Current HIV/AIDS Reports

, Volume 5, Issue 3, pp 150–158

The aging of the HIV epidemic

  • Kavita P. Bhavan
  • Vinay N. Kampalath
  • Edgar Turner Overton
Article

Abstract

Since the advent of highly active antiretroviral therapy, life expectancies for persons with HIV infection are similar to those for unifected people. A growing proportion of HIV-infected individuals are now over the age of 50. We are also seeing an increase in the incidence of HIV infection in older adults. To meet the challenges of the ongoing HIV epidemic, prevention efforts should include a focus on older adults. Also, HIV care providers must address the many comorbidities that are common in the aging population. Additional research will clarify how the processes of aging and HIV infection overlap and interact. This review addresses many of these important considerations.

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References and Recommended Reading

  1. 1.
    Joyce GF, Goldman DP, Leibowitz AA, et al.: A socioeconomic profile of older adults with HIV. J Health Care Poor Underserved 2005, 16:19–28.PubMedCrossRefGoogle Scholar
  2. 2.
    Williams E, Donnelly J: Older Americans and AIDS: some guidelines for prevention. Social Work 2002, 47:105–111.PubMedGoogle Scholar
  3. 3.
    Justice AC, Landefield CS, Asch SM, et al.: Justification for a new cohort study of people aging with and without HIV infection. J Clin Epidemiol 2001, S4:S3–S8.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention: Epidemiology of HIV/AIDS—United States, 1981–2005. MMRW Morb Mortal Wkly Rep 2006, 55:589–592.Google Scholar
  5. 5.
    Ledergerber B: Epidemiology of HIV, including response to ART, in older populations [abstract 108]. Presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA; February 3–6, 2008.Google Scholar
  6. 6.
    Paul SM, Martin RM, Lu SE, Lin Y: Changing trends in human immunodeficiency virus and acquired immunodeficiency syndrome in the population aged 50 and older. J Am Geriatr Soc 2007, 55:1393–1397.PubMedCrossRefGoogle Scholar
  7. 7.
    Giunta S. Is inflammaging an auto[innate]immunity subclinical syndrome? Immun Ageing 2006, 3:12.PubMedCrossRefGoogle Scholar
  8. 8.
    Lindau ST, Schumm LP, Laumann EO, et al.: A study of sexuality and health among older adults in the United States. N Engl J Med 2007, 357:762–774.PubMedCrossRefGoogle Scholar
  9. 9.
    Bosch RJ, Bennett K, Collier AC, et al.: Pretreatment factors associated with 3-year (144-week) virologic and immunologic responses to potent antiretroviral therapy. J Acquir Immune Defic Syndr 2007, 44:268–277.PubMedCrossRefGoogle Scholar
  10. 10.
    Silverberg MJ, Leyden W, Horberg MA, et al.: Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med 2007, 167:684–691.PubMedCrossRefGoogle Scholar
  11. 11.
    Sabin C; Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study: Response to combination ART: variation by age [abstract 528]. Presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA; February 25–28, 2007.Google Scholar
  12. 12.
    Onen NF, Presti R, Overton ET, et al.: Immune discordance on highly active antiretroviral therapy can still be regarded as a therapeutic success [abstract 952]. Presented at the 45th annual meeting of the Infectious Diseases Society of America. San Diego, CA; October 4–7, 2007.Google Scholar
  13. 13.
    Müller V, Ledergerber B, Perrin L, et al.: Stable virulence levels in the HIV epidemic of Switzerland over two decades. AIDS 2006, 20:889–894.PubMedGoogle Scholar
  14. 14.
    Patterson K, Napravnik S, Eron J, et al.: Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy. HIV Med 2007, 8:406–410.PubMedCrossRefGoogle Scholar
