HIV and the ageing patient

• Published in: Medicine (Abingdon. 1995, UK ed.) Vol. 41; no. 8; pp. 456 - 460
• Main Authors: Cresswell, Fiona, Fisher, Martin
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.08.2013
• Subjects: ageing; antiretroviral; co-morbidity; frailty; Internal Medicine; survival; antiretroviral; frailty; ageing; co-morbidity; survival
• ISSN: 1357-3039; 1878-9390
• DOI: 10.1016/j.mpmed.2013.05.014

Abstract Since the advent of combination antiretroviral therapy (cART) life expectancy has dramatically improved in HIV-infected individuals and approaches normal. In addition to people ageing with HIV, newly diagnosed infections are increasing in the over-50s. As a result, the proportion of individuals with HIV aged over 50 has increased significantly. There is a perspective that HIV infection may accelerate the ageing process and it has been shown that co-morbidity prevalence in HIV-infected individuals is in line with the general population who are 10–15 years older. Whether this finding is true, or whether it can be explained simply by lifestyle factors and co-infections remains the subject of ongoing research. Older people derive substantial benefit from cART but it is not clear whether CD4+ T-cell thresholds for starting cART should be higher or whether the increased occurrence of cART-associated toxicities in older people offsets any benefit. We explore in more depth the occurrence and management of age-related co-morbidities including cardiovascular, bone, renal diseases, metabolic disturbances and frailty. We suggest ways to screen for non-AIDS co-morbidity and control modifiable risk factors in the clinic setting. HIV care becomes more complex as people age and management in a multidisciplinary team is the best way to optimize the physical and emotional well-being of older people living with HIV.