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HIV/AIDS in the elderly

Epidemiology: 1) 10% of AIDS diagnosis in patients > 50 years (1999) 2) 10-fold increase in AIDS in patients > 65 years of age in decade of 1990-2000 3) persons most likely to have risky behavior are married men 50-60 years of age Pathology: - comorbidities contribute to likelihood of AIDS at presentation - HIV1 progresses faster in the elderly [2] Complications: 1) depression (65%) 2) AIDS dementia (40%) 3) multiple comorbid illness (40% with > 2 comorbid conditions) a) drug-induced hepatitis, hyperlipidemia, peripheral vascular disease, lung cancer, coronary artery disease, peripheral neuropathy, stroke b) cardiovascular disease major cause of mortality 4) older women likely to have: - psychosocial illness, depression, anxiety, substance abuse, psychosis Management: 1) adults > 50 & < 50 years of age respond equally well to antiretroviral therapy 2) adults > 50 generally sustain 1/2 the rise in CD4 count in response to antiretroviral therapy a) 2 phase response of CD4 count b) 4 weeks: return of memory CD4 cells, not different in patients > 50 years c) 24 weeks: formation of naive CD4 cells, diminished in patients > 50 years 3) hormone replacement therapy in women associated with increased survival

Related

age-associated changes in immunity; immunosenescence elderly (senior citizen) human immunodeficiency virus-1 (HIV-1)

General

HIV1 infection; human immunodeficiency virus-1 infection

References

  1. Ardos Moe MD, UCLA Multicampus Program in Geriatric/Gerontology, Lecture series, 02/15/2002
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  3. Luther VP1, Wilkin AM. HIV infection in older adults. Clin Geriatr Med. 2007 Aug;23(3):567-83, PMID: 17631234
  4. Greene M, Justice AC, Lampiris HW, et al. Management of human immunodeficiency virus infection in advanced age. JAMA. 2013;309:1397-1405 PMID: 23549585
  5. HIV, AIDS, and Older People http://www.niapublications.org/engagepages/aids.asp