Evaluation of a Clinic Dedicated to People Aging with HIV at Chelsea and Westminster Hospital: Results of a 10-Year Experience

Pereira, Branca; Mazzitelli, Maria; Milinkovic, Ana; Casley, Christina; Rubio, Javier; Channa, Rachel; Girometti, Nicolò; Asboe, David; Pozniak, Anton; Boffito, Marta

doi:10.1089/aid.2021.0083

Cited by 32 publications

(33 citation statements)

References 42 publications

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“…30 However, recent studies found that FRAX scores may not be an appropriate tool to define eligibility to perform DXA scans in HIV patients older than 50 years and it often underestimates the fracture risk in HIV patients and may fail to detect a significant proportion of patients at risk of osteoporotic fractures. 31,32 So, we did not use FRAX to estimate fracture risk in this study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study

Meng

Chen

Song

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Our study aimed to investigate the prevalence and risk factors of low bone mineral density (BMD) among HIV/AIDS patients in China. Methods:We performed a cross-sectional analysis of HIV-infected patients from October 2017 to August 2020. Demographic information, clinical data, and serum parameters were obtained. Univariable and multiple logistic regression analyses were performed.Results: A total of 1143 patients were included. In the ART-naive group, low BMD was diagnosed in 19.2% (117/608), including osteoporosis in 1.0% (6/608) and osteopenia in 18.3% (111/608). In the ART group, low BMD was diagnosed in 32.2% (231/717), including osteoporosis in 2.4% (17/717) and osteopenia in 29.8% (214/717). Using multivariate analysis, we identified age older than 50 years, body mass index , 18.5 kg/m 2 , and treatment based on tenofovir disoproxil fumarate as independent risk factors for low BMD. Low high-density lipoprotein cholesterol was a protective factor for low BMD. Among low BMD participants, the most common number of low BMD sites for a patient to have was 4 (33.6%, 117/348). Conclusion:We confirmed a high prevalence of low BMD and osteoporosis in HIV/AIDS patients, and we identified age older than 50 years, low body mass index, and a treatment based on tenofovir disoproxil fumarate as risk factors for low BMD. Low high-density lipoprotein cholesterol had a protective effect against low BMD. Among low BMD patients, patients most commonly had 4 sites with low BMD, which has been associated with fracture risk. In addition, bone changes to L1 can present before low BMD diagnosis and may be a potentially useful indicator that low BMD is developing.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study

Meng

Chen

Song

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…HIV clinics with established care programs for OPLWH currently use various metrics to screen for frailty. These include assessing gait speed and using the FRAIL Scale [ 20 , 112 , 113 ] and the Clinical Frailty Scale [ 114 ]. Several centers have published their experience in managing frail OPLWH.…”

Section: Introductionmentioning

confidence: 99%

“…A US, tertiary care, academic-based HIV and aging clinic accepts all referrals of OPLWH and then performs interdisciplinary geriatric assessments to screen for the most vulnerable [ 21 ]. The Chelsea and Westminster Clinic in London screens OPLWH with the CFS and refers those who are more than Stage 5 (at least mildly frail) to a dedicated Geriatric HIV clinic [ 114 ]. The evidence does not support using one frailty screening measure over another.…”

Section: Introductionmentioning

confidence: 99%

Frailty in older people living with HIV: current status and clinical management

et al. 2022

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This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH’s clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.

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“…One of the most important issues is the management of the metabolic disease because MTBS is not only the main drivers of major cardiovascular events, but it is also associated with an increased risk of respiratory disorders and malignancies [7,8] and possible side effects due to polypharmacy [9]. This is the reason why dedicated clinics and services for a multidimensional approach to ageing PLWH have been implemented over time [10].…”

Section: Introductionmentioning

confidence: 99%

Weight of Clinical and Social Determinants of Metabolic Syndrome in People Living with HIV

Mazzitelli

Fusco

Michele

et al. 2022

Viruses

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Background. Comorbidities in people living with HIV (PLWH) represent a major clinical challenge today, and metabolic syndrome (MTBS) is one of the most important. Objective. Our objective was to assess the prevalence of MTBS and the role of both clinical/socio-behavioral risk factors for MTBS in a cohort of PLWH. Methods. All PLWH, over 18 years of age, attending all Infectious Disease Units in Calabria Region (Southern Italy) for their routine checks from October 2019–January 2020 were enrolled. MTBS was defined by NCEP-ATP III criteria. Logistic regression analysis was performed to assess factors significantly associated with the main outcome (MTBS). Results. We enrolled 356 PLWH, mostly males (68.5%), with a mean age of 49 years (standard deviation: 12), including 98 subjects with and 258 without MTBS. At logistic regression analysis, a statistically significant association was found between MTBS and alcohol use, osteoporosis, polypharmacy, and a history of AIDS. Conclusions. Identifying and addressing risk factors, including those that are socio-behavioral or lifestyle-related, is crucial to prevent and treat MTBS. Our results suggest the importance of implementing educational/multidimensional interventions to prevent MTBS in PLWH, especially for those with particular risk factors (alcohol abuse, osteoporosis, previous AIDS events, and polypharmacy). Moreover, alcohol consumption or abuse should be routinely investigated in clinical practice.

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Evaluation of a Clinic Dedicated to People Aging with HIV at Chelsea and Westminster Hospital: Results of a 10-Year Experience

Cited by 32 publications

References 42 publications

Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study

Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study

Frailty in older people living with HIV: current status and clinical management

Weight of Clinical and Social Determinants of Metabolic Syndrome in People Living with HIV

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