Division of Geriatric Medicine, Comprehensive HIV Aging Initiative, Combined Viral Illness Service, Division of Infectious Diseases, McGill University Health Center, Quebec, Canada.
Division of Geriatrics, Hospital Universitario Infanta Leonor, Madrid, Spain.
Curr Opin HIV AIDS. 2021 May 1;16(3):133-140. doi: 10.1097/COH.0000000000000677.
Older adults account for the majority of people with HIV (PWH) in high-income countries and have increasingly complex clinical profiles related to premature aging. Frailty is an important geriatric syndrome affecting a minority of PHW. Frailty negatively affects PHW's clinical status and quality of life. This review will update care providers on the current state of frailty that limits the healthspan of PWH.
Ongoing low-level HIV replication in treated PWH leads to immune activation and chronic inflammation contributing to the destabilization of normally autoregulated physiologic systems in response to environmental and biologic challenges characteristic of frailty. Understanding these underlying mechanisms will determine potential intervention options. Potentially reversible risk factors that promote progression to and reversion from the dynamic state of frailty are being studied and will help prevent frailty. Simple assessment tools and treatment strategies for frailty are being adapted for aging PWH.
Insight into underlying biologic mechanisms and adapting proven geriatric principles of interdisciplinary care will inform the healthy aging of PWH.
在高收入国家，老年人占 HIV 感染者（PWH）的大多数，并且与过早衰老相关的临床特征越来越复杂。衰弱是影响少数 PHW 的重要老年综合征。衰弱会对 PHW 的临床状况和生活质量产生负面影响。本综述将使护理人员了解限制 PWH 健康寿命的衰弱现状。
在接受治疗的 PWH 中，持续的低水平 HIV 复制会导致免疫激活和慢性炎症，从而导致正常的自动调节生理系统在应对衰弱特征的环境和生物学挑战时不稳定。了解这些潜在的机制将确定潜在的干预选择。正在研究促进衰弱发展和逆转的潜在可逆风险因素，以预防衰弱。正在为衰老的 PWH 调整适用于衰弱的简单评估工具和治疗策略。
对潜在生物学机制的深入了解和适应经过验证的老年医学多学科护理原则将为 PWH 的健康老龄化提供信息。
