European Geriatric Medicine

, Volume 10, Issue 2, pp 259–265 | Cite as

Geriatric-HIV Medicine: the geriatrician’s role

  • Fátima BrañasEmail author
  • Pablo Ryan
  • Jesús Troya
  • Matilde Sánchez-Conde


The scenario of people living with HIV has dramatically changed, and nowadays older adults with HIV constitute almost half of the HIV population—and the percentage is growing. Frailty and geriatric syndromes have been highly demonstrated among older adults with HIV; therefore, the application of geriatric medicine principles to their approach has become essential. Geriatric-HIV Medicine, specific, collaborative work between HIV specialists and geriatricians, is a young discipline that has the goal of ensuring a global and specific approach to older patients that is focused on function and the continuum of care. The geriatrician’s role adds value to the care of older people living with HIV through Comprehensive Geriatric Assessment for those patients who can benefit but goes beyond the clinical approach and involves generating scientific evidence that impacts and changes the current model of care.


HIV Older adults Geriatric medicine Geriatrician 


The HIV population is aging due to the success of combination antiretroviral therapy (cART), which prolongs survival, and the growing number of newly diagnosed cases among older adults [1, 2]. Over half of the people living with HIV (PLWH) are 50 years old or older, and close to 20% of subjects with a new diagnosis of HIV are older than 50 in the United States [3]. In 2030, 73% of people living with HIV are estimated to be 50 years old or older, and close to 40% will be older than 65 [4]. Therefore, the aging of PLWH is already a fact.

The scenery has dramatically changed since the beginning. In the 1980s–90s, PLWH were mostly young and the sole objective of their health care was survival. The development of antiretroviral therapy (ART) in the early twenty-first century, which involved a combination of new and improved drugs, drastically reduced mortality; although survival remained a crucial goal, adverse effects and interactions between drugs became a significant problem that merited attention. In recent years, ART toxicity has been notably reduced and the treatment regimens have been simplified, both of which have positively impacted the quality of life for PLWH. Nowadays, the HIV population appears to be prematurely aging. HIV individuals suffer from a persistent and chronic activation of the immune system that leads to immune exhaustion and accelerated immunosenescence, even when they are on an optimal immuno-virological control treatment. The clinical expression is an increased prevalence of aging-related, non-HIV associated comorbidities and frailty that occurs earlier than within the general population [5]. These facts make it reasonable for the 50s to be considered as the cut-off to define older adults with HIV, taking into account that biological age is more decisive than chronological age with regard to health.

Older adults with HIV have been demonstrated to be particularly vulnerable, in terms of physical function, frailty, cognitive and mood status, and social situation, which are the main domains in which geriatricians are specialists who approach health care through the Comprehensive Geriatric Assessment (CGA). An independent association between HIV infection and reduced physical performance and early frailty development has been identified. Frailty prevalence among PLWH is variable, due to the specific groups studied and the tools used to measure it (mostly an adapted phenotype), but it is around 15% [6] twice as high as that of the largest studies that used the frailty criteria established by Fried et al. in community-dwelling older adults [7, 8, 9]. Physical performance is early affected among HIV patients as well; one in five older adults with HIV has a slow gait (< 0.8 m/s) and more than half have a short physical performance battery (SPPB) score of < 9 [6], which signifies functional impairment [10, 11]. Only one-third of older adults with HIV are free of cognitive impairments [12, 13] and the prevalence of depression ranges from 30 to 79% [14, 15, 16]. HIV-related stigma causes PLWH to become socially vulnerable. Social vulnerability is both a cause and consequence of limited access to HIV prevention and treatment, can severely compromise the health-related quality of life (HRQoL), is associated with poor medication adherence, contributes to high morbidity and high mortality, isolates PLWH from family and community support, and creates cultural barriers that inhibit integration into social networks [17, 18].

These geriatric conditions among PLWH appear at chronologic ages during which patients are not expected to be frail, depressed, or physically or cognitively impaired because they would not typically be considered geriatric. This fact currently results in a gap of care among older HIV patients. On the one hand, geriatric syndromes, frailty, and physical function require a specific, validated, and specialized evaluation that is not included in the routine HIV approach, is time-consuming, and must be followed by an intervention strategy. On the other hand, despite the fact that geriatricians are experts on complexity who are focused on function and contend that medical decisions should not be never based solely on chronological age, the reality so far is that most geriatricians understand that they do not have any role in the clinical approach of older adults with HIV because they are not “geriatric patients” according to their chronological age. Moreover, the health system and its structures are often too rigid and fail to facilitate the new ways of approaching “new patients” that older adults with HIV require.

