1. 老年艾滋病感染的全球流行趋势与区域差异
1.1 全球老年感染者数量增长的时间序列分析
近20年来，全球50岁及以上人群中HIV感染者的数量呈现持续增长的趋势，艾滋病疫情的“银发化”特征日益显著。这一现象在全球范围内普遍存在，但在不同区域表现出一定的差异性。
从全球范围来看，虽然缺乏针对50岁以上人群的详细流行病学数据，但现有研究和趋势分析表明，老年HIV感染者数量及其在新发感染和存活感染者中的占比正在逐步上升。例如，有研究指出，全球和中国的艾滋病标准化发病率在1990年至2021年间呈现先上升后下降的趋势，但在老年人群中观察到了较高的发病率，特别是全球在60-69岁年龄段达到高峰，而中国则在75-79岁年龄段最高 1。这提示我们，尽管整体发病率有所波动，但老年群体仍然是受影响较严重的群体之一。
具体到不同区域，撒哈拉以南非洲（SSA）作为全球艾滋病疫情最严重的地区，老年感染者的增长尤为突出。尽管传统上该地区人口预期寿命较低，但随着抗逆转录病毒治疗（ART）的普及和有效性提升，越来越多的感染者得以长期存活并步入老年 2。这意味着该地区不仅面临着新发老年感染者的挑战，同时也要应对大量长期存活的、携带HIV的老年人口带来的医疗和社会服务需求。例如，在撒哈拉以南非洲，与HIV相关的脑膜炎导致的死亡率在常规护理环境中非常高，其中隐球菌脑膜炎的短期死亡率高达44%，结核性脑膜炎和肺炎球菌脑膜炎的短期死亡率也分别达到46%和54% 3。这些并发症在老年感染者中可能更为普遍且预后不佳。
在亚洲地区，特别是中国，老年HIV感染者的增长也成为一个不容忽视的问题。尽管整体艾滋病发病率在某些时期有所下降，但老年人群中的发病率仍维持在高位，且男性感染者负担高于女性 1。这可能与行为模式的变化、健康意识不足以及检测覆盖率等因素有关。
欧美等发达国家，由于早期疫情控制和ART的广泛应用，HIV感染者的预期寿命显著延长，使得老年HIV感染者群体不断壮大。这些地区的“银发化”趋势更多体现在长期存活感染者的老龄化，而非新发感染的激增。然而，即使在这些地区，HIV感染仍然与某些疾病的高风险相关，例如，HIV感染者突发心脏死亡的风险更高，特别是在CD4细胞计数低于200个/mm³或病毒载量高于500拷贝/mL的个体中 4。这些都加剧了老年感染者面临的健康挑战。
总体而言，全球老年HIV感染者数量的持续增长，是抗病毒治疗成功延长感染者寿命的积极结果，但也凸显了全球公共卫生系统在应对“艾滋病老年化”趋势方面的不足。各国和地区需要更加细致地分析本地数据，识别关键风险因素，并制定有针对性的防控策略，以应对这一日益严峻的挑战。
1.2 不同地区老年感染的流行病学差异
老年HIV感染在全球范围内的流行病学特征呈现出显著的区域异质性，特别是在传播途径、诊断时机及疾病进展方面，发达国家与发展中国家之间存在明显差异。
在传播途径方面，发达国家如美国和欧洲，老年HIV感染主要与男男性行为（MSM）相关。例如，在美国，HIV-1亚型多样性研究显示，B亚型在总体的HIV感染中占93.6%的主导地位，且MSM是主要的传播途径之一5。此外，静脉注射吸毒也是部分老年感染者的传播途径，但相较于MSM，其比例通常较低。然而，在发展中国家，特别是中国和印度等亚洲国家，异性传播在老年HIV感染中占据主导地位。在中国宁夏地区，2018年至2023年间的老年HIV-1/AIDS患者中，异性传播占80.77%，且患者主要为男性、已婚且文化程度较低的农民6。这些差异反映了社会文化背景、性行为模式以及公共卫生干预措施在不同区域的特异性影响。
在诊断延迟率方面，发展中国家的老年群体普遍面临更高的诊断延迟风险。例如，南非的一项研究显示，尽管HIV检测的可及性显著提高，但老年男性群体的检测率相对较低7。这意味着许多老年感染者在疾病进展到晚期，甚至出现机会性感染后才被诊断，错失了早期干预的最佳时机。巴西的一项研究也发现，老年艾滋病患者在诊断时存在明显延迟，他们在诊断时常伴有更多的艾滋病定义性疾病，且最常见的机会性感染是肺结核8。相比之下，发达国家在HIV检测和早期诊断方面通常拥有更完善的体系，但仍面临挑战。例如，在澳大利亚，尽管整体HIV检测水平较高，但50岁以上的男男性行为者在诊断前进行HIV检测的可能性显著低于年轻群体，导致他们被诊断时CD4 T细胞计数更低9。这表明即使在发达国家，老年群体的检测依从性仍需加强。
疾病进展特征是老年HIV感染者面临的另一个关键差异点。由于诊断延迟，发展中国家的老年感染者在确诊时往往处于疾病晚期，CD4细胞计数较低，更容易发生机会性感染。中国的一项研究表明，基线CD4 T淋巴细胞计数低于200个/L的患者死亡风险更高10。此外，老年感染者在未经诊断的情况下经历疾病进展（CD4细胞计数低于350个/μl）的概率在40岁以上人群中超过50%7。这种晚期诊断不仅增加了死亡风险，也使得后续抗逆转录病毒治疗（ART）的难度和复杂性更高。相比之下，发达国家由于ART的广泛应用和早期诊断的普及，老年感染者的CD4细胞计数通常能维持在较高水平，但他们面临的挑战更多地体现在非艾滋病定义性疾病（NADCs）的负担上，如心血管疾病、神经认知障碍和骨质疏松等，这些疾病在长期存活的老年感染者中更为常见。不过，一项对60岁以上HIV感染者的回顾性病例对照研究发现，老年感染者在诊断时CD4+淋巴细胞计数和机会性感染史与年轻患者相似，但他们的生存期更短11。这提示，即使在CD4计数相似的情况下，衰老本身也可能对预后产生不利影响。
综上所述，不同地区老年HIV感染的流行病学差异巨大，发展中国家面临着异性传播高发、诊断延迟和疾病晚期化等严峻挑战，而发达国家则更多地关注长期存活老年感染者的共病管理和生活质量。这些差异要求各国根据自身情况，制定更加精细化和本土化的防控策略。
2. 老年艾滋病感染的多维度风险因素解析
2.1 行为与认知层面的驱动因素
老年群体HIV感染风险的上升，并非单一因素所致，而是行为、认知、社会、文化以及生理等多重因素交织作用的结果。在行为与认知层面，以下几个关键因素显著推动了老年HIV感染人数的增长。
首先，老年群体安全性行为认知偏差是一个普遍且重要的风险因素。传统观念往往认为老年人性需求下降或性生活不再活跃，这导致了针对老年人的性健康教育和HIV预防宣传的缺失或不足 12。许多老年人因此缺乏对HIV传播途径和预防方法的正确认知，或者错误地认为自己感染HIV的风险较低。例如，由于不再面临生育风险，部分老年人可能会减少甚至停止使用安全套，从而增加感染性传播疾病的风险 13。此外，健康专业人员中存在的年龄歧视也可能导致他们不愿与老年患者讨论性健康问题，进一步加剧了老年人获取正确信息和进行风险评估的障碍 12。这种认知偏差使得老年人在性行为中更易忽视保护措施，从而暴露于感染风险之中。