  15. 15.
    Cuzin L, Delpierre C, Gerard S, et al.: Immunologic and clinical responses to highly active antiretroviral therapy in patients with HIV infection aged > 50 years. Clin Infect Dis 2007, 45:654–657.PubMedCrossRefGoogle Scholar
  16. 16.
    Gandhi RT, Spritzler J, Chan E, et al.: Effect of baseline-and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: results from ACTG 384. J Acquir Immune Defic Syndr 2006, 42:426–434.PubMedCrossRefGoogle Scholar
  17. 17.
    Bestilny LJ, Gill MJ, Mody CH, Riabowol KT: Accelerated replicative senescence of the peripheral immune system induced by HIV infection. AIDS 2000, 14:771–780.PubMedCrossRefGoogle Scholar
  18. 18.
    Douek DC, McFarland RD, Keiser PH, et al.: Changes in thymic function with age and during the treatment of HIV infection. Nature 1998, 396:690–695.PubMedCrossRefGoogle Scholar
  19. 19.
    Ho Tsong Fang R, Colantonio AD, Uittenbogaart CH: The role of the thymus in HIV infection: a 10 year perspective. AIDS 2008, 22:171–184.PubMedGoogle Scholar
  20. 20.
    Overton ET, Mondy K, Bush T, et al.: Factors associated with low bone mineral density in a large cohort of HIV-infected US adults: baseline results from the SUN study [abstract 836]. Presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA; February 25–28, 2007.Google Scholar
  21. 21.
    Arnsten JH, Freeman R, Howard AA, et al.: Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection. AIDS 2007, 21:617–623.PubMedCrossRefGoogle Scholar
  22. 22.
    Gallant JE, Staszewski S, Pozniak AL, et al.: Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 2004, 292:191–201.PubMedCrossRefGoogle Scholar
  23. 23.
    Tebas P, Umbleja T, Dubé M, et al.: Initiation of ART is associated with bone loss independent of the specific ART regimen. The results of ACTG A5005s [abstract 837]. Presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA; February 25–28, 2007.Google Scholar
  24. 24.
    Mondy K, Powderly WG, Claxton SA, et al.: Alendronate, vitamin D, and calcium for the treatment of osteopenia/osteoporosis associated with HIV infection. J Acquir Immune Defic Syndr 2005, 38:426–431.PubMedCrossRefGoogle Scholar
  25. 25.
    McComsey GA, Kendall MA, Tebas P, et al.: Alendronate with calcium and vitamin D supplementation is safe and effective for the treatment of decreased bone mineral density in HIV. AIDS 2007, 21:2473–2482.PubMedCrossRefGoogle Scholar
  26. 26.
    Guaraldi G, Orlando G, Squillace N, et al.: Prevalence of secondary causes of osteoporosis among HIV-infected individuals. Antiviral Therapy 2006, 11:L9.Google Scholar
  27. 27.
    DAD Study Group; Friis-Møller N, Reiss P, et al.: Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007, 356:1723–1735.PubMedCrossRefGoogle Scholar
  28. 28.
    Bozzette SA, Ake CF, Tam HK, et al.: Long-term survival and serious cardiovascular events in HIV-infected patients treated with highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2008, 47:338–341.PubMedGoogle Scholar
  29. 29.
    Strategies for Management of Antiretroviral Therapy (SMART) Study Group; El-Sadr WM, Lundgren JD, et al.: CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006, 355:2283–2296.PubMedCrossRefGoogle Scholar
  30. 30.
    Lichtenstein K, Armon C, Buchacz K, et al.: Analysis of cardiovascular risk factors in the HIV Outpatient Study Cohort [abstract 735]. Presented at the 13th Conference on Retroviruses and Opportunistic Infections. Denver, CO; February 5–8, 2006.Google Scholar
  31. 31.
    Grundy SM: Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab 2007, 92:399–404.PubMedCrossRefGoogle Scholar
  32. 32.