Therefore, one of the present challenges is to detect those older adults with HIV who are at risk of unhealthy aging because of their higher vulnerability. These complex patients living with HIV are prematurely aging with a high burden of geriatric syndromes and frailty, therefore, they demand a specific, global, and multidisciplinary approach to achieve the best quality of life.

The history of nascent HIV-geriatric medicine

Interest in the specific characteristics of older adults with HIV has been present since the moment ART was developed. 15 years after the first HIV diagnosis, it permitted clinicians and researchers to focus on something more than survival. In 1998, the Centers for Disease Control and Prevention (CDC) published the first review of HIV infection cases among individuals who were 50 years old or older in the United States from 1991 to 1996 [19]. In the following years, from 1998 to 2006, the number of indexed scientific publications that focused on older HIV adults reached a thousand, including case reports [20, 21, 22, 23], reviews [24, 25, 26, 27], and a few original articles [28, 29, 30, 31, 32, 33].

As of 2007, much of the scientific evidence centered on older adults with HIV was about specific comorbidities, the high burden of comorbidity in this group, or how this comorbidity appears 10 years earlier in comparison to the general population [5]. Further, works began to appear that focused on the oldest of older adults with HIV [34] and on topics specifically related to aging, such as frailty and geriatric syndromes among PLWH. For the study of frailty, large epidemiological studies designed for other purposes—in the United States—adapted Fried’s criteria for assessing frailty and contributed valuable information about the prevalence and impact of frailty in specific risk groups: men who have sex with men in the Multicenter AIDS Cohort Study (MACS) [35, 36, 37, 38], injection drugs users in the AIDS Linked to the Intravenous Experience Study (ALIVE) [39, 40, 41], and women in the Women’s Interagency HIV Study (WHIS) [42, 43]. In Europe, data are also available about frailty prevalence and its impact on the general HIV population from cohorts not specifically designed for the study of frailty, including the Modena HIV Metabolic Clinic (MHMC) Cohort, which uses the Frailty Index [44], and from the AGEhIV Cohort Study Group, which uses the Fried frailty phenotype. Beyond the contribution of epidemiological studies, case–control and cohort studies with the main objective of studying frailty and geriatric syndromes within older adults with HIV have been developed, most of them in the United States [45, 46, 47, 48, 49, 50, 51, 52, 53], as well as South Africa [54], Mexico [55], Spain [6], Italy [56], and France [57]. In the decade from 2007 to 2017, the interest in older adults with HIV has grown tremendously and can be proven by the increased number of indexed publications on this topic (Fig. 1).
Fig. 1

Evolution of indexed publications on “[HIV] and [older adults]”

The knowledge of the specific characteristics of older adults with HIV among the scientific community started to spread and the need to work specifically in this direction was forged. Workshops on HIV and aging led by HIV specialists and the first voices asking for the integration of geriatric principles into infectious diseases research emerged [58]. Researchers and clinicians started to define a new target in the assessment of older adults with HIV: frailty, physical function, and geriatric syndromes have not been included thus far in the routine HIV approach. In 2004, Tinetti [59] called for the end of the disease era. As she noted, a primary focus on disease may inadvertently lead to under treatment, overtreatment, or mistreatment, and this concern perfectly applies to care for older adults with HIV. If the care is focused only on HIV-related issues and comorbidities, other health problems impacting patients’ quality of life, such as geriatric syndromes, pain, falls or functional or cognitive impairment can be under-detected, undertreated or mistreated. In addition, a focus on disease without a global and integrated approach can lead to overtreatment of comorbidities if each one’s specific guidelines are strictly followed. Therefore, HIV care should intersect routinely with geriatric medicine [4].

But a huge gap usually exists between clinical research and clinical care. Years, large efforts and the nerve to break the mold are needed to implement new strategies, especially if they involve a change in the model of care. The transition from a disease-centered model to a global, integrating and interdisciplinary model centered on function and quality of life implies a structural and a cultural change in HIV care [60]. Medical care for older adults with HIV must evolve to meet all their health care needs [4], therefore, a different approach is needed. More of the same is not enough as the World Report on Aging and Health from the World Health Organization showed in 2015 [61].

