Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, HIV/AIDS Clinical Research Center, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2013 Jul-Aug;17(4):464-79. doi: 10.1016/j.bjid.2012.11.007. Epub 2013 May 25.
The worldwide elderly population is expected to grow by an additional 694 million people by 2025. By that time, there will be approximately two billion elderly people in the world, most of whom (80%) will be living in developing countries. Based on recent estimates, this population will number over 40 million in 2030 in Brazil and a consequent increase in governmental spending for this population can be expected. Since highly active antiretroviral therapy became available in the mid-1990s, the life expectancy of people living with HIV has increased significantly. Approximately 12 million life years were added to the world between 1996 and 2008 as a consequence of wider access to highly active antiretroviral therapy. In Brazil, the incidence of AIDS among the population aged ≥50 years doubled between 1996 and 2006. The development of antiretroviral therapy has allowed individuals diagnosed at a younger age to live longer, which partially explains the aging tendency associated with the HIV/AIDS epidemic. It is estimated that by 2015, subjects aged ≥50 years will represent 50% of the people living with HIV undergoing clinical treatment. This scenario presents some challenges, including the fact that the diagnosis of HIV tends to be delayed in older patients compared to younger patients because the symptoms of HIV can be confused with those of other common diseases among the elderly and also because healthcare professionals do not consider this population to be at high risk for HIV infection. In regard to the individuals diagnosed with HIV, a further challenge is presented by the morbidity normally associated with aging. Finally, the elderly also exhibit higher susceptibility to the toxic effects and pharmacological interactions of medications. The present article reviews the literature regarding the profile of HIV infection among individuals aged ≥50 years focusing on practical features related to the clinical approach and long-term follow-up of this population.
预计到 2025 年，全球老年人口将增加 6.94 亿。届时，全球将有大约 20 亿老年人，其中大多数（80%）将生活在发展中国家。根据最近的估计，到 2030 年，巴西的这一人口将超过 4000 万，预计这一人群的政府支出将会增加。自 20 世纪 90 年代中期高效抗逆转录病毒疗法问世以来，艾滋病毒感染者的预期寿命显著增加。由于更广泛地获得高效抗逆转录病毒疗法，1996 年至 2008 年期间，全球增加了约 1200 万年的预期寿命。在巴西，1996 年至 2006 年期间，≥50 岁人群中的艾滋病发病率增加了一倍。抗逆转录病毒疗法的发展使在更年轻时被诊断出的个体能够活得更长，这在一定程度上解释了与艾滋病毒/艾滋病流行相关的老龄化趋势。据估计，到 2015 年，≥50 岁的患者将占接受临床治疗的艾滋病毒感染者的 50%。这种情况带来了一些挑战，包括与年轻患者相比，老年患者的艾滋病毒诊断往往更迟，这是因为艾滋病毒的症状可能与老年人的其他常见疾病的症状相混淆，还因为医疗保健专业人员认为这一人群感染艾滋病毒的风险不高。对于被诊断出患有艾滋病毒的人来说，另一个挑战是与衰老相关的发病率。最后，老年人对药物的毒性作用和药物相互作用也更为敏感。本文综述了≥50 岁人群中艾滋病毒感染的文献，重点关注与该人群临床方法和长期随访相关的实用特征。
