Hawkins Kellie L, Brown Todd T, Margolick Joseph B, Erlandson Kristine M
aUniversity of Colorado, Aurora, Colorado bJohns Hopkins School of Medicine cJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS. 2017 Jun 1;31 Suppl 2(Suppl 2):S137-S146. doi: 10.1097/QAD.0000000000001444.
: HIV infection, in many circumstances, can now be managed as a chronic disease due to the marked increase in life expectancy since the introduction of combination antiretroviral therapy (ART). As the patients who first had access to combination ART age into their 50s and 60s, the effects of chronic HIV infection on health have become an important research focus in HIV infection. People living with HIV appear to exhibit an earlier occurrence of some aging-related conditions compared to people without HIV, in part due to higher rates of comorbidities, high-risk behaviors (e.g. smoking, substance use), chronic immune activation, inflammation, and ART-specific factors. Some studies have even suggested an earlier-than-expected appearance of the 'geriatric syndromes,' which are complex medical syndromes of older adults that are associated with morbidity and mortality. The geriatric syndromes include a wide variety of disease processes ranging from incontinence and dementia to impairments in physical function. This review will focus on one geriatric syndrome, sarcopenia, in older HIV-infected populations, and its relation to other aging syndromes, including frailty and falls. The contribution of HIV itself, ART exposure, and specific comorbidities, and the importance of early recognition and prevention of these aging syndromes will be highlighted.
由于联合抗逆转录病毒疗法(ART)问世以来预期寿命显著增加,在许多情况下,HIV感染现在可以作为一种慢性病来管理。随着首批接受联合ART治疗的患者步入五六十岁,慢性HIV感染对健康的影响已成为HIV感染领域的一个重要研究重点。与未感染HIV的人相比,HIV感染者似乎更早出现一些与衰老相关的状况,部分原因是合并症发生率更高、存在高危行为(如吸烟、使用毒品)、慢性免疫激活、炎症以及ART相关因素。一些研究甚至表明,“老年综合征”的出现比预期更早,这些是与老年人发病率和死亡率相关的复杂医学综合征。老年综合征包括从尿失禁、痴呆到身体功能受损等各种各样的疾病过程。本综述将聚焦于老年HIV感染人群中的一种老年综合征——肌肉减少症,及其与其他衰老综合征(包括衰弱和跌倒)的关系。将强调HIV本身、ART暴露、特定合并症的作用,以及早期识别和预防这些衰老综合征的重要性。