Geriatric Syndromes in People Living with HIV Associated with Ageing and Increasing Comorbidities: Implications for Neurocognitive Complications of HIV Infection

Falutz, Julian; Kirkland, Susan; Guaraldi, Giovanni

doi:10.1007/7854_2019_119

Cited by 10 publications

(7 citation statements)

References 127 publications

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“…CGA has demonstrated significant functional deficits and frailty in older people with HIV 35 and offers opportunities to identify and treat many other aging-related conditions in older PWH. 36 This study reports findings from a selected group – they were referred by their providers and they agreed to the consultation; the mean MoCA was 21/30 and only 48.5% were completely independent in IADL, indicating a significant need. A study of 359 adults in San Francisco (mean age 57) who underwent geriatric assessment also revealed high functional burden, including 40% with at least one IADL impairment and 40% with possible mild cognitive impairment.…”

Section: Discussionmentioning

confidence: 92%

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Siegler¹,

Moxley²,

Glesby³

2021

HIV

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Purpose People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient’s needs. Patients and Methods We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. Results A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. Conclusion Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.

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Section: Discussionmentioning

confidence: 92%

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Siegler¹,

Moxley²,

Glesby³

2021

HIV

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“…Within our population, age was associated with an increased risk of NCI, similar to previous studies [ 9 , 11 , 12 , 22 ]. The prolonged exposure to HIV and to cART, together with age-related comorbidities and concomitant medication use, may interact and contribute to the development of NCI in older PWH [ 34 ]. A recent matched study involving aging individuals with and without HIV demonstrated the association between NCI and HIV in such a population [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Declining Prevalence of Human Immunodeficiency Virus (HIV)–Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy–Treated Individuals With HIV

Mastrorosa

Pinnetti

Brita

et al. 2022

Clinical Infectious Diseases

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Background Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-living-with-HIV (PLWH). Methods ART-treated PLWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009-2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted. Results Overall, 1,424 PLWH were enrolled during four three-years periods. HAND prevalence was 24%. Among complainers (572/1,424), HAND prevalence was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (p < 0.001) and in complaining (p < 0.001); in not-complaining it remained stable (p = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to Non-Nucleoside Reverse Transcriptase Inhibitors, individuals receiving dual and Integrase Strand Transfer Inhibitor (INSTI)-based therapies were associated with a decreased risk of HAND, as well as participants tested in more recent years. Conclusions In this large cohort of ART-treated PLWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability.

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“…9,10 With aging of PWH and increasing access to combination antiretroviral therapy, underlying etiologies for neurocognitive impairment among PWH have shifted. 11 Earlier in the epidemic, HIV-associated Neurocognitive Disorder and HIV-associated Dementia were disturbingly commonplace, but since the advent of combination antiretrovirals, these conditions are rare. 12 However, Mild Neurocognitive Disorder and Asymptomatic Neurocognitive Impairment still occur and may make PWH more susceptible to the effects of medications and alcohol.…”

Section: Introductionmentioning

confidence: 99%

Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications

Akgün

Krishnan

Tate

et al. 2023

J American Geriatrics Society

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Background People aging with and without HIV (PWH and PWoH) want to avoid neurocognitive dysfunction, especially delirium. Continued use of alcohol in conjunction with neurocognitively active medications (NCAMs) may be a largely underappreciated cause, especially for PWH who experience polypharmacy a decade earlier than PWoH. We compare absolute and relative risk of delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs. Methods Using the VACS cohort, we compare absolute and relative risk of inpatient delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs between 2007 and 2019. We matched each case based on age, race/ethnicity, sex, HIV, baseline year, and observation time with up to 5 controls. The case/control date was defined as date of admission for cases and the date corresponding to the same length of time on study for controls. Level of alcohol use was defined using Alcohol Use Disorder Identification Test–Consumption (AUDIT‐C). Medication exposure was measured from 45 to 3 days prior to index date; medications were classified as anticholinergic NCAM, non‐anticholinergic NCAM, or non NCAM and counts generated. We used logistic regression to determine odds ratios (ORs) for delirium associated with medication counts stratified by HIV status and adjusted for demographics, severity of illness, and related diagnoses. Results PWH experienced a higher incidence of delirium (5.6, [95% CI 5.3–5.9/1000 PY]) than PWoH (5.0, [95% CI 4.8–5.1/1000 PY]). In multivariable analysis, anticholinergic and non‐anticholinergic NCAM counts and level of alcohol use demonstrated strong independent dose–response associations with delirium. Conclusions Decreasing alcohol use and limiting the use of neurocognitively active medications may help decrease excess rates of delirium, especially among PWH.

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Geriatric Syndromes in People Living with HIV Associated with Ageing and Increasing Comorbidities: Implications for Neurocognitive Complications of HIV Infection

Cited by 10 publications

References 127 publications

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Declining Prevalence of Human Immunodeficiency Virus (HIV)–Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy–Treated Individuals With HIV

Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications

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