Guaraldi G, Marcotullio S, Maserati R, Gargiulo M, Milic J, Franconi I, Chirianni A, Andreoni M, Galli M, Lazzarin A, D'Arminio Monforte A, Di Perri G, Perno C-F, Puoti M, Vella S, Di Biagio A, Maia L, Mussi C, Cesari M, Antinori A
Giovanni Guaraldi, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy. Tel: +39-0594225318; Fax: +39-0594333710; E-mail:
J Frailty Aging. 2019;8(1):10-16. doi: 10.14283/jfa.2018.42.
This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons.
The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viro-immunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians.
The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.
本文探讨了在2017年版意大利抗逆转录病毒药物使用指南及HIV-1感染者诊断临床管理中，将HIV治疗与老年护理管理相结合的尝试。
概述的建议基于近年来在同行评审期刊上发表和/或在国际科学会议上展示的随机临床试验和观察性研究证据。老年患者开始抗逆转录病毒治疗的原则和病毒免疫学目标与一般HIV人群相同。然而，有一些需要考虑的特殊性，涉及宿主以及治疗本身。老年患者的HIV护理必须从单纯的抗逆转录病毒联合治疗方法转变为更全面的管理，从基于疾病的模式（共病列表）转变为多病症和虚弱的视角。基于综合老年评估实施老年护理方法至关重要，这包括对健康状况进行更广泛的评估。这种多维度和多学科的评估侧重于制定量身定制的干预计划。多重用药在老年人群中很常见，并且是与健康相关负面结果的独立危险因素。这可以通过涉及HIV专家、老年病医生和初级保健医生的多学科合作方法来克服。
由于不断变化的患者群体的新需求，纳入老年护理变得必要。必须强调的是，HIV专家将继续领导多维度干预并优化HIV阳性患者的护理质量。
