Sangarlangkarn Aroonsiri, Yamada Yuji, Ko Fred C
Department of Medicine, Temple University, Philadelphia, PA 19122, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Manhattan, NY 10029, USA.
Pathogens. 2021 Oct 15;10(10):1332. doi: 10.3390/pathogens10101332.
With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.
随着抗逆转录病毒疗法的进步以及随之而来的预期寿命增加，感染艾滋病毒的人（PWH）如今在老龄化加剧和多种疾病增多的情况下经历多种老年综合征。艾滋病毒临床医生有责任为这一弱势群体提供老年护理，尽管他们接受的老年医学培训有限，且艾滋病毒服务网络的支持也有限，而这些网络传统上并非为照顾老年人群体而设计。尽管艾滋病毒临床医生报告称，针对老年PWH的正式指南是最有帮助的干预措施之一，但当前的艾滋病毒指南在应用于老年PWH的护理时存在多个问题，包括老年人病情的多因素性质、难以衡量以患者为中心的结果、临床试验中缺乏老年PWH的代表性、针对老年综合征的指南有限，以及尽管PWH已步入高龄，但仍以实足年龄作为纳入标准。鉴于认识到应对上述挑战的更新指南可能需要多年时间才能制定出来，我们提供了关于应用当前指南的策略，包括使用基线特征、获益时间以及老年医学5M模型，以帮助进行共同决策并改善老年PWH的治疗效果。