其次，性活跃期延长也是老年HIV感染风险增加的重要驱动因素。随着医疗技术的进步和生活水平的提高，人们的健康寿命显著延长，老年人的身体机能和生活质量得到改善，性活跃期也相应延长。一些老年人可能因丧偶或离婚等原因，重新进入约会市场，寻求新的伴侣关系。这种情况下，他们可能面临发生性行为的风险，且由于前述的认知偏差，可能忽视安全性行为，从而增加了HIV暴露的机会。在泰国北部清迈省进行的一项研究显示，328名50岁及以上的HIV感染者中，有近三分之一的人有性生活，其中男性、年龄较轻、已婚、对性持积极态度以及没有慢性疾病是最近12个月内有性生活的独立预测因素 14。尽管该研究指出，由于坚持使用安全套、病毒载量低以及婚外性行为发生率低，HIV性传播的风险可能较低，但这仍强调了老年人中存在的性活跃现象以及其潜在的感染风险 14。
最后，社交场景变迁也为老年人带来了新的HIV感染风险。随着互联网和智能手机的普及，老年人的社交方式也发生了改变。老年社交平台和在线约会应用的兴起，为老年人提供了更便捷的交友和寻找伴侣的途径。这些线上平台拓宽了老年人的社交圈，但也可能使得他们更容易接触到陌生人，并在缺乏足够了解和防范的情况下发生性行为。线下活动，如老年大学、公园舞会、旅行团等，也为老年人提供了更多的社交和互动机会，其中不乏可能发展出非固定伴侣关系的情况。在这些新的社交场景中，如果老年人对性健康风险的认知不足，或因社交需求驱动而忽视安全性行为，则其感染HIV的风险将随之升高。有研究指出，社会媒体的使用有助于HIV感染者获得社会支持，但也强调了在技术操作和隐私保护方面的挑战。例如，一项研究发现，多数认为Facebook难以使用或技术经验较少的人群年龄在50岁以上，这可能影响他们参与基于社交媒体的干预措施 15。这间接说明了老年人在新兴社交场景中，可能因对数字工具的不熟悉而面临信息获取和自我保护的不足。
2.2 社会与文化层面的潜在诱因
除了行为与认知层面的驱动因素外，老年艾滋病感染风险的上升也深受社会与文化因素的深刻影响。这些因素往往隐藏在社会结构和传统观念之中，对老年群体的性健康行为产生微妙而持久的作用。
首先，老年群体性需求的社会忽视和污名化是导致老年人艾滋病感染风险增加的一个重要文化障碍。在许多社会中，特别是受传统价值观影响较深的亚洲文化背景下，老年人的性行为常被视为“不恰当的”、“不健康的”甚至是“可耻的”行为。这种普遍存在的偏见和年龄歧视（Ageism）导致社会不愿公开讨论老年人的性健康问题，使得针对老年群体的性教育和艾滋病预防信息严重缺失 16。当老年人的性需求被社会所忽视或污名化时，他们往往难以获得正确、全面的性健康知识和支持，从而可能在秘密进行性活动时，因缺乏保护意识和措施而面临更高的感染风险。这种社会压抑也使得老年感染者更易遭受污名和歧视，影响其寻求检测和治疗的意愿 17。
其次，丧偶/独居比例上升与孤独感驱动非固定伴侣关系的现象，也显著增加了老年人感染HIV的潜在风险。随着预期寿命的延长，老年人群中丧偶或离婚的比例增加，导致独居老年人数量庞大。孤独感是老年群体普遍面临的心理健康挑战之一，它与较高的抑郁和焦虑发生率相关 181920。为缓解孤独感、寻求情感慰藉和亲密关系，一些独居老年人可能会寻求新的伴侣，甚至发展非固定伴侣关系。研究表明，孤独感与艾滋病感染者（PLWH）的吸烟率较高相关 21。此外，有研究指出，中年和老年性少数男性（无论是否感染HIV）的孤独感是衰弱的先行因素 18。这种因孤独驱动的伴侣寻求行为，如果缺乏安全性行为的意识和实践，极易导致HIV等性传播疾病的传播。在西班牙的一项研究中，有10%的老年HIV感染者报告了孤独感，5.8%报告了社会孤立，而“不情愿地独居”是孤独感和社会孤立的重要风险因素 22。
再者，代际健康信息断层是老年防艾教育覆盖不足的另一个关键原因。当前主流的艾滋病预防宣传往往聚焦于青年群体，其宣传内容、形式和渠道往往难以触达或引起老年人的共鸣。老年人获取健康信息的渠道相对有限，对互联网和社交媒体的依赖程度低于年轻人，而传统的宣传媒介（如电视、报纸）在特定健康信息传播上可能存在滞后。此外，由于家庭成员对老年人性健康的讳莫如深，使得老年人难以从子女或亲属那里获得相关信息。这种信息断层导致老年群体在面对新的性健康风险时，缺乏足够的知识储备和应对能力。这种忽视使得老年人成为防艾教育中的“被遗忘的群体”，增加了他们因信息不对称而感染HIV的风险。
2.3 生理与病理层面的易感性特征
老年群体在生理和病理层面具有独特的易感性特征，使得他们不仅更易感染HIV，而且在感染后疾病进展和治疗管理上也面临更多挑战。这些特征主要体现在衰老相关免疫功能衰退、合并慢性疾病的协同作用以及抗逆转录病毒治疗（ART）的药代动力学特殊性。
首先，衰老相关的免疫功能衰退是老年人HIV易感性增加的核心生理因素。随着年龄增长，人体免疫系统会发生一系列被称为“免疫衰老”（immunosenescence）的变化。主要表现为CD4+ T细胞耗竭以及免疫激活和炎症状态持续存在 23。这些变化削弱了老年人对病原体的免疫应答能力，使其在接触HIV时更易感染。此外，衰老还会导致慢性炎症和免疫激活状态，即便在没有HIV感染的情况下，老年人也常表现出持续的低度炎症 2324。这种慢性炎症状态会进一步促进免疫细胞的耗竭和功能障碍，为HIV的复制和传播提供更有利的环境。研究表明，HIV感染本身也会加速免疫衰老的过程，使得HIV感染者的免疫系统比同龄非感染者更早出现衰老特征，形成“过早衰老”现象 2324。
其次，合并慢性疾病对HIV易感性的协同作用显著增加了老年感染的风险。老年群体常伴有多种慢性非传染性疾病，如糖尿病、心血管疾病、慢性肾病和骨质疏松等。这些合并症不仅增加了老年人的整体健康负担，也可能直接或间接影响其对HIV的易感性。例如，糖尿病会增加对结核病的易感性 25。心血管疾病与慢性炎症密切相关，而慢性炎症是多种疾病进展的重要驱动因素。此外，某些慢性疾病的治疗药物可能与HIV感染的免疫抑制作用叠加，进一步削弱机体的防御能力。研究指出，HIV感染者罹患心血管疾病的风险更高，且其发生时间通常比未感染者提前 2627。这些合并症的存在使得老年人在感染HIV后，更容易出现严重的并发症和更快的疾病进展。
