The clinical implications of HIV infection and aging

Abstract

The objectives of this study, presented as part of a plenary session at WW7 in Hyderabad, India were to review (i) the epidemiology and current clinical issues of HIV infection with regard to HIV and older populations and (ii) models for increased morbidity and mortality in older HIV-positive individuals with implications for clinical care. HIV infection for those in treatment has become a complex chronic disease in which end-organ injury and resulting morbidity, functional decline, and mortality do not have a single etiology but reflect cumulative loss of organ system reserve from multiple interacting sources leading to functional decline, organ system failure, and death. Emerging guidelines and recommendations suggest a need for increased awareness and treatment of the multifaceted needs of the aging HIV-infected patient. Oral Diseases (2016) 22, 79-86

HIV and Aging: Demographic Change in the Asia-Pacific Region

“…Aging populations have already been described in Western and Central Europe and North America where more than half the PLWHA are over 50 years old [6,11]. With further ART roll-out and advances in care, changes in TAHOD-LITE will possibly catch up with trends seen in those regions today.…”

“…Widespread consensus exists that HIV and/or its treatment affects the process of adult aging and the development of non-AIDS disorders, including cardiovascular disease, cancer, kidney disease, liver disease, osteopenia or osteoporosis, and neurocognitive disease typically associated with advanced age [9–11]. The demonstrated higher prevalence of such age-associated non-communicable comorbidities among HIV-positive patients over 50 years compared to HIV-negative peers [12], contributes to increased medical complexity of care [11].…”

“…The demonstrated higher prevalence of such age-associated non-communicable comorbidities among HIV-positive patients over 50 years compared to HIV-negative peers [12], contributes to increased medical complexity of care [11]. …”

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

“…In coming years, healthcare for this population will become increasingly complex as it encompasses not only HIV management but also non-AIDS HIV-related conditions associated with advanced aging (Ball, 2014). As a result, healthcare systems will need to establish strategies that more efficiently integrate HIV and additional care for older adults to ensure their longer term needs are met (High et al, 2012; John, 2016). …”

Prevalence of dental symptoms and access to dental care in an American HIV outpatient clinic

“…Oral disease appears common in the setting of HIV, with rates of chronic periodontitis reported to be as high as 76% in HIV-positive individuals (Kroidl et al, 2005), yet the incidence of dental disease and access to dentistry in the era of modern anti-retroviral therapy (ART) is not well defined, and has been an area largely neglected by researchers and policymakers. As discussed in your supplement, dental disease has widespread health impacts on nutrition, immune activation, and inflammation and has been associated with increased rates of cardiovascular disease (John, 2016). Treatment of periodontal disease can reduce systemic inflammation, increase CD4+ T-cell counts in HIVpositive individuals (Valentine et al, 2016), and improve endothelial function and reduce cardiovascular risk (Tonetti et al, 2007).…”