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Aging with HIV in Latin America and the Caribbean: a Systematic Review

  • Global Health (SH Vermund, Section Editor)
  • Published:
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Abstract

Purpose of Review

With the establishment of antiretroviral treatment (ART) programs in low- and middle-income countries, people with HIV (PWH) in Latin America and the Caribbean (LAC) are living longer, subsequently developing chronic non-communicable diseases (NCDs). Few studies focus on the impact of aging among older LAC PWH. This systematic review aims to fill this information gap and understand the burden of aging with HIV in LAC. We identified peer-reviewed literature published in English, Spanish, or Portuguese from several databases to assess currently available evidence on the burden of aging with HIV in LAC and selected six common NCDs found in older PWH (cardiovascular disease [CVD], bone and musculoskeletal [MSK] disorders, cancer, renal disease, neurocognitive impairment [NCI], and depression).

Recent Findings

Of the 5942 publications reviewed, only 53 articles were found with populations 40 years and older or age-related findings (27 CVD, 13 NCI or depression, 6 MSK disorders, 4 renal disease, 3 cancer). Most (79%) publications were from Brazil with few longitudinal studies on aging with HIV. Prevalence of illnesses such as CVD, NCI, depression, or osteoporosis varied widely depending on the screening instrument utilized and geographic population surveyed. Age was a significant predictor of comorbidity in nearly all studies.

Summary

Our results demonstrate the need for longitudinal studies and validated screening instruments appropriate for use among PWH in LAC. Understanding the mechanisms behind aging in HIV and the roles of sociocultural factors and genetic diversity specific to LAC is needed to appropriately manage chronic comorbidities as PWH age.

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Acknowledgments

We would like to thank the library staff at Yale University School of Medicine and Universidad Peruana Cayetano Heredia. We would also like to thank the National Institute of Health Fogarty International Center for supporting this work.

Funding

Dr. Diego M. Cabrera serves as a Fogarty Global Health Trainee and is supported by the Fogarty International Center (FIC) at the National Institutes of Health (NIH) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) under grant number D43TW010540. Dr. Monica M. Diaz serves as a Fogarty Global Health Trainee and is supported by the FIC at the NIH under grant number D43TW009343. Dr. Hsieh is supported by NIH/Fogarty International Center K01TW009995 and the Rheumatology Research Foundation K Supplement Award.

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Authors and Affiliations

  1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

    Diego M. Cabrera

  2. Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru

    Diego M. Cabrera, Monica M. Diaz & Patricia J. Garcia

  3. Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Monica M. Diaz

  4. Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA

    Alyssa Grimshaw

  5. Medical Library, Universidad Peruana Cayetano Heredia, Lima, Peru

    Justina Salvatierra

  6. Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, 300 Cedar Street TAC S-525, PO Box 208031, New Haven, CT, 06520-8031, USA

    Evelyn Hsieh

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  1. Diego M. Cabrera
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Correspondence to Evelyn Hsieh.

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Appendices

Appendix A: Search Strategy

Search for Ovid Embase

Additional databases provided upon request: Alyssa.grimshaw@yale.edu

1. exp Caribbean Islands/

2. exp Caribbean/

3. (Caribbean or Carib or West Indies).mp.

4. (Anguilla* or Antilles or Antigua* or Aruba* or Barbuda or Bahamas or Bahamian* or Barbados or Barbadian* or Barthelemy or Saint Barthelemois or Barts or Bermuda or Bermudian* or Bonaire or Bonairian* or Cuba* or Cayman or Caymanian* or Curacao* or Caicos or Belonger* or croix or Crucian* or Dominica or Dominican Republic or Dominican* or Santo Domingo).mp.

5. (Eustatius or Grenada or Grenadian* or Guadeloupe* or grenadines or Haiti* or Hispaniola or Jamaica* or Martinique or Martiniquais or Martinican* or Puerto Rico or Puerto Rican* or Nevis or Nevisian* or Montserrat* or Virgin Island or Virgin Islands or Virgin Islander or Virgin Islanders or Saba or Statia or Suriname* or Trinidad or Tobago or Trinidadian or Tobagonian or Tortola or Turks Island* or French Guiana or French Guianese or Leeward or Windward).mp.

6. (USVI or BVI).ti,ab.

7. ("St Lucia" or Saint Lucia or Lucian* or "St Kitts" or Saint Kitts or Kittian* or Saint Martin or "St Martin" or St Marteen or Saint Marteen or "St Thomas" or "St John" or Saint Thomas or Saint John or Sint Marteen or Water islander* or st thomian* or st johnian*).mp.

8. exp "South and Central America"/

9. (Costa Rica* or El Salvador or Salvadoran* or Guatemala* or Honduras or Honduran* or Nicaragua* or Nica or Nicoya or Pinolero or Nicaraguenses or Panama or Panamanian*).mp.