再者，抗病毒治疗（ART）在老年群体中的药代动力学特殊性也构成了一项独特的挑战。随着年龄增长，老年人的肝肾功能可能出现生理性下降，这些因素均可能影响药物的吸收、分布、代谢和排泄，导致ART药物在体内的药代动力学发生改变 2829。例如，肾功能下降可能导致某些经肾脏排泄的ART药物（如替诺福韦）在体内蓄积，增加肾毒性风险 2830。肝功能改变则可能影响经肝脏代谢的ART药物（如蛋白酶抑制剂）的血药浓度，增加药物不良反应或影响疗效 28。此外，老年感染者往往因合并多种慢性疾病而需要服用多种药物（即多重用药，polypharmacy），这显著增加了ART药物与其他药物之间发生潜在药物相互作用的风险，可能导致ART药物疗效降低或毒性增加 2831。虽然目前大多数研究认为，在依从性良好且无显著肾功能障碍的情况下，老年HIV感染者对ART的病毒学应答与年轻患者相似，但他们在CD4免疫恢复方面可能较慢且效果不佳 2930。因此，为老年HIV感染者制定个体化的ART方案，需充分考虑其生理特点、合并症及其用药情况，以确保治疗的安全性和有效性。
3. 老年HIV感染者的临床挑战与健康负担
3.1 诊断与治疗的特殊性
老年HIV感染者在诊断和治疗上面临诸多特殊挑战，这主要是由于其非典型症状表现、合并症复杂性以及抗逆转录病毒治疗（ART）药物相互作用的潜在风险。
诊断方面的特殊性
老年HIV感染者常常出现非典型症状，这极大地增加了漏诊和误诊的风险。例如，艾滋病相关性疾病如衰弱综合征（frailty syndrome）在老年人中更为常见 32。衰弱可能表现为非特异性的体重减轻、乏力、活动能力下降等，这些症状容易被误认为是正常衰老过程的一部分，而非HIV感染的指征。老年人可能不会将自己视为HIV感染的高风险人群，医疗服务提供者也可能因为年龄偏见而较少对老年患者进行HIV检测，导致诊断延迟 29。一项研究指出，老年感染者在诊断时，CD4+淋巴细胞计数通常更低，且更容易出现艾滋病定义性疾病，这表明他们往往在疾病晚期才被确诊 29。这种诊断延迟不仅错失了早期干预的最佳时机，也增加了疾病进展和机会性感染的风险，使得预后不佳。
治疗方面的特殊性
在治疗方面，老年HIV感染者面临的主要挑战是合并症与ART药物的相互作用，以及治疗依从性问题。
合并症与ART药物的相互作用：老年HIV感染者普遍存在多种合并症，如高血压、糖尿病、骨质疏松、慢性肾病和心血管疾病等 33。这些合并症往往需要同时服用多种药物，从而增加了多重用药（polypharmacy）的风险 3435。多重用药显著增加了ART药物与其他药物之间发生药物相互作用的可能性，可能导致ART药物疗效下降、毒性增加或合并症药物失效。例如，某些ART药物可能与降压药、降糖药或降脂药之间存在复杂的代谢相互作用，影响血药浓度。替诺福韦是一种常用的ART药物，但其已知具有肾毒性，可能引起蛋白尿或导致范可尼综合征，表现为低磷血症和骨软化 363738。在老年患者中，由于生理性肾功能下降，替诺福韦的肾毒性风险可能更高，需要密切监测肾功能。此外，虽然参考文献未直接指出长期ART治疗加速动脉粥样硬化，但其强调了老年HIV感染者需要关注心血管疾病风险，并提及ART的益处和潜在的有害影响 32。因此，为老年HIV感染者制定ART方案时，必须仔细评估所有用药，避免潜在的药物相互作用，并选择对合并症影响最小的ART方案。
治疗依从性影响因素：尽管一些研究表明老年HIV感染者可能对ART有更高的依从性 31，但多重用药、认知障碍和记忆力减退等因素仍可能影响其依从性。服用多种药物可能会使患者感到困惑，难以记住每种药物的正确服用时间和剂量。此外，个体对药物的必要性和担忧信念也会影响依从性 39。虽然有研究发现老年HIV感染者在依从性方面可能与年轻患者无显著差异，但仍然需要关注依从性的维持，尤其是当面临复杂的治疗方案和多种合并症管理时 31。非依从性与药物相关问题、不良反应以及滥用精神活性物质密切相关，这些因素在老年群体中也可能存在 40。因此，简化治疗方案、提供个性化的服药提醒、以及加强患者教育和支持是提高老年感染者ART依从性的关键。
综上所述，老年HIV感染者的诊断和治疗需要更加细致和个性化的管理策略。这包括提高医护人员对老年HIV感染的认识、加强早期筛查、在制定ART方案时充分考虑合并症和药物相互作用，并提供全面的支持以维持治疗依从性。
3.2 合并症与多器官损伤的叠加效应
随着抗逆转录病毒治疗（ART）的广泛应用，HIV感染已从致死性疾病转变为一种可管理的慢性疾病，使得感染者的寿命显著延长。然而，长寿也带来了新的挑战，即老年HIV感染者面临着更高的非艾滋病定义性疾病（NADCs）负担，这些疾病的发生率和进展速度通常高于未感染的同龄人，形成了多器官损伤的叠加效应，严重影响其生活质量和预期寿命 4142。这种现象被认为是HIV感染和ART共同作用加速了“过早衰老”（accelerated aging）的结果 4344。
心血管疾病 (Cardiovascular Diseases, CVD) 是老年HIV感染者最突出的NADCs之一。研究表明，HIV感染者罹患心血管疾病的风险是未感染者的两倍 45。即使病毒载量得到有效控制，HIV感染者患心肌梗死（MI）、中风、外周动脉疾病、心力衰竭和心源性猝死的风险仍然显著增加 46。这种高风险归因于多种机制的相互作用：首先，HIV感染本身导致的慢性炎症和免疫激活即使在病毒受到抑制的情况下也会持续存在，促进动脉粥样硬化的发展 2443。其次，一些ART药物，特别是早期的蛋白酶抑制剂和核苷类逆转录酶抑制剂，可能导致血脂异常、胰岛素抵抗等代谢紊乱，从而增加心血管风险。此外，传统心血管危险因素（如高血压、糖尿病、吸烟）在HIV感染者中也可能更为普遍且管理不足 46。
神经退行性病变 (Neurodegenerative Diseases) 在老年HIV感染者中也日益普遍，其中最常见的是HIV相关神经认知障碍 (HIV-associated neurocognitive disorder, HAND)。HAND影响了大约一半的HIV阳性人群，症状包括认知迟缓、注意力不集中和记忆力问题，严重影响日常生活 47。虽然高效抗逆转录病毒疗法（HAART）的引入使得重症HAND病例减少，但轻度形式的HAND患病率却持续上升，特别是在老龄化HIV感染者中 4748。慢性HIV感染、ART的神经毒性（尤其是一些渗透血脑屏障的药物）以及衰老本身都可能导致神经元功能障碍和炎症，加速神经退行性过程 444950。有研究提出，衰老相关的血管认知障碍（VCI）与HIV相关的神经认知障碍之间存在根本性的联系，HIV相关的脑损伤可能主要作用于神经血管单元 (neuro-vascular unit, NVU) 51。这提示了VCI在老年HIV感染者认知功能下降中的重要作用。