The seed of Geriatric-HIV Medicine was planted very recently by those who, after working for the best care of older adults with HIV proposed to integrate geriatric assessment into HIV/AIDS clinical care to target interventions that optimize clinical care and quality of life for older adults with HIV [62]. But it officially originated in March 2017. This was the first time the term “Geriatric-HIV Medicine” was used to define the application of the geriatric medicine principles to the treatment of older adults with HIV. A specific collaborative effort between HIV specialists and geriatricians, integrated in an interdisciplinary team and centered on older patients with HIV, that ensures a global approach and provides a continuum of care was proposed [63]. It is a science in its infancy as Guaraldi said, and we do not yet know which is the most effective way to develop this collaboration [64], but we are absolutely convinced that collaboration is necessary. In the twenty-first century, a model in which super-specialists work alone and isolated from others is doomed to fail and cause more harm than benefits for patients and the system. The collaborative work between geriatricians and other specialists has largely proven successful in ortho-geriatrics [65], cardio-geriatrics [66] and onco-geriatrics [67]. The skill to work in collaboration is the core of geriatricians’ training [68]. But in this century, geriatricians have to break down the wall of chronological age, specifically the 80s as the geriatric patient cut-off, and understand that geriatric medicine principles can and should be applied to any older patient nevertheless those who will benefit the most from the Comprehensive Geriatric Assessment (CGA) followed by the specific care plan are those at risk of frailty, functional or cognitive impairment, unhealthy aging, ultimately those biologically older regardless of their chronological age.

No evidence exists of how this care of older adults with HIV should be provided, but some clinical programs have recently been initiated. Siegler has summarized the care models for older adults with HIV [69], but highlighting those led by HIV providers in co-management with geriatricians are the following: Massachusetts General Hospital/Aging Positively, Boston (United States); Brighton and Sussex University Hospital Silver Clinic, Brighton (England); University of Colorado, Denver (United States); Infanta Leonor University Hospital, Madrid (Spain); McGill University, Montreal (Canada), Ward 86/Golden Compass, San Francisco (United States); and Weill Cornell Medicine/New York Presbyterian Hospital, New York (United States) [62]. The basis of the consultation was CGA, but referral criteria, team composition, venue, goals and interventions are not homogeneous. More local experiences probably exist, but evidence is still very scarce, and no trials are available; therefore, feedback from patients and HIV care providers are needed, and generating scientific evidence is mandatory to answer the key questions about Geriatric-HIV Medicine: who should be targeted, how should they be assessed, which outcomes should be studied and what clinical effectiveness indicators should be used to measure success?

The geriatrician’s role

The geriatrician’s role in the approach and care of older PLWH has yet to be defined. Because no specific evidence on this topic exists, we are able nowadays just to point to the core that constitutes the geriatrician’s specific expertise and extrapolate knowledge from the role and benefits of a geriatrician’s contribution in other disciplines. However, generating scientific evidence in this field seems to be crucial.

What does CGA mean? Who must develop a CGA?

It is worth first of all to underline some concepts that are relevant to speaking the same language and not generating confusion. Screening is a process for evaluating the possible presence of a particular problem. The purpose of screening is to determine whether a patient needs assessment. Screening tools are designed to enable an examiner to say simple “yes” or “no.” Screening can be provided by any trained health staff. Assessment is a process for defining the nature of a problem, determining a diagnosis, and developing treatment and recommendations for addressing the problem. Assessment should include multiple sources of information and evaluation to obtain a broad perspective of a patient’s situation. Assessment requires specific and specialized training. CGA is defined as ‘a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated, coordinated care plan to meet those needs’ [70]. CGA originated in the 1940s [71], and its benefits have been demonstrated in randomised controlled trials [72] and in meta-analyses of controlled trials [73]. CGA is a core technology for geriatricians to perform geriatric medicine [74]. The domains CGA explores beyond comorbidities and a patient’s medical situation are lifestyle, risk factors for fragility fractures, medications, physical function, physical activity, frailty, falls, cognition, depression and or anxiety, nutritional status, social network, and a patient’s goals, values, and preferences.

Without developing an integrated, coordinated care plan to meet patients’ needs, CGA does not exist. Using tools to screen cognitive impairment, depression, frailty, or other geriatric syndromes is not synonymous with CGA. Screening tools can be implemented by anyone trained on them, but if no intervention and care plan are available if an impairment is detected, then screening may even be counterproductive [69]. The CGA must be developed by those who are experts in geriatric assessment, the geriatricians. However, referring older patients with HIV to geriatricians is not enough [62]. A geriatrician should be integrated in an interdisciplinary team taking care of older adults with HIV. Isolated approaches to the same patient by different specialists could generate more harm than benefits if their assessments and recommendations are not integrated in a unique, personalized, and well-understood manner by all the agents who care for an older adult with HIV. To develop Geriatric-HIV Medicine successfully, interdisciplinary teams have to be built. Everyone has to know his or her role and those of others, and fluid communication channels have to be available with regularly held meetings to determine and evaluate the specific goals for each specific patient.

