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Internal medicine/primary care reminder: What are the standards of care for HIV-positive patients aged 50 years and older?

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Abstract

The demographics of HIV-positive persons in the United States signal a steady shift toward an older population. The relationship between aging and HIV infection suggests that there is an additive and possibly synergistic effect increasing the risk for numerous common medical conditions, including heart disease, cancer, osteoporosis, frailty, depression, and dementia. Given the current crisis in the US health care system regarding universal access to quality primary and geriatric care, the aging of the HIV-positive population will pose numerous challenges to providers and policy makers. This review summarizes key areas of knowledge and concern regarding the care of HIV-positive persons aged 50 years and older.

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References and Recommended Reading

  1. Hall HI, Song R, Rhodes P, et al.: for the HIV Incidence Surveillance Group: Estimation of HIV incidence in the United States. JAMA 2008, 300:520–529.

    Article  PubMed  CAS  Google Scholar 

  2. Aging with HIV: four profiles. The New York Times. August 17, 2004. Available at http://query.nytimes.com/gst/fullpage.html?res=9C01E7DA133FF934A2575BC0A9629C8B63&sec=&spon=&pagewanted=2. Accessed February 3, 2009.

  3. Lohse N, Hansen ABE, Pederson G, et al.: Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007, 146:87–95.

    PubMed  Google Scholar 

  4. Lewden C, Chene G, Morlat P, et al.: HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach the same mortality as the general population. J Aquir Immune Defic Syndr 2007, 46:72–77.

    Article  Google Scholar 

  5. Center for Disease Control and Prevention: HIV+ persons aged 50 and over. http://www.cdc.gov/hiv/topics/over50/index.htm. Accessed February 3, 2009.

  6. CBS News: More seniors living with HIV. http://www.cbsnews.com/stories/2005/05/16/health/webmd/main695487.shtml. Accessed February 3, 2009.

  7. Kane RL, Ouslander JG, Abrass IB, Resnick B: Essentials of Clinical Geriatrics. New York: McGraw Hill; 2009:111–115.

    Google Scholar 

  8. US Preventative Services Task Force 2008. The Guide to Clinical Preventative Services. http://www.ahrq.gov/clinic/pocketgd.htm. Accessed February 3, 2009.

  9. Cao W, Jamieson B, Hultin L, et al.: Premature aging of T cells is associated with faster HIV-1 disease progression. J Acquir Immune Defic Syndr 2009, 50:137–147.

    Article  PubMed  Google Scholar 

  10. Desai S, Ronquillo R, Usugal X, et al.: Immune senescence, activation, and abnormal T cell homeostasis despite effective HAART, a hallmark of early aging in HIV disease [abstract 381]. Paper presented at the 16th Conference on Retroviruses and Opportunistic Infections. Montreal, Canada; February 8–11, 2009.

  11. Silverberg M, Leyden W, Horberg M, et al.: Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med 2007, 167:684–691.

    Article  PubMed  CAS  Google Scholar 

  12. The DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents 2008. http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guideliness&Search=Off&GuidelineID=7&ClassID=1. Accessed February 3, 2009.

  13. Kuller LH, Tracy R, Belloso W, et al.: Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med 2009, 5:e203.

    Article  Google Scholar 

  14. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group: Class of antiretroviral drugs and risk of myocardial infarction. N Engl J Med 2007, 356:1723–1735.

    Article  Google Scholar 

  15. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group: Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the DAD study: a multi-cohort collaboration. Lancet 2008, 371:1417–1426.

    Article  Google Scholar 

  16. Dube MP, Stein JH, Aberg JA, et al.: Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis 2003, 37:613–627.

    Article  PubMed  Google Scholar 

  17. National Heart and Blood Institute: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 2004. http://www.nhlbi.nih.gov/guidelines/cholesterol/. Accessed May 20, 2009.

  18. American Diabetes Association: Clinical Practice Recommendations 2008. Diabetes Care 2008, 31(Suppl 1):S1–S104.

    Google Scholar 

  19. Patel P, Hanson DL, Sullivan PS, et al.: Incidence of cancer among HIV-infected persons compared to the general population in the United States, 1992–2003. Ann Intern Med 2008, 148:728–736.

    PubMed  Google Scholar 

  20. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group: HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS defining malignancies. AIDS 2008, 22:2143–2153.

    Article  Google Scholar 

  21. Baker JV, Peng G, Rapkin J, et al.: CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS 2008, 22:841–848.

    Article  PubMed  Google Scholar 

  22. Wright TC, Cox JT, Massad LS, et al.: 2001 consensus guidelines for the management of women with cervical cytological abnormalities. JAMA 2002, 287:2120–2129.

    Article  PubMed  Google Scholar 

  23. US Department of Health and Human Services: Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents-April 10, 2009. http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=211&ClassID=4. Accessed June 3, 2009.

  24. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009. Ann Intern Med 2009, 150:40–44.

