Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
AIDS. 2012 Jul 31;26 Suppl 1:S39-53. doi: 10.1097/QAD.0b013e32835584ea.
It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years of age or older. As this population ages, the frequency of non-AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and psychiatric disorders. As a result, medical management of the aging HIV population can be complicated by polypharmacy and higher pill burden, leading to poorer antiretroviral therapy (ART) adherence. Adherence to ART is generally better in older populations when compared to younger populations; however, cognitive impairment in elderly patients can impair adherence, leading to worse treatment outcomes. Practical monitoring tools can improve adherence and increase rates of viral load suppression. Several antiretroviral drugs exhibit inhibitory and/or inducing effects on cytochrome P450 isoenzymes, which are responsible for the metabolism of many medications used for the treatment of comorbidities in the aging HIV population. The combination of ART with polypharmacy significantly increases the chance of potentially serious drug-drug interactions (DDIs), which can lead to drug toxicity, poorer ART adherence, loss of efficacy of the coadministered medication, or virologic breakthrough. Increasing clinicians awareness of common DDIs and the use of DDI programs can prevent coadministration of potentially harmful combinations in elderly HIV-infected individuals. Well designed ART adherence interventions and DDI studies are needed in the elderly HIV population.
据估计，到 2015 年，美国超过一半的 HIV 感染者将年满 50 岁或以上。随着这一人群的老龄化，与艾滋病无关的合并症的发病率增加，包括心血管、代谢、胃肠道、泌尿生殖系统和精神疾病。因此，由于多种药物治疗和更高的药物负担，老年 HIV 人群的医疗管理可能变得复杂，从而导致抗逆转录病毒治疗（ART）的依从性较差。与年轻人群相比，老年人群的 ART 依从性通常更好；然而，老年患者的认知障碍可能会影响依从性，导致治疗效果更差。实用的监测工具可以提高依从性并增加病毒载量抑制率。一些抗逆转录病毒药物对细胞色素 P450 同工酶具有抑制和/或诱导作用，这些同工酶负责代谢许多用于治疗老年 HIV 人群合并症的药物。ART 与多种药物联合使用显著增加了潜在严重药物相互作用（DDI）的可能性，这可能导致药物毒性、ART 依从性降低、联合用药的疗效丧失或病毒学突破。提高临床医生对常见 DDI 的认识并使用 DDI 方案可以防止在老年 HIV 感染者中联合使用潜在有害的药物组合。老年 HIV 人群需要进行精心设计的 ART 依从性干预和 DDI 研究。
