Growing old with HIV: The AIDS epidemic and an aging population

Myers, Jeffrey D.

doi:10.1097/01720610-200901000-00005

Cited by 16 publications

(11 citation statements)

References 34 publications

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“…Our results should be considered in light of the fact that there is a rapidly growing population of aging seropositive gay and bisexual men ages 50 years and older (CDC, 2009; GMHC, 2010; Myers, 2009), and that men are acquiring HIV at an older age (Gebo, 2006; Shah & Mildvan, 2006), creating a population comprised of both long-term survivors and recent seroconverters, who, in comparison to their younger counterparts, experience multiple overlapping psychosocial stressors and decreased social support (Emlet & Poindexter, 2004; GMHC, 2010). Older seropositive gay and bisexual men must confront the ongoing demands of HIV as well as myriad physical and cognitive changes that accompany the normal aging process.…”

Section: Discussionmentioning

confidence: 96%

“…As we enter the third decade of the HIV/AIDS epidemic, approximately 33% of all individuals living with the disease in the United States are ages 50 and older and this proportion is projected to rise to nearly 50% by 2015 (Centers for Disease Control and Prevention, (CDC), 2009; Gay Men's Health Crisis (GMHC), 2010; Myers, 2009). In New York City, one of the HIV/AIDS epicenters, nearly one third of people living with HIV are over age 50, and more than 70% are over age 40, most likely a result of antiretroviral therapy (ART) which became available in 1996 (Grabar, Weiss, & Costagliola, 2006; Karpiak, 2008; Myers, 2009). …”

Section: Introductionmentioning

confidence: 99%

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Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City

Pappas

Halkitis

2011

AIDS Care

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This study examined club drug use, (i.e., cocaine, ecstasy, ketamine, GHB, and methamphetamine) and unprotected anal intercourse (UAI) in an ethnically and racially diverse sample of 166 New York City-based seropositive, club drug-using, gay and bisexual men, ages 19 to 61, and considered these behaviors in relation to age category (20s, 30s, 40+) and number of years living with HIV. Club drug use was common across all age categories, with differences arising only in the type of club drug used. Multivariate logistic regression modeling indicated older participants (30s, 40+) were more likely to use cocaine and methamphetamine and less likely to use GHB and ketamine than those in their 20s. We examined unprotected anal intercourse (UAI) with casual partners in relation to age category, the number of years living with HIV, and club drug use. The likelihood of engaging in UAI with seronegative casual partners was greater among those in their 20s than those in their 30's or 40+. Further, participants were equally likely to engage in unprotected receptive anal intercourse and unprotected insertive anal intercourse with each casual partner serostatus type. With regard to number of years living with HIV, those living longer with the disease were more likely to report UAI with casual partners with a seropositive status than with a negative or unknown serostatus. Our findings suggest that UAI and club drug use is common among seropositive gay and bisexual men regardless of age category, but that differential patterns of risk emerge in relation to the number of years one has been living with HIV and age. These findings are of significance as both the aging population of seropositive gay and bisexual men and HIV infection rates continue to grow, and demonstrate a need for differentiated and tailored prevention strategies across the age continuum.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City

Pappas

Halkitis

2011

AIDS Care

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“…We, like others [11], [15], [16], [19], [21], [27], did find that a lower eGFR was independently associated with increasing age. This finding was particularly relevant given the rising incidence of HIV infection in older adults [43], [44] and the remarkable success of cART, which is allowing younger infected adults to age [45]. In addition, HIV-associated inflammation, exposure to potentially toxic antiretroviral drugs, accelerated aging, and chronic comorbidities contribute to the premature occurrence of “non-AIDS” degenerative diseases, including CKD [46], [47].…”

Section: Discussionmentioning

confidence: 99%

Screening for Decreased Glomerular Filtration Rate and Associated Risk Factors in a Cohort of HIV-Infected Patients in a Middle-Income Country

et al. 2014

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With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR) of decreased GFR (defined as <60 mL/min/1.73 m2) was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6%) had a GFR between 60 and 89 mL/min/1.73 m2, 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR <15. Decreased GFR was found in only 74 patients (3.8%). In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m2 were as follows: age ≥50 years (PR = 3.4; 95% CI: 1.7–6.8), diabetes (PR = 2.0; 95% CI: 1.2–3.4), hypertension (PR = 2.0; 95% CI: 1.3–3.2), current CD4+ cell count <350 cells/mm3 (PR = 2.1; 95% CI: 1.3–3.3), past exposure to tenofovir (PR = 4.7; 95% CI: 2.3–9.4) and past exposure to indinavir (PR = 1.7; 95% CI: 1.0–2.8). As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare.

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“…Indeed, approximately 24% of HIV-1-infected individuals in the United States are 50 years of age or older (Centers for Disease Control and Prevention, 2007). It is estimated that 50% of HIV-1-infected patients will be aged 50 or more by 2015 (Myers, 2009). This emerging development in HIV-1 epidemic has significant consequences, because the increased age of infected patients has a detrimental effect on the progress of diseases, including the development of cognitive dysfunction and neurodegenerative diseases (Brew, et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

HIV-1 Tat-induced cerebrovascular toxicity is enhanced in mice with amyloid deposits

Chen

Choi

et al. 2012

Neurobiology of Aging

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HIV-1-infected brains are characterized by elevated depositions of amyloid beta (Aβ); however, the interactions between Aβ and HIV-1 are poorly understood. In the present study, we administered specific HIV-1 protein Tat into the cerebral vasculature of 50–52 week old double transgenic (B6C3-Tg) mice that express a chimeric mouse/human amyloid precursor protein (Mo/HuAPP695swe) and a mutant human presenilin 1 (PS1-dE9) and are characterized by increased Aβ depositions in the brain. Exposure to Tat increased permeability across cerebral capillaries, enhanced disruption of zonula occludens (ZO)-1 tight junction protein, and elevated brain expression of matrix metalloproteinase-9 (MMP-9) in B6C3-Tg mice as compared to age-matched littermate controls. These changes were associated with increased leukocyte attachment and their transcapillary migration. The majority of Tat-induced effects were attenuated by treatment with a specific Rho inhibitor, hydroxyfasudil. The results of animal experiments were reproduced in cultured brain endothelial cells exposed to Aβ and/or Tat. The present data indicate that increased brain levels of Aβ can enhance vascular toxicity and proinflammatory responses induced by HIV-1 protein Tat.

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Growing old with HIV: The AIDS epidemic and an aging population

Cited by 16 publications

References 34 publications

Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City

Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City

Screening for Decreased Glomerular Filtration Rate and Associated Risk Factors in a Cohort of HIV-Infected Patients in a Middle-Income Country

HIV-1 Tat-induced cerebrovascular toxicity is enhanced in mice with amyloid deposits

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