骨骼肌肉系统损伤，特别是骨质疏松 (Osteoporosis) 和骨折 (Fractures)，是老年HIV感染者面临的另一个主要健康负担。HIV感染者发生骨质疏松的风险较未感染者高2-3倍 5253。HIV感染、慢性炎症、营养不良以及某些ART药物（如替诺福韦）的长期使用都可能导致骨密度下降 5253。此外，老年HIV感染者也更容易出现肌少症（sarcopenia）和虚弱（frailty），这些因素不仅增加了跌倒的风险，也进一步加剧了骨折的发生率 4253。一项系统性综述发现，在HIV感染的绝经后女性中，骨质疏松的患病率高达7.3%至84%，远高于未感染女性的0.7%至23% 52。这表明女性HIV感染者在骨健康方面面临更大的挑战，尤其是在绝经后。
除了上述主要疾病外，老年HIV感染者还常伴有慢性肾病、肝病（如非酒精性脂肪性肝病，NAFLD，可能进展为非酒精性脂肪性肝炎，NASH）和某些非艾滋病定义性恶性肿瘤的风险增加 4254。这些合并症的叠加，使得老年HIV感染者的管理变得异常复杂，需要多学科协作的综合性医疗护理模式。
3.3 心理健康与社会支持的双重困境
老年HIV感染者不仅要面对生理上的疾病挑战，更深陷于心理健康和缺乏社会支持的双重困境之中。这种困境严重影响他们的生活质量，并可能阻碍其持续接受治疗和护理。
首先，污名化体验对心理状态的影响是老年HIV感染者面临的核心问题之一。尽管社会对艾滋病的认知有所提升，但艾滋病相关的污名化依然根深蒂固，尤其是在老年群体中更为突出。这种污名化表现为多方面：
- 社会对“老年性行为”的污名化：社会普遍认为老年人不应有性生活，或对老年人的性行为持有负面看法。这使得老年HIV感染者在被诊断后，不仅要承受感染的痛苦，还要面对可能被指责“行为不检点”的社会压力，进一步加剧了内疚和羞耻感 1655。有研究显示，艾滋病相关的羞耻感与物质使用增加和抗逆转录病毒治疗依从性困难相关 56。
- HIV相关歧视：老年HIV感染者可能遭受来自家庭、朋友、社区甚至医护人员的歧视 57。例如，在医疗环境中，一些医护人员对HIV患者存在污名化和歧视态度，不愿提供医疗服务，甚至会担心接触HIV患者的衣物或进行抽血操作 58。这种歧视可能导致感染者在就医时遭遇障碍，从而影响医疗服务的可及性 5960。社会污名和对老年HIV感染者的刻板印象可能会导致他们缺乏社会或机构支持，减少幸存的同伴，并缺乏家庭照护 55。
- 内化污名：长期遭受污名和歧视，可能导致老年感染者将负面评价内化，形成自我歧视。这种内化污名会对心理健康产生严重负面影响，增加抑郁、焦虑的风险。研究表明，HIV感染者普遍存在较高的情绪困扰和相关疾病，尤其是抑郁 55。一项针对HIV阳性注射吸毒者的研究发现，74%的患者有焦虑症状，61%的患者有抑郁症状 61。另一项研究也指出，与没有报告孤独感或社会孤立的人相比，报告有这些问题的人更容易出现焦虑和抑郁症状 22。
其次，社会支持网络的缺失使得老年HIV感染者在心理和生理上都处于脆弱状态。社会支持被证明是艾滋病感染者改善生活质量的保护因素 626364。然而，老年HIV感染者在社会支持方面面临多重困境：
- 家庭支持不足：由于社会污名、子女不理解或家庭成员自身负担重等原因，老年HIV感染者可能无法获得足够的家庭支持 5565。在一些传统文化背景下，家庭成员对艾滋病缺乏正确认知，可能因恐惧感染而疏远感染者，甚至排斥他们。
- 同伴支持减少：随着年龄增长，老年感染者的同龄朋友和伙伴可能会因各种原因（如疾病、死亡、居住地分散等）减少 55。这意味着他们更难找到可以分享经验、互相支持的同伴群体，进一步加剧了孤独感 225566。
- 社区支持和长期照护需求与现有养老体系的适配性缺口：许多老年HIV感染者在晚年可能面临失能或半失能状态，需要长期的生活照护和医疗护理。然而，当前的养老体系往往缺乏针对HIV感染者的特殊照护服务。养老机构可能因对HIV感染缺乏了解或担心传播风险而拒绝接收，导致老年感染者难以获得专业的长期照护。社区层面也缺乏专门为老年HIV感染者提供的心理咨询、社会融入和生活支持服务。有研究强调，需要制定策略以检测和管理HIV感染者（≥50岁）的孤独感和社会孤立 22。
综上所述，老年HIV感染者的心理健康与社会支持困境是复杂且多维的。消除污名和歧视、加强心理干预、构建多层次的社会支持网络以及完善针对老年HIV感染者的长期照护体系，是应对这一挑战的关键。
4. 老年艾滋病防控的现存障碍与优化策略
4.1 现有防控体系的薄弱环节
当前针对艾滋病防控的传统策略在老年群体中面临显著的适用性局限，主要体现在宣传教育、检测服务和医疗管理等多个层面，这导致了现有防控体系在应对老年艾滋病疫情上升趋势时的薄弱。
首先，宣传材料以青年为中心，导致老年群体防艾教育覆盖不足。 传统的艾滋病宣传教育通常针对年轻人设计，其内容、形式和传播渠道（如社交媒体、校园宣传）往往难以有效触达老年群体。老年人获取健康信息的渠道可能偏向传统媒体（如电视、报纸）或社区活动，但这些渠道中针对老年性健康和HIV预防的专题宣传却相对匮乏或内容枯燥 67。例如，许多宣传资料可能忽略老年人的文化背景、生活习惯和性健康需求，甚至可能包含对老年人性行为的刻板印象或回避态度，使得老年人难以从中获得有益的信息，也无法引起他们的共鸣。这种“代际健康信息断层”使得老年群体对HIV感染风险、传播途径及预防措施的认知水平普遍较低 67。有研究显示，健康护理人员对HIV/AIDS的知识水平也仅为平均水平，这进一步凸显了在教育和培训方面的需求 68。
其次，检测点覆盖社区老年活动场所不足，影响检测可及性。 现有的HIV检测服务体系，尤其是在社区层面，往往未能充分考虑到老年人的生活轨迹和活动习惯。例如，检测点可能集中在医院、疾控中心或年轻人常去的场所，而老年人经常活动的社区中心、公园、老年大学、文化宫等场所却缺乏便捷的HIV检测服务。这不仅增加了老年人前往检测点的交通和时间成本，也可能因为隐私顾虑和对检测流程的不熟悉，降低他们主动寻求检测的意愿。此外，部分老年人可能对HIV检测存在羞耻感和恐惧，若检测环境不够私密或工作人员缺乏老年友好型服务意识，都可能成为检测的障碍 67。有研究指出，撒哈拉以南非洲地区的老年人不太可能接受HIV检测，且缺乏针对该脆弱人群的预防和治疗数据 69。
