Implications of HIV as a Long-Term Chronic Disease

Many patients with HIV who were on the leading edge of treatment advances are now in their 50s and 60s. For them, HIV has become a chronic disease. Researchers are interested in examining how these patients age, and if their senescence differs from those of patients who do not have HIV.

The June issue of the journal AIDS includes a supplement that addresses many issues germane to the aging patient with HIV. One article looks at frailty, geriatric syndromes, and sarcopenia in this subpopulation of geriatrics.

Researchers from around the United States have assembled data that discuss the unique issues senior patients with HIV face. These patients tend to age slightly earlier than others, and are at elevated risk for cardiovascular disease, liver disease, depression, and neurocognitive impairment. This leads to greater polypharmacy and more morbidity.

Geriatric syndromes are interrelated medical conditions that generally occur in older adults, especially those who are frail. They include sarcopenia, falls, urinary incontinence, and other conditions that often lead to nursing home admission. The researchers focus on sarcopenia (muscle wasting and loss of muscle mass) and its comorbidities.

The HIV clinical community considers sarcopenia an emerging issue in patients with HIV. HIV infection itself has been associated with myopathy. Myopathy is also a drug-induced adverse effect of some antivirals. The authors reviewed a plethora of studies that indicate adults with HIV are at significantly elevated risk of sarcopenia.

They also examined frailty, emphasizing that experts have yet to determine a clear definition of this condition. People who had HIV early in the epidemic often developed frailty, profound wasting, and fatigue. At this time, it appears that frailty in patients with HIV is more closely related to the development of AIDS than just HIV infection. Risk factors in individuals with HIV resemble those in the uninfected individual, and include medication toxicities, greater immune function dysfunction, and chronic inflammation.

When the researchers looked at falls, they found that individuals with HIV tend to experience falls at rates similar to the rates of uninfected individuals, but beginning earlier in life (around the time of middle age). Approximately one third of individuals with HIV reported falls between ages 45 and 65 years old.

The researchers emphasized that there is no 1 approach to any of these conditions and stressed the importance of physical activity and aerobic/anaerobic exercise.

Reference

Hawkins KL, Brown TT, Margolick JB, Erlandson KM. Geriatric syndromes: new frontiers in HIV and sarcopenia. AIDS. 2017 Jun 1;31 Suppl 2:S137-S146.