  25. Ciesla JA, Roberts JE: Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 2001, 158:725–730.

    Article  PubMed  CAS  Google Scholar 

  26. Geriatric depression scale. http://www.stanford.edu/~yesavage/Testing.htm. Accessed February 4, 2009.

  27. Mini-Cog tool for dementia or memory loss assessment. http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/clock_drawing_test.pdf. Accessed February 3, 2009.

  28. Kaul M, Lipton SA: Mechanisms of neuronal injury and death in HIV-1 associated dementia. Curr HIV Res 2006, 4:307–318.

    Article  PubMed  CAS  Google Scholar 

  29. Valcour V, Shikuma C, Shiramizu B, et al.: Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort. Neurology 2004, 63:822–827.

    PubMed  CAS  Google Scholar 

  30. Robertson KR, Smurzynski M, Parson TD, et al.: The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007, 21:1915–1921.

    Article  PubMed  Google Scholar 

  31. Ances B, Yeh J, Vaida F, et al.: Additive effects of aging and HIV serostatus on cerebral blood flow [abstract 157]. Paper presented at the 16th Conference on Retroviruses and Opportunistic Infections. Montreal, Canada; February 8–11, 2009.

  32. Ellis R, Rosario D, Clifford D, et al.: Persisting high prevalence of HIV distal sensory peripheral neuropathy in the era of combination ART: correlates in the CHARTER study [abstract 461]. Paper presented at the 16th Conference on Retroviruses and Opportunistic Infections. Montreal, Canada; February 8–11, 2009.

  33. Looker A, Orwoll ES, Johnston CC, et al.: Prevalence of low femoral bone density in older US adults from NHANES III. J Bone Miner Res 1997, 12:1761–1768.

    Article  PubMed  CAS  Google Scholar 

  34. Cazanave C, Dupon M, Lavignolle-Aurillac V, et al.: Reduced bone mineral loss in human immunodeficiency virus infected patients: prevalence and associated factors. AIDS 2008, 22:395–402.

    Article  PubMed  Google Scholar 

  35. National Osteoporosis Foundations: Clinician’s Guide to Prevention and Treatment of Osteoporosis. http://www.nof.org/professionals/Clinicians_Guide.htm. Accessed February 5, 2009.

  36. Overton T, Mondy K, Bush T, et al.: Factors associated with a low bone mineral density in a large cohort of HIV-infected US adults: baseline results from the SUN Study [abstract 836]. Paper presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA; February 25–28, 2007.

  37. Rodriguez M, Daniels B, Gunawardene S, Robbins GK: High frequency of vitamin D deficiency in ambulatory HIV-positive patients. AIDS Res Hum Retroviruses 2009, 25:9–14.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  CAS  Google Scholar 

  39. Fried LP, Tangent CM, Walston J, et al.: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146–M156.

    PubMed  CAS  Google Scholar 

  40. 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.

    PubMed  Google Scholar 

  41. Desquilbet L, Margolick JB, Fried LP, et al.: Relationship between a frailty-related phenotype and progressive deterioration of the immune system in HIV-infected men. J Acquir Immune Defic Syndr 2009, 50:299–306.

    Article  PubMed  Google Scholar 

  42. Fick DM, Cooper JW, Wade WE, et al.: Updating the Beers Criteria for potentially inappropriate medication use in older adults—results of a US consensus panel of experts. Arch Intern Med 2003, 163:2716–2724.

    Article  PubMed  Google Scholar 

  43. Chen RY, Accortt NA, Westfall AO, et al.: Distribution of health care expenditures for HIV-infected patients. Clin Infect Dis 2006, 42:1003–1010.

    Article  PubMed  CAS  Google Scholar 

  44. Lee TH, Treadway, K, Bodenheimer T, et al.: The future of primary care. N Engl J Med 2008, 359:2085.

    Article  PubMed  CAS  Google Scholar 

  45. Hauer KE, Durning SJ, Kernan WN, et al.: Factors associated with medical students’ career choices regarding internal medicine. JAMA 2008, 300:1154–1164.

    Article  PubMed  CAS  Google Scholar 

  46. Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  47. Pearson TA, Laurora I, Chu H, Kafonek S: The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000, 160:459–467.

    Article  PubMed  CAS  Google Scholar 

  48. Saydah SH, Fradkin J, Cowie CC: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004, 291:335–342.

    Article  PubMed  CAS  Google Scholar 

  49. Karvounis N: The geriatrician shortage: Taking note—A Century Foundation Group blog. http://takingnote.tcf.org/2008/08/the-geriatricia.html. Accessed January 5, 2009.

  50. Martin CP, Fain MJ, Klotz SA: The older HIV-positive adult: a critical review of the medical literature. Am J Med 2008, 121:1032–1037.

    Article  PubMed  Google Scholar 

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Henry, K. Internal medicine/primary care reminder: What are the standards of care for HIV-positive patients aged 50 years and older?. Curr HIV/AIDS Rep 6, 153–161 (2009). https://doi.org/10.1007/s11904-009-0021-0

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