Older HIV-infected adults: complex patients—comorbidity (I)
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Life expectancy in people living with HIV has increased in the past decades, since the introduction of highly active antiretroviral treatment. Increased survival comes along with new challenges for the HIV physician, as these patients will present comorbidities inherent to ageing that can appear more frequently and at younger age than the general population. The older HIV patient poses a unique challenge, as management should take into account different factors, some related to global ageing such as geriatric syndromes, traditional risk factors, social vulnerability, and age-related diseases, and others related to HIV infection like ART toxicity, drug–drug interactions, immune dysregulation and chronic inflammation. All the above can amount to great polypharmacy and multimorbidity that physician have to be aware of. Little is known about the best screening, management and treatment strategies to improve long-term health outcomes in this ageing population. The following article briefly reviews the main comorbidities that can affect the ageing HIV patient.
KeywordsHIV Ageing Comorbidities Chronicity
Rosa de Miguel is supported by a Río Hortega fellowship from the Fondo de Investigación Sanitaria.
Compliance with ethical standards
Conflict of interest
Dr. Bernardino reports grants and personal fees from Gilead Sciences, personal fees from ViiV Healthcare, Janssen Pharmaceuticals, and Merck Sharp & Dohme, outside the submitted work. Dr de Miguel reports personal fees from Gilead Sciences and Janssen Pharma outside the submitted work. Dr Montejano received personal fees from Janssen Pharmaceuticals, personal fees from Merck Sharp & Dohme, and Gilead Sciences outside the submitted work.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study informed consent is not required.
- 4.HIV/AIDS surveillance in Europe 2017–2016 data (2017) pp 1–124. https://ecdc.europa.eu/en/publications-data/presentation-hivaids-surveillance-europe-2017-2016-data. Accessed 3 Nov 2018
- 8.Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, Prins M, Reiss P, AGEhIV Cohort Study Group (2014) Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 59:1787–1797PubMedCrossRefGoogle Scholar
- 14.Wikby A, Nilsson B-O, Forsey R, Thompson J, Strindhall J, Löfgren S, Ernerudh J, Pawelec G, Ferguson F, Johansson B (2006) The immune risk phenotype is associated with IL-6 in the terminal decline stage: findings from the Swedish NONA immune longitudinal study of very late life functioning. Mech Ageing Dev 127:695–704PubMedCrossRefGoogle Scholar
- 19.Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A, DC Cohort Executive Committee (2017) High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Medicine 18:724–735PubMedPubMedCentralCrossRefGoogle Scholar
- 26.European AIDS Clinical Society Guidelines (2018) Version 9.1 Octubre 2018. 1–104. http://www.eacsociety.org/files/2018_guidelines-9.1-english.pdf. Accessed 3 Nov 2018
- 28.Whelton PK, Carey RM, Aronow WS et al (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the american college of cardiology/American heart association task force on clinical practice guidelines. Circulation 138:e426–e483PubMedGoogle Scholar
- 29.Williams B, Mancia G, Spiering W et al (2018) 2018 practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC task force for the management of arterial hypertension. J Hypertens 36:2284–2309PubMedCrossRefGoogle Scholar
- 38.Ladapo JA, Richards AK, DeWitt CM, Harawa NT, Shoptaw S, Cunningham WE, Mafi JN (2017) Disparities in the quality of cardiovascular care between HIV-infected versus hiv-uninfected adults in the United States: a cross-sectional study. J Am Heart Assoc. https://doi.org/10.1161/jaha.117.007107 CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Freiberg MS, Chang C-CH, Skanderson M et al (2017) Association between HIV infection and the risk of heart failure with reduced ejection fraction and preserved ejection fraction in the antiretroviral therapy era: results from the veterans aging cohort study. JAMA Cardiol 2:536–546PubMedPubMedCentralCrossRefGoogle Scholar
- 57.Rasmussen LD, Helleberg M, May MT, Afzal S, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, Nordestgaard BG, Obel N (2015) Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking. Clin Infect Dis 10:1–9Google Scholar
- 72.Hoy JF, Grund B, Roediger M et al (2017) Immediate initiation of antiretroviral therapy for HIV infection accelerates bone loss relative to deferring therapy: findings from the START bone mineral density substudy, a randomized trial. J Bone Miner Res 32:1945–1955PubMedPubMedCentralCrossRefGoogle Scholar
- 73.McComsey GA, Kitch D, Daar ES, Tierney C, Jahed NC, Tebas P, Myers L, Melbourne K, Ha B, Sax PE (2011) Bone mineral density and fractures in antiretroviral-naive persons randomized to receive abacavir-lamivudine or tenofovir disoproxil fumarate-emtricitabine along with efavirenz or atazanavir-ritonavir: Aids Clinical Trials Group A5224s, a substudy of ACTG A5202. J Infect Dis 203:1791–1801PubMedPubMedCentralCrossRefGoogle Scholar
- 75.Cotter AG, Vrouenraets SME, Brady JJ, Wit FW, Fux CA, Furrer H, Brinkman K, Sabin CA, Reiss P, Mallon PWG (2013) Impact of switching from zidovudine to tenofovir disoproxil fumarate on bone mineral density and markers of bone metabolism in virologically suppressed HIV-1 infected patients; a substudy of the PREPARE study. J Clin Endocrinol Metab 98:1659–1666PubMedCrossRefGoogle Scholar
- 76.Bernardino JI, Mocroft A, Mallon PW et al (2015) Bone mineral density and inflammatory and bone biomarkers after darunavir-ritonavir combined with either raltegravir or tenofovir-emtricitabine in antiretroviral-naive adults with HIV-1: a substudy of the NEAT001/ANRS143 randomised trial. Lancet HIV 2:e464–e473PubMedCrossRefGoogle Scholar
- 77.Sax PE, Wohl D, Yin MT et al (2015) Tenofovir alafenamide versus tenofovir disoproxil fumarate, coformulated with elvitegravir, cobicistat, and emtricitabine, for initial treatment of HIV-1 infection: two randomised, double-blind, phase 3, non-inferiority trials. Lancet 385:2606–2615PubMedCrossRefGoogle Scholar
- 78.Young B, Dao CN, Buchacz K, Baker R, Brooks JT, the HIV Outpatient Study (HOPS) Investigators (2011) Increased Rates of Bone Fracture Among HIV-Infected Persons in the HIV Outpatient Study (HOPS) Compared With the US General Population, 2000-2006. Clin Infect Dis 52:1061–1068PubMedCrossRefGoogle Scholar
- 81.Güerri-Fernandez R, Vestergaard P, Carbonell C, Knobel H, Avilés FF, Castro AS, Nogués X, Prieto-Alhambra D, Diez-Perez A (2013) HIV infection is strongly associated with hip fracture risk, independently of age, gender, and comorbidities: a population-based cohort study. J Bone Miner Res 28:1259–1263PubMedCrossRefGoogle Scholar