Which older adults with HIV should undergo CGA?

Determining which older adults with HIV should undergo CGA is a key question that cannot be categorically answered because scientific evidence on this topic is not yet available. This is one of the biggest challenges nowadays in the care of older adults with HIV. Older PLWH are a heterogeneous population and ranges from robust to frail to dependent. In the general population, it is well-known that those at risk of frailty and functional or cognitive impairment will benefit most from CGA. Most older adults with HIV today are robust, according to the data available about frailty prevalence [6, 53], but one in four of older PLWH suffer from geriatric syndromes and, specifically, functional impairment [6, 53]. Robust older PLWH probably do not need to undergo CGA, but the status “robust–frail–prefrail–dependent” has to be screened to be known, and validated tools should be used for this goal. Therefore, the first step to offering the best approach and care to these patients is to be able to stratify them in terms of function. Various groups are already working on the way to do this stratification. Based on the evidence already available and on expert opinion, different tools could be used to stratify this population in terms of function: walking speed, SPPB, and frailty (Frailty Phenotype [7], FRAIL Index [75], and Clinical Frailty Scale [76]). This screening should be done in all the new cases of HIV diagnosis among those 50 years old or older and once a year in the follow-up. The screening could be provided by different health staff depending on the specific resources of each clinic, but a trained nurse should be indicated. In Fig. 2, the algorithm we propose for screening older adults with HIV to define who should undergo CGA is described. According to this algorithm, a small percentage of all older adults with HIV should probably undergo CGA and be assessed by a geriatrician, but those for whom CGA is indicated will benefit the most if the healthy aging is really the goal [77]. However, this is just an expert opinion, and other proposals would be equally valid while scientific evidence is coming.
Fig. 2

Algorithm proposed for screening older adults with HIV

The geriatrician’s role in the clinical care of older adults with HIV is to bring value with the development of CGA for the more complex older patients with HIV and to work integrated in the interdisciplinary team to define the global and personalized care plan of each patient. Geriatricians, working with HIV specialist colleagues, also have the essential role of contributing their knowledge to the design and development of clinical trials focused specifically on older PLWH to generate scientific evidence that impacts and changes the current model of care and the guidelines for HIV care of this specific group. Moreover, because they are specialists in complex patients and they have experience in co-management, geriatricians have to be involved (and are already involved) in the development and growth of this new discipline called Geriatric-HIV Medicine.


Older adults with HIV are a growing group that represents nowadays half of the total HIV population. Frailty and geriatric syndromes are common among older PLWH, and a new, global and specific approach taking into account these problems is needed. Geriatric-HIV Medicine makes strong sense because it is specific, collaborative work between HIV specialists and geriatricians trying to offer the best care to older patients with HIV and adapt the current model of care to the real needs of these older patients. The geriatrician’s role adds value to the care of older adults with HIV.


