Geriatric Syndromes in Older HIV-Infected Adults

Abstract

Background Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exists on these conditions in older HIV-infected adults and no studies have comprehensively examined these conditions. Methods Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression and cognitive impairment were measured in a cross-sectional study of HIV-infected adults age 50 and older who had an undetectable viral load on antiretroviral therapy (ART). We examined both HIV and non-HIV related predictors of geriatric syndromes including sociodemographics, number of co-morbidities and non-antiretroviral medications, and HIV specific variables in multivariate analyses. Results We studied 155 participants with a median age of 57 (IQR 54-62); (94%) were men. Pre-frailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir (IRR 1.16, 95% CI 1.06-1.26), non-white race (IRR 1.38, 95% CI 1.10-1.74), and increasing number of comorbidities (IRR 1.09, 95%CI 1.03-1.15) were associated with increased risk of having more geriatric syndromes. Conclusions Geriatric syndromes are common in older HIV infected adults. Treatment of comorbidities and early initiation of ART may help to prevent development of these age related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles.

Deterioro cognitivo en adultos mayores con VIH/sida y síndrome de fragilidad

“…En este estudio, al seguimiento de un año la mitad de los participantes desarrolló algún tipo de deterioro cognitivo, y los mayormente afectados fueron aquellos con un mayor grado de fragilidad, lo cual apoya la idea de la relación entre la intensidad de la fragilidad y el grado de deterioro cognitivo en los individuos con VIH 55 . En el mismo sentido, el estudio del Hospital HIV Clinic y del San Francisco Veterans Affairs Medical Center Infectious Diseases Clinic (155 participantes, 93.6% hombres y con media de edad de 57 años) mostró la presencia de fragilidad en un 9% y de deterioro cognitivo en un 46.7%, lo cual es un reflejo de la alta prevalencia de estas dos afecciones vistas común-mente en el adulto mayor, pero también entre una población relativamente joven con VIH+ 56 . Los estudios previos apoyan la hipótesis de que el síndrome de fragilidad puede observarse en la población VIH+ independientemente de su edad.…”

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults

“…Factors associated with increased rates of frailty in persons with HIV infection include CD4+ cell count, HIV RNA level, increased age, and low BMI. 35 …”

Invecchiamento cellulare e infezione da HIV

“…L'infiammazione persistente è il principale fattore nella patogenesi delle alterazioni metaboliche e dell'aterosclerosi che sono a loro volta fattori di rischio dell' "impairment" fisico o "frailty". Per il paziente HIV+ si può parlare in generale di "geriatric syndromes", termine che viene usato per indicare un'ampia varietà di condizioni associate all'invecchiamento, quali cadute, incontinenza urinaria, difficoltà nelle comuni attività quotidiane, andatura lenta, deficit di udito e vista, danno neurologico (22). La prevalenza di "frailty" aumenta con l'età sia nei soggetti HIV negativi sia nei pazienti HIV+, ma si presenta con maggiore frequenza nella popolazione HIV+ dopo i 50 anni di età ed è inversamente correlata con la conta assoluta dei linfociti TCD4+.…”