    Mondy K, Overton ET, Grubb J, et al.: Metabolic syndrome in HIV-infected patients from an urban, midwestern US outpatient population. Clin Infect Dis 2007, 44:726–734.PubMedCrossRefGoogle Scholar
  33. 33.
    Bonfanti P, Giannattasio C, Ricci E, et al.: HIV and metabolic syndrome: a comparison with the general population. J Acquir Immune Defic Syndr 2007, 45:426–431.PubMedCrossRefGoogle Scholar
  34. 34.
    Wand H, Calmy A, Carey DL, et al.: Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection. AIDS 2007, 21:2445–2453.PubMedGoogle Scholar
  35. 35.
    Monforte AD, Abrams D, Pradier C, et al.: HIV-induced immunodeficiency and risk of fatal AIDS-defining and non-AIDS-defining malignancies: results from the D:A:D Study [abstract 84]. Presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA; February 25–28, 2007.Google Scholar
  36. 36.
    Burgi A, Brodine S, Wegner S, et al.: Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer 2005, 104:1505–1511.PubMedCrossRefGoogle Scholar
  37. 37.
    Maurer T, Ponte M, Leslie K: HIV-associated Kaposi’s sarcoma with a high CD4 count and a low viral load. N Engl J Med 2007, 357:1352–1353.PubMedCrossRefGoogle Scholar
  38. 38.
    Patel P, Hanson D, Novak RM, et al.: Trends in cancer incidence among HIV-infected persons in the United States in the HAART era [abstract 813]. Presented at the 4th International AIDS Society Conference. Sydney, Australia; July 22–25, 2007.Google Scholar
  39. 39.
    Piketty C, Selinger-Leneman H, Grabar S, et al.: Dramatic increase in the incidence of anal cancer despite HAART in the French hospital database of HIV [abstract TUAB0305]. Presented at the XVI International AIDS Conference. Toronto, Canada; August 13–16, 2006.Google Scholar
  40. 40.
    Conley L, Bush T, Darragh T, et al.: Incidence and predictors of anal squamous intraepithelial lesions in the SUN Study after 1 year of follow-up [abstract 1022. Presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA: February 3–6, 2008.Google Scholar
  41. 41.
    Janssen RS, Nwanyanwu OC, Selik RM, Stehr-Green JK: Epidemiology of human immunodeficiency virus encephalopathy in the United States. Neurology 1992, 42:1472–1476.PubMedGoogle Scholar
  42. 42.
    Cherner M, Ellis RJ, Lazzaretto D, et al.: Effects of HIV-1 infection and aging on neurobehavioral functioning: preliminary findings. AIDS 2004, 18(Suppl 1):S27–S34.PubMedGoogle Scholar
  43. 43.
    Valcour VG, Sacktor NC, Paul RH, et al.: Insulin resistance is associated with cognition among HIV-1-infected patients: the Hawaii Aging With HIV cohort. J Acquir Immune Defic Syndr 2006, 43:405–410.PubMedCrossRefGoogle Scholar
  44. 44.
    Bortz WM: A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 2002, 57:M283–M288.PubMedGoogle Scholar
  45. 45.
    Desquilbet L, Jacobson LP, Fried LP, et al.: HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol A Biol Sci Med Sci 2007, 62:1279–1286.PubMedGoogle Scholar
  46. 46.
    Breen EC, Rezai AR, Nakajima K, et al.: Infection with HIV is associated with elevated IL-6 levels and production. J Immunol 1990, 144:480–484.PubMedGoogle Scholar
  47. 47.
    Leng S, Chaves P, Koenig K, Walston J: Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. J Am Geriatr Soc 2002, 50:1268–1271.PubMedCrossRefGoogle Scholar
  48. 48.
    Effros RB: Immune exhaustion in aging and AIDS: parallel mechanisms and possible solutions [abstract 105]. Presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA; February 3–6, 2008.Google Scholar
  49. 49.
    Tsangari H, Findlay DM, Kuliwaba JS, et al.: Increased expression of IL-6 and RANK mRNA in human trabecular bone from fragility fracture of the femoral neck. Bone 2004, 35:334–342.PubMedCrossRefGoogle Scholar