第三，医疗系统对老年HIV管理的专业能力缺口，主要体现在老年科与感染科协作机制缺失。 老年HIV感染者常常合并多种慢性疾病（如心血管疾病、糖尿病、骨质疏松等），且因衰老导致器官功能退化，使得他们的医疗管理比年轻感染者更为复杂 41。然而，当前的医疗体系中，老年医学科医生可能缺乏HIV感染的专业知识，而感染科医生则可能对老年综合评估、多重用药管理和老年综合征（如衰弱、认知障碍）的识别和管理经验不足。这种专业知识的交叉缺失，导致老年HIV感染者难以获得整合性的、以人为中心的照护。缺乏老年科与感染科的有效协作机制，使得老年感染者在疾病诊治、药物管理和长期照护方面存在盲区，可能面临漏诊或误诊，治疗方案不够优化，以及合并症未能得到及时有效管理等问题。例如，老年人对HIV的诊断表现出明显的延迟，他们在诊断时往往伴有更多的AIDS定义疾病，这进一步凸显了专业能力缺口带来的负面影响。此外，社会隔离和孤独感也是老年HIV感染者面临的挑战，这需要更全面的社会支持和医疗服务 55。
综上所述，现有防控体系在老年艾滋病防控方面存在明显的结构性缺陷，亟需通过创新干预措施和多部门协同，弥补这些薄弱环节。
4.2 针对性干预措施的创新方向
针对老年艾滋病感染防控的现有薄弱环节，迫切需要开发并实施更具适配性的创新干预措施。可以借鉴“三级预防”框架，为老年群体量身定制全面的防控方案，以期提高其对HIV的认知、检测率、治疗依从性以及生活质量。
4.2.1 一级预防：促进健康与降低风险
一级预防旨在通过教育和行为改变，降低老年人群感染HIV的风险。
开发老年友好型防艾教育工具包：传统的防艾宣传材料往往针对青年人设计，内容和形式难以吸引老年群体。应开发专门针对老年人的防艾教育工具包，其内容应简洁明了，语言通俗易懂，避免使用晦涩的医学术语。宣传重点应包括：
社区活动中心嵌入检测服务：将HIV检测服务融入老年人日常生活的场景中，提高检测的可及性和便利性。
- 在老年人常去的场所设置临时或常态化检测点：例如，在社区老年活动中心、公园、老年大学、棋牌室、文化宫等场所，定期或不定期提供免费、保密的HIV快速检测服务。
- 提供隐私友好的检测环境：确保检测过程的私密性，减少老年人因担心隐私泄露和污名化而产生的顾虑。
- 培训老年友好型检测咨询员：检测咨询员应具备与老年人沟通的技巧，能够理解老年人的特殊需求和顾虑，并提供耐心、专业的咨询服务。例如，可以招募培训老年志愿者参与宣传和引导工作，发挥同伴教育的作用。
- 推广自检工具：条件允许的地区，可以推广便捷的HIV自检工具，让老年人在家中即可进行初步筛查，从而降低前往医疗机构检测的心理负担。
4.2.2 二级预防：早期诊断与转介
二级预防旨在通过早期发现和及时转介，阻止疾病进展，改善预后。
推广老年群体HIV快速检测技术：快速检测操作简便、出结果快，非常适合在社区和基层医疗机构推广，尤其能提高老年群体的检测意愿。
- 基层医疗机构普及快速检测：鼓励和支持社区卫生服务中心、乡镇卫生院等基层医疗机构配备HIV快速检测设备，并培训医护人员掌握快速检测技术。
- 体检项目纳入HIV检测：将HIV检测纳入老年人常规体检项目，特别是对于有高危行为史或不明原因体重减轻、发热等症状的老年人，医生应主动建议进行HIV检测，消除年龄偏见造成的检测盲区。
- 提升检测覆盖率：通过多种形式的宣传，鼓励高危老年人群主动进行检测，并强调早期诊断对治疗和健康管理的重要性。
建立“家庭医生-感染专科”转诊路径：为老年HIV感染者提供无缝的医疗服务衔接。
- 加强家庭医生培训：对家庭医生进行HIV感染最新知识和老年感染者管理特点的培训，使其能够识别高风险老年人，并进行初步筛查和咨询。
- 明确转诊标准与流程：制定明确的转诊指南，当家庭医生发现老年患者HIV初筛阳性或出现相关症状时，能够迅速、有效地将其转诊至感染专科医院或具备HIV诊治能力的综合医院。
- 建立双向转诊与信息共享机制：感染专科医生在对老年HIV感染者进行治疗的同时，应与家庭医生保持沟通，及时反馈患者的治疗进展和特殊需求，以便家庭医生在社区层面提供持续的健康管理和支持。这种双向转诊模式有助于实现全程化、个性化的健康管理，特别是对于需要复杂多药联用的老年患者，家庭医生可以协助管理非HIV相关慢性疾病，减少就医奔波。
4.2.3 三级预防：优化治疗与管理
三级预防旨在对已感染者进行规范化治疗和管理，减少并发症，提高生活质量。
制定老年ART个体化用药指南：考虑到老年HIV感染者普遍存在的合并症、多重用药以及生理功能下降等特点，需要制定专门的ART用药指南。
- 药物选择考量：指南应优先推荐肾毒性、肝毒性较小、药物相互作用风险低、每日一次服用的ART方案，以简化治疗，提高依从性 71。
- 药代动力学监测：对于老年患者，应根据其肝肾功能、体重等个体差异，定期进行药物血浆浓度监测，以调整剂量，减少不良反应，确保疗效。
- 药物相互作用管理：指南应详细列出常用ART药物与老年人常见合并症药物之间的相互作用，并提供相应的管理策略和替代方案，避免因药物相互作用导致的疗效下降或毒性增加。
- 不良反应监测与管理：关注老年人ART治疗中可能出现的特有不良反应，如骨质疏松、神经认知功能下降等，并提供早期识别和干预措施。
整合老年综合评估 (CGA) 的长期管理模式：CGA是一种多维度、跨学科的评估方法，可全面评估老年患者的健康状况和功能状态，对于老年HIV感染者的长期管理至关重要。
- CGA在HIV护理中的应用：将CGA整合到老年HIV感染者的常规护理中，定期评估其身体功能、认知功能、营养状况、心理健康、社会支持以及药物使用情况等，以便及时发现并解决老年综合征和合并症问题 72。
- 多学科团队协作：建立由感染科医生、老年科医生、药师、营养师、心理咨询师、社会工作者等多学科专家组成的团队，共同制定和实施个性化的管理计划。
- 关注非艾滋病定义性疾病 (NADCs) 管理：对心血管疾病、糖尿病、慢性肾病、骨质疏松、HAND等NADCs进行积极的筛查、预防和管理，以减少其对老年HIV感染者生活质量和寿命的影响。
- 心理和社会支持：提供心理咨询和支持服务，帮助老年感染者应对污名化、抑郁、焦虑和孤独感。鼓励和帮助他们融入社区，建立社会支持网络。
- 生活方式干预：根据CGA结果，提供个性化的健康生活方式指导，包括饮食、运动、戒烟限酒等，以改善整体健康状况，延缓衰老进程。
4.3 多部门协同的政策支持需求
应对老年艾滋病感染人数持续上升带来的挑战，单靠医疗卫生部门的努力是远远不够的。这需要一个全面、系统的多部门协同政策支持体系，将老年防艾工作提升至国家老龄化战略的高度。