Compliance with ethical standards

Conflict of interest

FB has received honoraria for the following: MISP grants from MSD, speaking at symposia organized on behalf of MSD and ViiV Healthcare; developing educational materials for MSD; and board membership from ViiV Healthcare. PR has received honoraria for the following: lectures and advisory boards from AbbVie, Gilead Sciences, Merck Sharp & Dohme, Janssen and ViiV. He has also received a MISP grant from Merck Sharp & Dohme and funding from the CHIME 2018 program from Gilead Sciences and travel grants from Gilead Sciences, Merck Sharp & Dohme and Janssen. JT has received honoraria for the following: lectures from Gilead Sciences, Merck Sharp & Dohme. He has also received travel grants from Gilead Sciences, and Janssen. MSC has received honoraria for the following: speaking at symposia organized on behalf of MSD, ViiV Healthcare and Gilead.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Bunting E, Rajkumar C, Fisher M (2014) The human immunodeficiency virus and ageing. Age Ageing 43:308–310CrossRefGoogle Scholar
  2. 2.
    HIV and aging. UNAIDS. A special supplement to the UNAIDS report on the global AIDS epidemic 2013.
  3. 3.
    Centers for Disease Control and Prevention (2014) HIV surveillance report, vol 25. http://www.cdcgov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport-uspdf. Accessed Nov 2015
  4. 4.
    Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A et al (2015) Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 15(7):810–818CrossRefGoogle Scholar
  5. 5.
    Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E et al (2011) Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis 53(11):1120–1126CrossRefGoogle Scholar
  6. 6.
    Brañas F, Jiménez Z, Sánchez-Conde M, Dronda F, López-Bernaldo De Quirós JC, Pérez-Elías MJ et al (2017) Frailty and physical function in older HIV-infected adults. Age Ageing 14:1–5Google Scholar
  7. 7.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  8. 8.
    Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R et al (2015) Frailty in older adults: a nationally representative profile in the United States. J Gerontol Ser A Biol Sci Med Sci 70(11):1427–1434CrossRefGoogle Scholar
  9. 9.
    Abizanda P, Sanchez-Jurado PM, Romero L, Paterna G, Martinez-Sanchez E, Atienzar-Nunez P (2011) Prevalence of frailty in a Spanish elderly population: the Frailty and Dependence in Albacete study. J Am Geriatr Soc 59(7):1356–1359 CrossRefGoogle Scholar
  10. 10.
    Greene M, Covinsky K, Astemborski J, Piggott DA, Brown T, Leng S et al (2014) The relationship of physical performance with HIV disease and mortality. AIDS 28(18):2711–2719CrossRefGoogle Scholar
  11. 11.
    Erlandson KM, Allshouse AA, Jankowski CM, Duong S, Mawhinney S, Kohrt WM et al (2012) Comparison of functional status instruments in HIV-infected adults on effective antiretroviral therapy. HIV Clin Trials 13(6):324–334CrossRefGoogle Scholar
  12. 12.
    Malaspina L, Woods SP, Moore DJ, Depp C, Letendre SL, Jeste D et al (2011) Successful cognitive aging in persons living with HIV infection. J Neurovirol 17(1):110–119CrossRefGoogle Scholar
  13. 13.
    Wallace LM, Ferrara M, Brothers TD, Garlassi S, Kirkland SA, Theou O et al (2017) Lower frailty is associated with successful cognitive aging among older adults with HIV. AIDS Res Hum Retrovir 33(2):157–163CrossRefGoogle Scholar
  14. 14.
    Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS et al (2001) Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry 58(8):721–728CrossRefGoogle Scholar
  15. 15.
    Dal-Bo MJ, Manoel AL, Filho AO, Silva BQ, Cardoso YS, Cortez J et al (2015) Depressive symptoms and associated factors among people living with HIV/AIDS. J Int Assoc Providers AIDS Care 14(2):136–140CrossRefGoogle Scholar
  16. 16.
    Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L (2015) Depression in HIV infected patients: a review. Curr Psychiatry Rep 17(1):530 CrossRefGoogle Scholar
  17. 17.
    Johnson Shen M, Freeman R, Karpiak S, Brennan-Ing M, Seidel L, Siegler EL (2018) The intersectionality of stigmas among key populations of older adults affected by HIV: a thematic analysis. Clin Gerontol 26:1–13 Google Scholar
  18. 18.
