Aging With HIV: A Cross-Sectional Study of Comorbidity Prevalence and Clinical Characteristics Across Decades of Life

Vance, David E.; Mugavero, Michael J.; Willig, James H.; Raper, James L.; Saag, Michael S.

doi:10.1016/j.jana.2010.04.002

Cited by 184 publications

(177 citation statements)

References 24 publications

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“…As aging with HIV becomes commonplace, it is inevitable that psychiatrists will be facing more of such complex patients to manage especially since available studies have reported a higher prevalence rate of psychiatric and medical co-morbidities in HIV patients [30,31]. Specifically-trained HIV psychiatrists are few in number, so the onus is on the general hospital psychiatrist to combine up-to-date knowledge with clinical acumen and sound clinical practice so as to provide these complex patients with the best available care.…”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric Complexities in the HIV Patient – Clinical Challenges beyond Neurocognitive Disorders

Sim¹,

Chan²

2017

J AIDS Clin Res

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Objective: To illustrate clinical challenges, explore existing literature and identify knowledge gaps in the management of neuropsychiatric issues beyond neurocognitive disorders in HIV patients. Methods:Three case vignettes from a consultation-liaison psychiatry setting in a general hospital were collated and summarised into a case series. Clinical questions were identified from each vignette and pertinent literature reviewed to aid a further discussion of management issues. Results:The first case vignette discusses the potential of a multi-dimensional approach to the formulation of a HIV patient with emergent psychiatric and cognitive symptoms. In the second, pharmacological treatment of a HIV patient with a severe manic relapse of Bipolar 1 Disorder and active TB disease is discussed. Lastly, the collective effects of severe Traumatic Brain Injury (TBI) and HIV infection superimposed on that of an ageing brain are described. Iatrogenic risks of polypharmacy in an elderly HIV patient are further explored. Conclusion:The practical aspects of clinical challenges regarding the management of HIV patients are multi-fold and most apparent in a real-world setting. Existing literature does not yet adequately address the diagnostic dilemmas and pharmacological complexities faced. The management of other neuropsychiatric manifestations in a HIV patient remains a crucial field to be explored.

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Section: Discussionmentioning

confidence: 99%

Neuropsychiatric Complexities in the HIV Patient – Clinical Challenges beyond Neurocognitive Disorders

Sim¹,

Chan²

2017

J AIDS Clin Res

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“…8 Baik karena proses penuaan yang dipercepat ataupun faktor gaya hidup, tingkat komorbid non-HIV yang terkait dengan HIV meningkat seiring dengan bertambahnya usia, setara jika dibandingkan dengan populasi yang tidak terinfeksi HIV yang berusia 10-15 tahun lebih tua. [8][9][10][11][12] teori dapat mempercepat proses penuaan. 15,16 Selain itu, pada pasien HIV yang belum mendapat terapi ARV, serta pada pasien HIVusia lanjut dijumpai hal-hal sebagai berikut: 1) ekspresi limfosit T dan cyclin-dependent kinase inhibitor 2A (CDKN2A); 2) akumulasi sel T CD28-CD8+; 3) berkurangnya generasi sel T naif; 4) sel T repertoire yang rendah; 5) rasio CD4+/CD8+ yang rendah; 6) ekspansi efektor sel T CD28; 7) kurangnya respons terhadap vaksin; dan 8) berlangsungnya aktivasi sistem imun yang terjadi terus menerus.…”

Section: Pengaruh Hiv Terhadap Proses Penuaanunclassified

“…17 Tanpa diberikan terapi ARV, pasien usia lanjut dengan HIV lebih cepat mengalami penurunan hitung limfosit CD4+ dan lebih cepat memasuki stadium AIDS dan kematian jika dibandingkan dengan pasien usia muda. 10 Diberikannya terapi ARV dapat memperbaiki hal tersebut. Pasien HIV usia lanjut dapat memperoleh perlindungan yang serupa dengan pasien usia muda.…”

Section: Aspek Diagnosisunclassified

HIV pada Geriatri HIV in Geriatrics

Ainun¹,

Yunihastuti²,

Roosheroe³

2017

JPDI

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ABSTRAKJumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial. PENDAHULUANJumlah pasien HIV berusia tua meningkat dari tahun ke tahun. Hal ini selain disebabkan oleh angka kejadian yang meningkat, juga disebabkan oleh terapi antiretroviral yang efektif sehingga angka harapan hidup bertambah. Sejak highly active anti-retroviral therapy (HAART) diperkenalkan pada tahun 1996 dan dimulai terapi anti retroviral kombinasi, pasien HIV yang terdiagnosis awal dan mendapat terapi antiretroviral dapat hidup seperti orang normal pada umumnya. 1 Pada penelitian yang dilakukan oleh Greene, dkk. 2 ditemukan rentang waktu terpanjang dari pasien terdiagnosis HIV hingga saat penelitian dilakukan mencapai 21 tahun. 2 Terapi antiretroviral menurunkan efek HIV dan peradangan kronik, namun tidak halnya dengan fungsi imunologis normal. Angka kesintasan pada pasien HIVusia lanjut yang mendapat terapi antiretroviral 30% lebih rendah dibanding populasi muda. Selain itu, kematian lebih cepat terjadi dalam empat tahun pertama semenjak terapi antiretroviral dimulai. 3 Belum diketahui pasti penyebabnya, namun diperkirakan perhatian yang kurang terhadap kepatuhan berobat, interaksi obat dan toksisitas, serta komorbid multipel memiliki pengaruh. Dengan demikian, dibutuhkan pendekatan tersendiri dalam menangani pasien HIVusia lanjut.

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“…ART is considered a positive advancement since it supports and assists the immune system and reduces peripheral viral load; however, there is evidence that the ART used to treat HIV may be responsible for exacerbating common illnesses, especially heart, hepatic, and renal disease [42]. The comorbidities themselves can cause neuro-inflammation that can further worsen cognitive functioning [43].…”

Section: Confounding and Complicating Factorsmentioning

confidence: 99%

HIV-Related Neurocognitive Disorders and Drugs of Abuse: Mired in Confound, Surrounded by Risk

Kennedy

Zerbo

2014

Curr Addict Rep

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It has long been known that human immunodeficiency virus (HIV) uses the central nervous system (CNS) as a reservoir and nursery to replicate; therein, it does damage to cells and creates an inflammation that in turn allows for more virus to pass the blood-brain barrier. The inflammatory process itself can cause considerable damage. Neurocognitive disturbance from HIV infection is also known to occur at any stage of the infection. Likewise, common drugs of abuse also have adverse neurocognitive effects on their own. This review examines the literature available to try to elucidate the mechanisms of neurocognitive disorders in the HIV-infected individuals who have used drugs of abuse. Although the incidence of HIV-associated dementia (HAD) has decreased with the advent of highly active anti-retroviral therapy, less severe forms of neurocognitive impairment persist, even with supported immune systems and undetectable viral loads. Considerations for prevention are discussed.

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Aging With HIV: A Cross-Sectional Study of Comorbidity Prevalence and Clinical Characteristics Across Decades of Life

Cited by 184 publications

References 24 publications

Neuropsychiatric Complexities in the HIV Patient – Clinical Challenges beyond Neurocognitive Disorders

Neuropsychiatric Complexities in the HIV Patient – Clinical Challenges beyond Neurocognitive Disorders

HIV pada Geriatri HIV in Geriatrics

HIV-Related Neurocognitive Disorders and Drugs of Abuse: Mired in Confound, Surrounded by Risk

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