首先，将老年防艾纳入国家老龄化战略具有紧迫性和必要性。随着全球人口老龄化的加速，老年人群的健康和福祉已成为各国面临的重大公共卫生和社会议题。艾滋病在老年群体中的流行不仅加剧了老年人的健康负担，也对养老服务、社会保障体系和经济发展带来新的压力。因此，各国政府应明确认识到老年防艾工作的战略意义，将其作为老龄化国家战略的有机组成部分，在顶层设计层面予以统筹规划和资源保障。这意味着在制定老年健康政策、养老服务规划时，需充分考虑老年HIV感染者的特殊需求，确保相关政策的普惠性和可及性。例如，在博茨瓦纳，尽管政策制定者已认识到HIV感染者老龄化的问题，但将其列为优先事项仍面临挑战，部分原因是医疗体系仍主要关注个体疾病而非多重共病管理 73。因此，将老年防艾纳入国家战略，有助于推动医疗体系从单一疾病管理向综合性、全生命周期健康管理转变。
其次，推动医保覆盖老年HIV检测/治疗费用是减轻经济负担的关键。老年群体往往收入有限，且常伴有多种慢性疾病，医疗开支较大。若HIV检测和治疗费用未能得到充分的医疗保障覆盖，将严重影响老年感染者寻求检测和坚持治疗的意愿与能力。政府应逐步扩大医保覆盖范围，确保老年HIV检测作为常规健康筛查项目被纳入医保报销范畴，并对ART药物及相关机会性感染的治疗费用提供稳定的、可持续的保障。这包括对自费药物的合理补贴，以及对长期护理和居家照护等非医疗费用提供一定的支持。例如，美国的Medicare医保系统虽然为HIV感染者提供了医疗服务，但老年HIV感染者通常伴随多重共病，导致其医疗支出远高于普通老年人，如加州2010年HIV感染者Medicare支出平均高达47036美元，其中药物费用占三分之二 74。这表明，在完善医保覆盖的同时，也需关注并控制总体医疗成本。
再者，培育老年健康服务专业人才至关重要。目前，既懂老年医学又懂感染病学，或者具备跨学科知识背景的医护人员相对匮乏。这导致老年HIV感染者在接受医疗服务时，可能无法获得整合性的、专业化的照护。政府和教育机构应加大投入，通过设立专业培训项目、继续教育课程和多学科协作平台，培养一批具备老年HIV感染管理能力的医务工作者。这包括感染科医生学习老年综合评估（CGA）方法，老年科医生熟悉HIV感染的临床特征和ART药物相互作用，以及社区医护人员掌握老年防艾宣教和初步筛查技能。此外，还需要培养社会工作者、心理咨询师和护理人员等，共同构建一支能够为老年HIV感染者提供全面支持的专业队伍。
此外，构建“社区-家庭-医院”联动的支持网络，提供全程照护。老年HIV感染者不仅需要医疗服务，更需要社会、心理和生活上的支持。
- 社区层面：应充分发挥社区在老年防艾中的枢纽作用。社区卫生服务中心、老年活动中心等应成为防艾宣教、检测推广和心理支持的重要阵地。鼓励发展和支持老年人互助小组，提供同伴支持。
- 家庭层面：认识到家庭在长期照护中的关键作用 75。通过家庭医生制度、志愿者服务等形式，为老年感染者提供居家医疗指导、生活照护支持，并帮助家庭成员消除对艾滋病的恐惧和偏见，鼓励他们为感染者提供情感和实际支持。例如，南非的一项研究表明，出院后家庭访视干预能够显著降低HIV相关死亡率，初步结果显示死亡率降低59% 76。这强调了家庭和社区照护的重要性。
- 医院层面：建立完善的转诊和会诊机制，确保老年HIV感染者在需要时能够获得高质量的专科医疗服务。同时，医院也应加强与社区和家庭的联系，实现信息共享和无缝衔接。例如，推行“全人健康管理”理念，将艾滋病管理与老年慢性病管理、心理健康支持相结合。
最后，通过媒体倡导消除老年性健康的社会偏见。社会对老年人性行为的刻板印象和污名化，是阻碍老年人获得性健康信息和服务的深层原因。主流媒体应承担起社会责任，通过科学、客观、正面的报道，普及老年性健康知识，破除社会偏见，营造一个对老年人更友好、更包容的社会环境。倡导老年人享有性健康的权利，强调安全性行为对所有年龄段人群的重要性，从而为老年防艾工作的顺利开展提供良好的社会舆论基础。消除艾滋病、老年和同性恋等相关的污名化以及种族主义，对于提升HIV感染者在政策和社会服务中的可见性至关重要 77。
内容由 AI 生成，仅供参考，请仔细甄别
参考文献
1Joinpoint regression and age period cohort analysis of global and Chinese HIV incidence trends from 1990 to 2021.PubMed
Menghan Wu, Cheng Hong, Zhengdong Dou
Sci Rep. 2025 Mar 9;15(1):8153. doi: 10.1038/s41598-025-92882-0.
In China and globally, to analyze the temporal trends of HIV incidence and age, period and cohort effects from 1990 to 2021. A Joinpoint regression model was applied to analyze the time-varying trends of standardized HIV incidence rates worldwide and in China from 1990 to 2021, using data from the Global Burden of Disease Study 2021. The study also explored the effects of age, period, and cohort on HIV incidence trends. From 1990 to 2021, the global standardized incidence of AIDS increased initially and then declined, with females experiencing a higher disease burden than males. In China, the burden was greater in males than females. The age-period-cohort model revealed that the global risk of AIDS incidence peaked between ages 60 and 69, while in China, it was highest between ages 75 and 79. From 1990 to 2021, the global and Chinese standardized incidence rates of AIDS generally followed an increasing trend before declining, with notable gender differences and the highest incidence rates observed in older populations. It is important to address the issues related to AIDS among the elderly and develop targeted health policies to reduce societal burdens and improve public health.