10. (Argentina* or Chile or Chilean* or Ecuador* or Paraguay* or Uruguay*).mp.

11. (Andean or Latin America* or Central America* or South America* or Bolivia* or Colombia* or Peru* or Venezuela* or Mexico or Mexican* or Brazil*).mp.

12. or/1-11

13. exp Human immunodeficiency virus infection/

14. (human immunodeficienc* or human immun* deficienc* or acquired immunodeficiency syndrome or HIV or AIDS or HIV?AIDS).tw,kw.

15. (Human T?Cell Lymphotropic Virus Type III or Human T?Cell Lymphotropic Virus Type III or LAV-HTLV-III or Lymphadenopathy Associated Virus or HTLV-III or HTLVIII?LAV).tw,kw.

16. 13 or 14 or 15

17. 12 and 16

18. exp kidney disease/

19. ((renal or kidney) and (disease or failure* or insufficienc* or injury or injuries or dysfunction*)).tw,kw.

20. (kidney tubular necrosis or lower nephron nephrosis or lower nephron nephroses).tw,kw.

21. exp Rhabdomyolysis/

22. exp Thrombotic Microangiopathies/

23. exp Glomerular Filtration Rate/

24. (nephropath* or Rhabdomyolysis or rhabdomyolses or Myoglobinuria* or Thrombotic Microangiopath* or urinary tract obstruction* or urinary obstruction* or urinary blockage* or tubulointerstitial renal or tubulo-interstitial renal or tubulointerstitial kidney* or tubulo-interstitial kidney* or Glomerular Filtration Rate*).tw,kw.

25. 18 or 19 or 20 or 21 or 22 or 23 or 24

26. 17 and 25

27. exp mood disorder/

28. exp cognitive defect/

29. exp neuropsychology/

30. exp "disorders of higher cerebral function"/

31. (Depression* or Depressive or Mood Disorder* or Mental Health or Affective Disorder* or neuropsychological or neuropsychiatric or dementia* or amentia* or senile* or senility or Alzheimer*).tw,kw.

32. ((Cognitive* or Neurocognitive*) adj3 (decline* or disorder* or impairment* or deterioration* or dysfunction*)).tw,kw.

33. 27 or 28 or 29 or 30 or 31 or 32

34. 17 and 33

35. exp malignant neoplasm/

36. (cancer* or malignanc* or neoplasm* or neoplasia* or tumor* or tumour* or leukemia* or carcinoma* or melanoma* or lymphoma).tw,kw.

37. (Human papillomavirus or human papilloma virus or HPV).tw,kw.

38. 35 or 36 or 37

39. 17 and 38

40. exp spine fracture/

41. exp hip fracture/

42. exp Bone Diseases, Metabolic/

43. exp bone mass/ or exp bone density/

44. (bone mass or bone densit* or bone mineral densit* or vertebral fracture* or spinal fracture* or hangman* fracture* or Intertrochanteric fracture* or hip fracture* or Trochanteric fracture* or Subtrochanteric fracture* or Vitamin D or Calcium or Body composition measurement* or frailty or osteopenia* or low bone densit* or bone disease* or osteoporosis or osteoporoses or bone loss).tw,kw.

45. 40 or 41 or 42 or 43 or 44

46. 17 and 45

47. exp cardiovascular disease/

48. exp Cholesterol/

49. (cardiovascular disease* or heart disease* or heart failure or stroke* or cerebrovascular accident* or Apoplex* or brain vascular accident* or heart attack* or myocardial infarct* or blood pressure* or hyperlipidemia* or Lipidemia* or Lipemia* or Hyperlipemia* or high blood pressure* or hypertension or Epicholesterol or cholesterol or cardiac fat infiltration* or myocardial fibrosis or cardiac fibrosis or left ventricular or systolic dysfunction* or diastolic dysfunction* or Atrial Fibrillation* or Thromboembolism* or Arteriosclerosis or Arterioscleroses or Coronary Artery Disease*).tw,kw.

50. 47 or 48 or 49

51. 17 and 50

52. (non-aids event* or non aids event* or serious clinical event* or non-aids clinical event* or non aids clinical event* or non-aids-related event* or non aids related event* or non-aids defining cancer* or non aids defining cancer* or NACD or NACDs or non-aids defining event* or non aids defining event* or non-aids morbidit* or non-aids morbidi* or non-aids endpoint* or non aids endpoint* or non-aids comorbidit* or non aids comorbidit*).tw,kw.

53. 12 and 52

54. 26 or 34 or 39 or 46 or 51 or 53

Appendix B: Table of Excluded Studies

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Cabrera, D.M., Diaz, M.M., Grimshaw, A. et al. Aging with HIV in Latin America and the Caribbean: a Systematic Review. Curr HIV/AIDS Rep 18, 1–47 (2021). https://doi.org/10.1007/s11904-020-00538-7

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