Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
HIV and Aging -Together we are > than AIDS
Plummets in Vit D, increased kidney stones, increased fractures (more than half do not have osteoporosis, 13% vs 5%), direct cellular aging as measured by telomeres fraying, increased depression, these are some of changes associated with HIV and aging.
In 2015, over half of the HIV population in North America and Europe will be over fifty years of age.
We can now say to a young person who is recently diagnosed with HIV "Some day you will be old!".
In Uganda a 35 yr old Man starting ART with a CD4 greater than 100 has a life expectancy of more than 35 years. Life expectancy gains in sub Saharan Africa are similar to those in western settings. Aging adds chronic disease to the mix of issues to address in the list of HIV health challenges.
It was recognised the limits of a silo based approach - care needs communication and coordination. Disability, frailty - depletion in organ system reserve and functional status - are terms increasingly applicable to those ageing with HIV. Each is a consequence of a chronic disease burden.
Age is accentuated not accelerated for those with HIV. There is increased risk of various conditions at the usual ages. Polypharmacy (>5) increases risk of an adverse drug reaction, this increases by 10% with each additional drug. The principles and risks of polypharmacy are applicable here.
Falls are increased by a vast range of medicines.
Call for a patient centred approach. Risks are greatly increased after 65 yrs compared to those 50-64.
Over 60% of mortality is due to Noncommunicable diseases (NCDs) in the developed world and only a little less in developing countries. The challenge of NCDs are made more complicated by HIV. The workforce is being challenged to task shift, as part of these new situations. This is supported internationally but is less welcomed in Australia. There will be an increased demand for primary care service providers, especially GPs to better provide comprehensive, integrated team based care. The new ASHM Life Plans (led by Edwina Wright and others) will be an important contribution.
We do not yet have good baseline markers for many NCDs in many, many countries especially in the 50+ age group- lots of research opportunities ahead.
Also see JAIDS, Vol 60, Supplement 1, July 1, 2012 And AIDS, Vol 26 Supplement 1, 2012-07-25 Both of these supplements focus on HIV and Aging.