    Shrestha R, Copenhaver M, Bazazi AR, Huedo-Medina TB, Krishnan A, Altice FL (2017) A moderated mediation model of HIV-related stigma, depression, and social support on health-related quality of life among incarcerated malaysian men with HIV and opioid dependence. AIDS Behav 21(4):1059–1069CrossRefGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention (CDC) (1998) AIDS among persons aged ≥ 50 years—United States, 1991–1996. MMWR Morb Mortal Wkly Rep 47:21–27Google Scholar
  20. 20.
    Jedlovsky V, Fleischman JK (2000) Pneumocystis carinii pneumonia as the first presentation of HIV infection in patients older than fifty. AIDS Patient Care STDs 14(5):247–249CrossRefGoogle Scholar
  21. 21.
    Truax J (2003) HIV infection and aging: a personal journey. J Acquir Immune Defic Syndr 33(Suppl 2):S169–S170CrossRefGoogle Scholar
  22. 22.
    Fowler JP (2003) Aging with HIV: one woman’s story. J Acquir Immune Defic Syndr 33(Suppl 2):S166–S168CrossRefGoogle Scholar
  23. 23.
    Cloud GC, Browne R, Salooja N, McLean KA (2003) Newly diagnosed HIV infection in an octogenarian: the elderly are not ‘immune’. Age Ageing 32(3):353–354CrossRefGoogle Scholar
  24. 24.
    Knodel J, Watkins S, VanLandingham M (2003) AIDS and older persons: an international perspective. J Acquir Immune Defic Syndr 33(Suppl 2):S153–S165CrossRefGoogle Scholar
  25. 25.
    Auerbach JD (2003) HIV/AIDS and aging: interventions for older adults. J Acquir Immune Defic Syndr 33(Suppl 2):S57–S58CrossRefGoogle Scholar
  26. 26.
    Manfredi R (2004) HIV infection and advanced age emerging epidemiological, clinical, and management issues. Ageing Res Rev 3(1):31–54CrossRefGoogle Scholar
  27. 27.
    Grabar S, Weiss L, Costagliola D (2006) HIV infection in older patients in the HAART era. J Antimicrob Chemother 57(1):4–7CrossRefGoogle Scholar
  28. 28.
    Manfredi R, Chiodo F (2000) A case-control study of virological and immunological effects of highly active antiretroviral therapy in HIV-infected patients with advanced age. AIDS 14(10):1475–1477CrossRefGoogle Scholar
  29. 29.
    Knobel H, Guelar A, Valldecillo G, Carmona A, Gonzalez A, Lopez-Colomes JL et al (2001) Response to highly active antiretroviral therapy in HIV-infected patients aged 60 years or older after 24 months follow-up. AIDS 15(12):1591–1593CrossRefGoogle Scholar
  30. 30.
    Wellons MF, Sanders L, Edwards LJ, Bartlett JA, Heald AE, Schmader KE (2002) HIV infection: treatment outcomes in older and younger adults. J Am Geriatr Soc 50(4):603–607CrossRefGoogle Scholar
  31. 31.
    Grimes RM, Otiniano ME, Rodriguez-Barradas MC, Lai D (2002) Clinical experience with human immunodeficiency virus-infected older patients in the era of effective antiretroviral therapy. Clin Infect Dis 34(11):1530–1533CrossRefGoogle Scholar
  32. 32.
    Perez JL, Moore RD (2003) Greater effect of highly active antiretroviral therapy on survival in people aged ≥ 50 years compared with younger people in an urban observational cohort. Clin Infect Dis 36(2):212–218CrossRefGoogle Scholar
  33. 33.
    Grabar S, Kousignian I, Sobel A, Le Bras P, Gasnault J, Enel P et al (2004) Immunologic and clinical responses to highly active antiretroviral therapy over 50 years of age. Results from the French Hospital Database on HIV. AIDS 18(15):2029–2038CrossRefGoogle Scholar
  34. 34.
    Conde M, Lopez-Bernaldo de Quiros JC, Miralles P, Cosin J et al (2008) The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy. Am J Med 121(9):820–824CrossRefGoogle Scholar
  35. 35.
    Desquilbet L, Jacobson LP, Fried LP, Phair JP, Jamieson BD, Holloway M et al (2007) HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol Ser A Biol Sci Med Sci 62(11):1279–1286CrossRefGoogle Scholar
  36. 36.
    Desquilbet L, Margolick JB, Fried LP, Phair JP, Jamieson BD, Holloway M et al (2009) Relationship between a frailty-related phenotype and progressive deterioration of the immune system in HIV-infected men. J Acquir Immune Defic Syndr 50(3):299–306CrossRefGoogle Scholar
  37. 37.
    Desquilbet L, Jacobson LP, Fried LP, Phair JP, Jamieson BD, Holloway M et al (2011) A frailty-related phenotype before HAART initiation as an independent risk factor for AIDS or death after HAART among HIV-infected men. J Gerontol Ser A Biol Sci Med Sci 66(9):1030–1038CrossRefGoogle Scholar