2Exploring the health status of older persons in Sub-Saharan Africa.PubMed
Keiron Audain, Michelle Carr, Derya Dikmen, et al.
Proc Nutr Soc. 2017 Nov;76(4):574-579. doi: 10.1017/S0029665117000398. Epub 2017 May 10.
Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
3Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.PubMed
Mark W Tenforde, Alida M Gertz, David S Lawrence, et al.
J Int AIDS Soc. 2020 Jan;23(1):e25416. doi: 10.1002/jia2.25416.
INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region.
4HIV Infection and the Risk of World Health Organization-Defined Sudden Cardiac Death.PubMed
Matthew S Freiberg, Meredith S Duncan, Charles Alcorn, et al.
J Am Heart Assoc. 2021 Sep 21;10(18):e021268. doi: 10.1161/JAHA.121.021268. Epub 2021 Sep 8.
Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO-defined SCD among those with elevated HIV viral load or low CD4 cell counts.
5Diversity and characterization of HIV-1 subtypes in the United States, 2008-2016.PubMed
Richard L Kline, Neeraja Saduvala, Tianchi Zhang, et al.
Ann Epidemiol. 2019 May;33:84-88. doi: 10.1016/j.annepidem.2019.02.010. Epub 2019 Mar 6.
PURPOSE: This article describes subtype diversity among diagnosed HIV-1 infections in the United States during 2008-2016 by demographic or risk group and over time. METHODS: HIV-1 polymerase sequences reported to the National HIV Surveillance System for persons in 17 U.S. states with HIV infection diagnosed during 2008-2016 were subtyped using COMET, an automated subtyping tool, and National HIV Surveillance System demographic data were analyzed. RESULTS: Subtype B was identified in 93.6% of 121,793 reported sequences. The most common non-B subtypes and circulating recombinant forms (CRFs) were C, CRF02_AG, A, CRF01_AE, and G. Elevated percentages of non-B subtypes or CRFs were found in persons who were female, aged less than 13 years at diagnosis, Asian, or had transmission attributable to heterosexual contact (females only) or perinatal exposure. Foreign-born persons had a higher percentage of non-B subtypes. The prevalence of non-B subtypes and CRFs increased from 5.0% in 2008 to 8.5% in 2016; among specific subtypes and CRFs, subtype G and CRF01_AE increased. CONCLUSIONS: Subtype B remains the predominant strain in the United States. Non-B subtypes and CRFs were not widespread, but diversity and numbers increased from 2008 through 2016, which could have consequences for clinical management, diagnostic testing, and vaccine development.
