et al. 2012

AIDS Research and Human Retroviruses

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The age of 50 has been considered as a cut-off to discriminate older subjects within HIV-infected people according to the Centers for Disease Control and Prevention (CDC). However, the International AIDS Society (IAS) mentions 60 years of age and the Department of Health and Human Services (DHHS) makes no consideration. We aimed to establish an age cut-off that could differentiate response to highly active antiretroviral therapy (HAART) and, therefore, help to define advanced age in HIV-infected patients. CoRIS is an open, prospective, multicenter cohort of HIV adults naive to HAART at entry ( January 2004 to October 2009). Survival, immunological response (IR) (CD4 increase of more than 100 cell/ml), and virological response (VR) (HIV RNA less than 50 copies/ml) were compared among 5-year age intervals at start of HAART using Cox proportional hazards models, stratified by hospital and adjusted for potential confounders. Among 5514 patients, 2726 began HAART. During follow-up, 2164 (79.4%) patients experienced an IR, 1686 (61.8%) a VR, and 54 (1.9%) died. Compared with patients aged < 25 years at start of HAART, those aged 50-54, 55-59, 60-64, 65-59, and 70 or older were 32% (aHR: 0.68, 95% CI: 0.52-0.87), 29% (aHR: 0.71, 95% CI: 0.53-0.96), 34% (aHR: 0.66, 95% CI: 0.46-0.95), 39% (aHR: 0.61, 95% CI: 0.37-1.00), and 43% (aHR: 0.57, 95% CI: 0.31-1.04) less likely to experience an IR. The VR was similar across all age groups. Finally, patients aged 50-59 showed a 3-fold increase (aHR: 3.58; 95% CI: 1.07-11.99) in their risk of death compared to those aged < 30 years. In HIV infection, patients aged ‡ 50 years have a poorer immunological response to HAART and a poorer survival. This age could be used to define medically advanced age in HIV-infected people.

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Section: Discussionmentioning

confidence: 99%

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

Blanco

Jarrín

Vallejo

et al. 2012

AIDS Research and Human Retroviruses

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“…These studies provide data on different populations at different time points: New York City clinic patients age 55 or older between 1996-1998, 13 U.S. veterans receiving care from 1999 to 2000, 14 and U.S. veterans receiving care from 1997 to 2004. 15 In a sample of 165 HIV-positive clinic patients aged 55 or older, 13 89% had at least one comorbid condition. The most frequently occurring were hypertension (41%), chronic airway disease (29%), diabetes mellitus (22%), arthritis (18%), hepatitis C virus infection (16%), and coronary artery disease (14%).…”

mentioning

confidence: 99%

Prevalence and Patient Awareness of Medical Comorbidities in an Urban AIDS Clinic

Weiss

Osorio

Ryan

et al. 2010

AIDS Patient Care and STDs

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Mortality in HIV-positive persons is increasingly due to non-HIV-related medical comorbidities. There are limited data on the prevalence and patient awareness of these comorbid conditions. Two hundred subjects at an urban HIV clinic were interviewed in 2005 to assess their awareness of 15 non-HIV-related medical comorbidities, defined as medical problems that are neither AIDS-defining by standard definitions, nor a direct effect of immune deficiency. Medical charts were subsequently reviewed to establish prevalence and concordance between selfreport and chart documentation. Eighty-four percent of subjects self-reported at least 1 of 15 medical comorbidities and 92% had at least 1 condition chart-documented. The top 5 chart-documented conditions were hepatitis C (51.5%), pulmonary disease (28.5%), high blood pressure (27%), high cholesterol (24.5%), and obesity (22.5%). In multivariate analysis, higher number of non-HIV-related medical comorbidities was associated with older age, female gender, and intravenous drug use as route of HIV transmission. Across self-reported non-HIV-related medical comorbidities, the absolute concordance rate ranged from 67% to 96%, the sensitivity ranged from 0% to 79%; the positive predictive value ranged from 0% to 100%. While the vast majority of largely urban minority HIVpositive subjects were diagnosed with non-HIV-related medical comorbidities, there is significant room for improvement in patient awareness. In order to help patients optimally access and adhere to medication and medical care for these non-HIV-related medical comorbidities, interventions and educational campaigns to improve patient awareness that take cultural background, literacy, and educational level into account should be developed, implemented, and evaluated.

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“…In addition, a study showed that these individuals have less access to healthcare services, which can contribute to this disparity (16) .Regarding sex, there is no consensus about what would be a risk factor, although males are more prevalent in studies as a risk factor for SAH (10,21,25) . Advanced age, especially over 50, becomes a key factor for the development of SAH in this population.Other studies show that SAH is the most important comorbidity among the elderly (28)(29) . Therefore, elders with HIV/AIDS are more vulnerable, so we noticed they have more chronic conditions than elders who do not live with HIV/AIDS.…”

Section: Discussionmentioning

confidence: 94%

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

et al. 2017

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Objective: To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA). Method: Integrative literature review in six databases, held in March 2016. “AIDS” and “hypertension” were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were “prevalence of SAH in PLWHA,” “risk factors for SAH in PLWHA” and “adverse events of antiretroviral therapy (ART) that contribute to HAS.” Results: There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most. Conclusion: Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.

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Comorbid Conditions, Treatment, and Health Maintenance in Older Persons with Human Immunodeficiency Virus Infection in New York City

Cited by 73 publications

References 22 publications

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

Prevalence and Patient Awareness of Medical Comorbidities in an Urban AIDS Clinic

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

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