Graying of the HIV epidemic: a challenge for inpatient medicine providers

Harris, Ché Matthew; McKenzie, Robin; Nayak, Seema; Kiyatkin, Dmitry; Baker, David; Kisuule, Flora

doi:10.3402/jchimp.v5.29428

Cited by 13 publications

(12 citation statements)

References 37 publications

(48 reference statements)

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“…People living with HIV (PLWH) have 2–3 times higher oral HPV prevalence than HIV-uninfected individuals, and are commonly taking multiple medications, in addition to antiretroviral therapy (ART) [11]. In a cross-sectional study of PLWH in the Southern U.S., 93% were receiving at least one non-ART medication, including antihypertensives (43%), lipid-lowering agents (34%) and antidepressants/antipsychotics/anxiolytics (34%), and the median number of medications per patient was 8 (IQR: 6–11) [12].…”

Section: Background and Rationalementioning

confidence: 99%

The association of medication use with clearance or persistence of oral HPV infection

Lam

Sugar

Cranston

et al. 2016

Cancer Causes Control

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Purpose Persistent oral human papillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown. Methods Scope® oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infected participants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent vs. incident infection, age, HIV status and CD4+ T-cell count. Results Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR=0.75, 95% CI=0.57–0.99), anxiolytics/sedatives (HR=0.78, 95% CI=0.63–0.96) and antidepressants (HR=0.82, 95% CI=0.67–0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR=0.67, 95%: CI 0.49–0.91), but not HIV-uninfected participants (p-interaction=0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR=0.75, 95% CI=0.57–0.99), and when restricted to only HIV-infected participants (aHR=0.66, 95% CI=0.48–0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance. Conclusions Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.

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Section: Background and Rationalementioning

confidence: 99%

The association of medication use with clearance or persistence of oral HPV infection

Lam

Sugar

Cranston

et al. 2016

Cancer Causes Control

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“…Older PLWH also report lower levels of physical ability than younger PLWH [ 5 ]. HIV decreases bone mineral density and increases osteoporosis, making older PLWH at an increased risk of fall-related injuries [ 6 , 7 ]. Interventions are needed to address both the psychological and physical symptoms related to aging with HIV.…”

Section: Introductionmentioning

confidence: 99%

A tai chi/qigong intervention for older adults living with HIV: a study protocol of an exploratory clinical trial

Ibáñez

Fennie

Larkey

et al. 2020

Trials

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Background Almost half of people living with HIV (PLWH) in the USA are over 50 years of age; this is expected to increase to 70% by 2020. Yet, few interventions exist for older PLWH that address psychological and physical symptoms combined, both prevalent in this population. There is a need to find innovative and accessible interventions that can help older PLWH to manage their symptoms. Mind-body interventions, like tai chi/qigong (TCQ), improve both physical and psychological health. TCQ is a series of slow, low-impact meditative movements that integrates breathwork, meditation, and stances. Methods The present study is an exploratory clinical trial that will evaluate the acceptability and feasibility of a 12-week, small group TCQ intervention (n = 24), a sham qigong control condition (n = 24), and a standard of care control condition (n = 24) for older people living with HIV/AIDS. It will also explore any preliminary associations between the TCQ intervention and symptom alleviation. Participants will be recruited from community-based health and social services organizations in Miami, FL, and randomized to one of the 3 conditions. Discussion We will assess feasibility and acceptability through questionnaires and adherence to TCQ. We will assess preliminary associations with symptoms such as depression, anxiety, social support, chronic HIV-related fatigue, and clinical outcomes. These will be described through proportions, means, and changes over time through graphing techniques. Outcomes will be assessed at baseline, at post-intervention, and at 3 months follow-up. These preliminary analyses also will provide information necessary to estimate effect size and power needed for a larger clinical trial. Trial registration ClinicalTrials.gov NCT03840525. Registered on 16 July 2018.

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“…Based on recent statistics, it is estimated that 50% of patients living with HIV are over 50 years old. By 2020, 70% of people with HIV will be over 50 years old and the number of seniors living with HIV infection will continue to rise in future decades [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis Jiroveci Pneumonia and Newly Diagnosed Human Immunodeficiency Virus (AIDS) in a 63-Year-Old Woman

Sabbagh

Darwich

2018

Am J Case Rep

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Patient: Female, 63Final Diagnosis: Pneumocystis jirovici pneumoniaSymptoms: CoughMedication: —Clinical Procedure: BronchoscopySpecialty: Infectious DiseasesObjective:Challenging differential diagnosisBackground:Pneumocystis jiroveci pneumonia (PCP) – formerly known as Pneumocyctis carinii pneumonia – with newly diagnosed AIDS is an uncommon presentation in people over 50 years of age. A high level of suspicion is required for this diagnosis when an elderly patient with pneumonia is not responding to broad-spectrum antibiotic treatment.Case Report:We describe the case of a 63-year-old woman who presented with dyspnea, cough, and significant hypoxemia requiring high-flow oxygen supplement with bilateral lung infiltrates, treated with broad-spectrum antibiotics for a presumed diagnosis of pneumonia. The patient demonstrated slow clinical improvement. A diagnostic bronchoscopy with transbronchial biopsy was done, which revealed unexpected findings of Pneumocystis organisms on GMS stain. The patient tested positive for HIV and was found to have a low CD4 of 47. She was treated for Pneumocystis jiroveci pneumonia (PCP) and recovered accordingly.Conclusions:It is essential to remember that HIV and the associated opportunistic infections can be very easily overlooked in the elderly. Taking a sexual history can be challenging, especially in the older population, but it should be performed. Keep in mind that aged people can get infected with HIV at an earlier stage in life and remain in latent phase for up to 15 years without specific symptoms.

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Graying of the HIV epidemic: a challenge for inpatient medicine providers

Cited by 13 publications

References 37 publications

The association of medication use with clearance or persistence of oral HPV infection

The association of medication use with clearance or persistence of oral HPV infection

A tai chi/qigong intervention for older adults living with HIV: a study protocol of an exploratory clinical trial

Pneumocystis Jiroveci Pneumonia and Newly Diagnosed Human Immunodeficiency Virus (AIDS) in a 63-Year-Old Woman

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