Aging with HIV: a practical review

Abstract

The worldwide elderly population is expected to grow by an additional 694 million people by 2025. By that time, there will be approximately two billion elderly people in the world, most of whom (80%) will be living in developing countries. Based on recent estimates, this population will number over 40 million in 2030 in Brazil and a consequent increase in governmental spending for this population can be expected. Since highly active antiretroviral therapy became available in the mid-1990s, the life expectancy of people living with HIV has increased significantly. Approximately 12 million life years were added to the world between 1996 and 2008 as a consequence of wider access to highly active antiretroviral therapy. In Brazil, the incidence of AIDS among the population aged ≥50 years doubled between 1996 and 2006. The development of antiretroviral therapy has allowed individuals diagnosed at a younger age to live longer, which partially explains the aging tendency associated with the HIV/AIDS epidemic. It is estimated that by 2015, subjects aged ≥50 years will represent 50% of the people living with HIV undergoing clinical treatment. This scenario presents some challenges, including the fact that the diagnosis of HIV tends to be delayed in older patients compared to younger patients because the symptoms of HIV can be confused with those of other common diseases among the elderly and also because healthcare professionals do not consider this population to be at high risk for HIV infection. In regard to the individuals diagnosed with HIV, a further challenge is presented by the morbidity normally associated with aging. Finally, the elderly also exhibit higher susceptibility to the toxic effects and pharmacological interactions of medications. The present article reviews the literature regarding the profile of HIV infection among individuals aged ≥50 years focusing on practical features related to the clinical approach and long-term follow-up of this population.

Ageing People Living with HIV: Impact on Healthcare

“…Even though HAART has been utilized to reduce mortality and morbidity, there was an increase rate of death due to non-AIDS related illnesses or due to non-communicable diseases such as liver disease, lung cancer, renal impairment, cognitive impairment, osteoporosis and non-AIDS malignancies (Cardoso et al, 2013).…”

Preliminaries

“…In HICs today, an estimated 30% of people with HIV are aged 50 years or older [1] . In countries in North and South America, including the United States and Brazil, this figure is an estimated 50% [2,3] . These figures are underpinned by 2 simultaneous shifts: an increasing proportion of individuals with HIV are living longer and aging with HIV globally; and older individuals are newly acquiring HIV [4] .…”

Human immunodeficiency virus in institutionalized elderly people

“…Nonetheless, the growing incidence of lethal solid tumors in individuals with HIV infection controlled by means of antiretroviral drugs has raised concerns. 30,31 Pharmacokinetic and pharmacodynamic characteristics are known to be changed through the aging process, 32,33 and polypharmacy is an additional contributory factor. [34][35][36][37] Prescribing drugs for the elderly, with or without HIV, therefore remains a constant clinical challenge, given the high risks of drug-to-drug interactions, side effects and potentially inappropriate medications in this age group.…”

“…[34][35][36][37] Prescribing drugs for the elderly, with or without HIV, therefore remains a constant clinical challenge, given the high risks of drug-to-drug interactions, side effects and potentially inappropriate medications in this age group. 13,14,[32][33][34][35][36] Metabolic changes and cardiovascular diseases associated with the use of antiretroviral therapy are known, and these call for heightened vigilance among elderly patients. Despite the lack of specific consensus, use of statins and ezetimibe would have been justified in the cases of the present study because of the history of neurovascular events in three of the four patients, and also because of the presence of hypothyroidism in two patients and the need to take risperidone in another.…”