  50. 50.
    Shippy RA, Karpiak SE: The aging HIV/AIDS population: fragile social networks. Aging Ment Health 2005, 9:246–254.PubMedCrossRefGoogle Scholar
  51. 51.
    Kalichman SC, Heckman T, Kochman A, et al.: Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS. Psychiatr Serv 2001, 51:903–907.CrossRefGoogle Scholar
  52. 52.
    Chesney MA, Chambers DB, Taylor JM, Johnson LM: Social support, distress, and well-being in older men living with HIV infection. J Acquir Immune Defic Syndr 2003, 33:S185–S193.PubMedGoogle Scholar
  53. 53.
    Emlet CA: “You’re awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist 2006, 46:781–790.PubMedGoogle Scholar
  54. 54.
    Emlet CA: A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care STDS 2006, 20:350–358.PubMedCrossRefGoogle Scholar
  55. 55.
    Branson BM, Handsfield HH, Lampe MA, et al.: Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006, 55:1–17.PubMedGoogle Scholar
  56. 56.
    Raw M, McNeill A, West R: Smoking cessation guidelines for health professionals. A guide to effective smoking cessation interventions for the health care system. Thorax 1998, 53(Suppl 5):S1–S19.CrossRefGoogle Scholar
  57. 57.
    National Osteoporosis Foundation: Clinicians Guide to Prevention and Treatment of Osteoporosis. Available at http://www.nof.org/professionals/Clinicians_Guide.htm. Accessed April 30, 2008.
  58. 58.
    Dube MP, Stein JH, Aberg JA, et al.: Guidelines for the evaluation and management of dyslipidemia in HIV infected adults receiving antiretroviral therapy. Clin Infect Dis 2003, 37:613–627.PubMedCrossRefGoogle Scholar
  59. 59.
    US Preventive Services Task Force: Guide to Clinical Preventive Services, edn 3. Available at http://www.ahrq.gov/clinic/uspstfix.htm. Accessed May 22, 2008.
  60. 60.
    Centers for Disease Control and Prevention; Workowski KA, Berman SM: Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006, 55:1–94.PubMedGoogle Scholar
  61. 61.
    National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology. Prostate Cancer Early Detection. Available at http://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf. Accessed May 1, 2008.
  62. 62.
    Levin B, Liberman DA, McFarland B, et al.: Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008 Mar 5 (Epub ahead of print).Google Scholar
  63. 63.
    Palefsky J: HPV infection in HIV infected persons. Top HIV Med 2007, 15:130–133.PubMedGoogle Scholar
  64. 64.
    American Cancer Society: Skin Cancer Prevention and Early Detection. Available at http://www.cancer.org/docroot/PED/content/ped_7_1_Skin_Cancer_Detection_What_You_Can_Do.asp. Accessed May 1, 2008.
  65. 65.
    American Association for the Study of Liver Diseases: Practice Guidelines-Viral Hepatitis. Available at https://www.aasld.org/eweb/DynamicPage.aspx?Site=AASLD3&webcode=viral Hepatitis. Accessed May 1, 2008.Google Scholar
  66. 66.
    Recommended adult immunization schedule: United States, October 2007–September 2008. Ann Intern Med 2007, 147:725–729.Google Scholar
  67. 67.
    Smith RA, Saslow D, Sawyer KA, et al.: American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 2003, 53:141–169.PubMedCrossRefGoogle Scholar
  68. 68.
    Sacktor NC, Wong M, Nakasujja N, et al.: The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS 2005, 19:1367–1374.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  • Kavita P. Bhavan
  • Vinay N. Kampalath
  • Edgar Turner Overton
    • 1
  1. 1.Division of Infectious DiseasesWashington University School of MedicineSt. LouisUSA

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