  38. 38.
    Althoff KN, Jacobson LP, Cranston RD, Detels R, Phair JP, Li X et al (2014) Age, comorbidities, and AIDS predict a frailty phenotype in men who have sex with men. J Gerontol Ser A Biol Sci Med Sci 69(2):189–198CrossRefGoogle Scholar
  39. 39.
    Piggott DA, Muzaale AD, Mehta SH, Brown TT, Patel KV, Leng SX et al (2013) Frailty, HIV infection, and mortality in an aging cohort of injection drug users. PloS One 8(1):e54910CrossRefGoogle Scholar
  40. 40.
    Piggott DA, Varadhan R, Mehta SH, Brown TT, Li H, Walston JD et al (2015) Frailty, inflammation, and mortality among persons aging with HIV infection and injection drug use. J Gerontol Ser A Biol Sci Med Sci 70(12):1542–1547CrossRefGoogle Scholar
  41. 41.
    Piggott DA, Muzaale AD, Varadhan R, Mehta SH, Westergaard RP, Brown TT et al (2017) Frailty and cause-specific hospitalization among persons aging with HIV infection and injection drug use. J Gerontol Ser A Biol Sci Med Sci 72(3):389–394Google Scholar
  42. 42.
    Terzian AS, Holman S, Nathwani N, Robison E, Weber K, Young M et al (2009) Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health (Larchmt) 18(12):1965–1974CrossRefGoogle Scholar
  43. 43.
    Gustafson DR, Shi Q, Thurn M, Holman S, Minkoff H, Cohen M et al (2016) Frailty and constellations of factors in aging HIV-infected and uninfected women-the women’s interagency HIV study. J Frailty Aging 5(1):43–48Google Scholar
  44. 44.
    Guaraldi G, Brothers TD, Zona S, Stentarelli C, Carli F, Malagoli A et al (2015) A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity. AIDS 29(13):1633–1641CrossRefGoogle Scholar
  45. 45.
    Onen NF, Agbebi A, Shacham E, Stamm KE, Onen AR, Overton ET (2009) Frailty among HIV-infected persons in an urban outpatient care setting. J Infect 59(5):346–352CrossRefGoogle Scholar
  46. 46.
    Onen NF, Patel P, Baker J, Conley L, Brooks JT, Bush T et al (2014) Frailty and pre-frailty in a contemporary cohort of HIV-infected adults. J Frailty Aging 3(3):158–165Google Scholar
  47. 47.
    Erlandson KM, Schrack JA, Jankowski CM, Brown TT, Campbell TB (2014) Functional impairment, disability, and frailty in adults aging with HIV-infection. Curr HIV/AIDS Rep 11(3):279–290CrossRefGoogle Scholar
  48. 48.
    Erlandson KM, Wu K, Koletar SL, Kalayjian RC, Ellis RJ, Taiwo B et al (2017) Association between frailty and components of the frailty phenotype with modifiable risk factors and antiretroviral therapy. J Infect Dis 215(6):933–937CrossRefGoogle Scholar
  49. 49.
    Rees HC, Ianas V, McCracken P, Smith S, Georgescu A, Zangeneh T et al (2013) Measuring frailty in HIV-infected individuals. Identification of frail patients is the first step to amelioration and reversal of frailty. J Vis Exp 24(77):50537Google Scholar
  50. 50.
    Ianas V, Berg E, Mohler MJ, Wendel C, Klotz SA (2013) Antiretroviral therapy protects against frailty in HIV-1 infection. J Int Assoc Providers AIDS Care 12(1):62–66CrossRefGoogle Scholar
  51. 51.
    Sandkovsky U, Robertson KR, Meza JL, High RR, Bonasera SJ, Fisher CM et al (2013) Pilot study of younger and older HIV-infected adults using traditional and novel functional assessments. HIV Clin Trials 14(4):165–174CrossRefGoogle Scholar
  52. 52.
    John MD, Greene M, Hessol NA, Zepf R, Parrott AH, Foreman C et al (2016) Geriatric assessments and association with VACS index among HIV-infected older adults in San Francisco. J Acquir Immune Defic Syndr 72(5):534–541Google Scholar
  53. 53.
    Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H et al (2015) Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr 69(2):161–167CrossRefGoogle Scholar
  54. 54.
    Pathai S, Gilbert C, Weiss HA, Cook C, Wood R, Bekker LG et al (2013) Frailty in HIV-infected adults in South Africa. J Acquir Immune Defic Syndr 62(1):43–51CrossRefGoogle Scholar
  55. 55.
    Zamudio-Rodriguez A, Belaunzaran-Zamudio PF, Sierra-Madero JG, Cuellar-Rodriguez J, Crabtree-Ramirez BE, Alcala-Zermeno JL et al (2018) Association between frailty and HIV-associated neurodegenerative disorders among older adults living with HIV. AIDS Res Hum Retrovir 34(5):449–455CrossRefGoogle Scholar
  56. 56.
