Bloch Mark
Holdsworth House Medical Practice, Darlinghurst, Level 3, 26 College St, Sydney, NSW, 2010, Australia.
AIDS Res Ther. 2018 Nov 16;15(1):19. doi: 10.1186/s12981-018-0210-2.
The life expectancy of people living with HIV (PLHIV) has dramatically improved with effective and well-tolerated antiretroviral therapy. This presents a new challenge in caring for this patient population, with up to 28% of older PLHIV being identified as frail. Studies suggest that the prevalence of frailty is higher in PLHIV compared to the general population, and that the onset of frailty occurs at an earlier age. Frail individuals often present with multiple and non-specific health complaints, fluctuating disability, falls and delirium, and are at higher risk for multiple adverse outcomes, post-operative complications, poor responses to vaccination and functional decline. They tend to require longer hospital admissions, are more likely to require nursing home care, and are at greater risk of mortality. The degree of frailty can fluctuate over time. Limited evidence exists to support the reversal of frailty, but epidemiological evidence suggests that interventions to assess and manage co-morbidities, reducing risk factors such as smoking, increasing exercise and optimising BMI, and improving personal and community resources, are all likely to reduce the risk of frailty. Physicians who care for PLHIV need to recognise and manage frailty in this patient population. This includes an understanding of: when to intervene aggressively in the management of an older patient with a new HIV diagnosis to delay or prevent permanent debility and frailty; when to acknowledge that the patient has become frail; and the role of geriatric medicine in addressing the specific issues and needs of this patient, such as maximising functional ability, preventing falls, reducing social isolation and improving quality of life.
随着有效且耐受性良好的抗逆转录病毒疗法的出现，艾滋病毒感染者（PLHIV）的预期寿命得到了显著提高。这给护理这一患者群体带来了新的挑战，高达28%的老年艾滋病毒感染者被认定为身体虚弱。研究表明，与普通人群相比，艾滋病毒感染者中身体虚弱的患病率更高，且身体虚弱的发病年龄更早。身体虚弱的个体常常有多种非特异性健康问题、残疾波动、跌倒和谵妄，并且面临多种不良后果、术后并发症、疫苗接种反应不佳和功能衰退的风险更高。他们往往需要更长时间的住院治疗，更有可能需要入住养老院，并且死亡风险更大。身体虚弱的程度会随时间波动。支持逆转身体虚弱的证据有限，但流行病学证据表明，评估和管理合并症、减少吸烟等风险因素、增加锻炼和优化体重指数以及改善个人和社区资源的干预措施，都可能降低身体虚弱的风险。护理艾滋病毒感染者的医生需要认识并管理这一患者群体中的身体虚弱问题。这包括了解：何时在新诊断为艾滋病毒的老年患者管理中积极干预，以延迟或预防永久性衰弱和身体虚弱；何时承认患者已变得身体虚弱；以及老年医学在解决该患者的特定问题和需求方面的作用，例如最大限度地提高功能能力、预防跌倒、减少社会隔离和改善生活质量。