    Guaraldi G, Malagoli A, Theou O, Brothers TD, Wallace L, Torelli R et al (2017) Correlates of frailty phenotype and frailty index and their associations with clinical outcomes. HIV Med 18(10):764–771CrossRefGoogle Scholar
  57. 57.
    Bregigeon S, Galinier A, Zaegel-Faucher O, Cano CE, Obry V, Laroche H et al (2017) Frailty in HIV infected people: a new risk factor for bone mineral density loss. AIDS 31(11):1573–1577CrossRefGoogle Scholar
  58. 58.
    Effros RB, Fletcher CV, Gebo K, Halter JB, Hazzard WR, Horne FM et al (2008) Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clin Infect Dis 47(4):542–553CrossRefGoogle Scholar
  59. 59.
    Tinetti ME, Fried T (2004) The end of the disease era. Am J Med 116(3):179–185CrossRefGoogle Scholar
  60. 60.
    Cesari M, Marzetti E, Canevelli M, Guaraldi G (2017) Geriatric syndromes: how to treat. Virulence 8(5):577–585CrossRefGoogle Scholar
  61. 61.
    World Health Organization (2015) World report on ageing and health. World Health Organization, Geneva, Switzerland.;jsessionid=DB5B11EB24ABAA78905DE1E7CE8DF414?sequence=1
  62. 62.
    Singh HK, Del Carmen T, Freeman R, Glesby MJ, Siegler EL (2017) From one syndrome to many: incorporating geriatric consultation into HIV care. Clin Infect Dis 65(3):501–506CrossRefGoogle Scholar
  63. 63.
    Guaraldi G, Palella FJ Jr (2017) Clinical implications of aging with HIV infection: perspectives and the future medical care agenda. AIDS 31(Suppl 2):S129–S135CrossRefGoogle Scholar
  64. 64.
    Guaraldi G, Cossarizza A (2017) Geriatric-HIV Medicine: a science in its infancy. Virulence 8(5):504–507CrossRefGoogle Scholar
  65. 65.
    Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U et al (2010) Ortho-geriatric service—a literature review comparing different models. Osteoporos Int 21(Suppl 4):S637–S646CrossRefGoogle Scholar
  66. 66.
    Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW et al (2016) Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society. Circulation 133(21):2103–2122CrossRefGoogle Scholar
  67. 67.
    Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M et al (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603CrossRefGoogle Scholar
  68. 68.
    Leipzig RM, Sauvigne K, Granville LJ, Harper GM, Kirk LM, Levine SA et al (2014) What is a geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs end-of-training entrustable professional activities for geriatric medicine. J Am Geriatr Soc 62(5):924–929CrossRefGoogle Scholar
  69. 69.
    Siegler EL, Burchett CO, Glesby MJ (2018) Older people with HIV are an essential part of the continuum of HIV care. J Int AIDS Soc 21(10):e25188CrossRefGoogle Scholar
  70. 70.
    Ellis G, Whitehead MA, O’Neill D, Langhorne P, Robinson D (2011) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Datab Syst Rev 6(7):CD006211Google Scholar
  71. 71.
    Warren MW (1946) Care of the chronic aged sick. Lancet 1(6406):841–843CrossRefGoogle Scholar
  72. 72.
    Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL (1984) Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med 311(26):1664–1670CrossRefGoogle Scholar
  73. 73.
    Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342(8878):1032–1036CrossRefGoogle Scholar
  74. 74.
    Parker SG, McLeod A, McCue P, Phelps K, Bardsley M, Roberts HC et al (2017) New horizons in comprehensive geriatric assessment. Age Ageing 46(5):713–721CrossRefGoogle Scholar
  75. 75.
    Abellan van Kan G, Rolland YM, Morley JE, Vellas B (2008) Frailty: toward a clinical definition. J Am Med Directors Assoc 9(2):71–72CrossRefGoogle Scholar
  76. 76.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495CrossRefGoogle Scholar
  77. 77.
    Harris TG, Rabkin M, El-Sadr WM (2018) Achieving the fourth 90: healthy aging for people living with HIV. AIDS 32(12):1563–1569CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  • Fátima Brañas
    • 1
    Email author
  • Pablo Ryan
    • 2
  • Jesús Troya
    • 2
  • Matilde Sánchez-Conde
    • 3
  1. 1.Geriatrics DepartmentInfanta Leonor University HospitalMadridSpain
  2. 2.HIV Unit, Internal Medicine DepartmentInfanta Leonor University HospitalMadridSpain
  3. 3.Infectious Diseases and HIV DepartmentRamón y Cajal University HospitalMadridSpain

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