6Epidemiological and spatiotemporal analysis of elderly HIV-1/AIDS patients in Ningxia, China, from 2018 to 2023.PubMed
Zhonglan Wu, Yichang Liu, Xiaofa Ma, et al.
Sci Rep. 2025 Apr 23;15(1):14161. doi: 10.1038/s41598-025-98791-6.
To analyze the epidemiological transmission characteristics and spatiotemporal distribution patterns of the elderly HIV-1/AIDS population in NHAR from 2018 to 2023, to provide theoretical support for the targeted formulation and implementation of HIV-1 interventions. A cross-sectional study was conducted in August 2024. Plasma samples were collected from the elderly HIV-1/AIDS patients (> 50 years old) in NHAR, followed by RNA extraction and RT-PCR to amplify the pol gene of HIV-1. The amplicons were sequenced for the partial pol region. Subtyping was performed using online tools from the HIV-1 database and MEGA11. Drug resistance was analyzed using the Stanford University HIVdb algorithm. Molecular transmission networks were constructed using Cytoscape 3.10.0. Logistic regression was performed to identify the potential risk factors. Spatial analysis revealed the geographic patterns of elderly HIV-1/AIDS patients. A total of 208 HIV-1/AIDS patients were included in this study, predominantly male (78.37%), primary school and below (46.63%), heterosexual transmission (80.77%) and farmers (52.40%). Nine genetic subtypes were identified, with CRF07_BC being the most common (54.81%). The overall drug resistance rate was 37.98%. The number of network nodes increased from 18 in 2018 to 107 in 2023, with large propagating clusters in 2023 merging or expanding from smaller clusters in previous years. Logistic regression analysis showed that males had a lower risk of transmission, individuals from Yinchuan, Shizuishan, and Wuzhong had a lower probability of entering the network, and CRF07_BC and CRF01_AE had a higher risk of transmission. From 2020 to 2023, there was a highly significant clustering pattern among elderly HIV/AIDS patients in NHAR, with shifts in hotspots. Yuanzhou District remained a persistent cold spot. This study reveals that the elderly HIV-1/AIDS patients in NHAR were predominantly married, male, and engaged in farming, with low levels of education. An increase in the diversity of viral genetic subtypes was observed, along with a high rate of drug resistance. The molecular network expanded significantly, accompanied by the emergence of large transmission clusters, indicating complex transmission patterns. The spatial distribution of these cases exhibited aggregation, with notable differences observed between districts and counties. To effectively intervene in the transmission of HIV-1 among the elderly population, it is essential to establish a long-term dynamic molecular transmission surveillance network and to improve AIDS screening and drug resistance testing.
7Rates of HIV testing and diagnosis in South Africa: successes and challenges.PubMed
Leigh F Johnson, Thomas M Rehle, Sean Jooste, et al.
AIDS. 2015 Jul 17;29(11):1401-9. doi: 10.1097/QAD.0000000000000721.
BACKGROUND: UNAIDS aims for 90% of HIV-positive individuals to be diagnosed by 2020, but few attempts have been made in developing countries to estimate the fraction of the HIV-positive population that has been diagnosed. METHODS: To estimate the rate of HIV diagnosis in South Africa, reported numbers of HIV tests performed in the South African public and private health sectors were aggregated, and estimates of HIV prevalence in individuals tested for HIV were combined. The data were integrated into a mathematical model of the South African HIV epidemic, which was additionally calibrated to estimates of the fraction of the population ever tested for HIV, as reported in three national household surveys. RESULTS: The fraction of HIV-positive adults who were undiagnosed declined from more than 80% in the early 2000s to 23.7% [95% confidence interval (95% CI) 23.1-24.3] in 2012. The undiagnosed proportion in 2012 was substantially higher in men (31.9%, 95% CI 29.7-34.3) than in women (19.0%, 95% CI 17.9-19.9). Projected probabilities of experiencing disease progression (CD4 cell count <350 cells/μl) without diagnosis are more than 50% for most HIV-positive adults over the age of 40. The fraction of HIV-positive adults who are undiagnosed is projected to decline to 8.9% by 2020 if current targets (10 million tests per annum) are met. CONCLUSION: South Africa has made significant progress in expanding access to HIV testing, and at current testing rates, the target of 90% of HIV-positive adults diagnosed by 2020 is likely to be reached. However, uptake is relatively low in men and older adults.
8Mortality of the elderly is still exceedingly high at diagnosis of AIDS despite favourable outcomes after highly active antiretroviral therapy in Recife, Brazil.PubMed
H R Lacerda, D Kitner
Int J STD AIDS. 2008 Jul;19(7):450-4. doi: 10.1258/ijsa.2008.007317.
This study aimed to compare the outcome of an elderly group of AIDS patients with that of a younger group and their features at the time of the diagnosis of AIDS. We evaluated 58 patients aged >60 years and 114 aged 20-39 years, followed for 35.3 months. There was an obvious delay in diagnosing the elderly as they had more AIDS-defining diseases at diagnosis and their most frequent opportunistic infection was pulmonary tuberculosis. Mortality at the time of the diagnosis of AIDS was four times higher in the elderly (24.1% versus 6.1%, P < 0.001). However, when comparing only those submitted to highly active antiretroviral therapy, there was a similar frequency of favourable outcomes; 76.9% in the elderly against 83.1% in the young (P = 0.455). Mean CD4 lymphocyte was 438 cells/mm(3) at the end of follow up in the young when compared with 442 cells/mm(3) in the elderly (P = 0.945). The types of antiretroviral schema and the number of antivirals per patient were similar in both groups.
9HIV treatment as prevention in a developed country setting: the current situation and future scenarios for Australia.PubMed
John M Murray
J Acquir Immune Defic Syndr. 2013 Dec 1;64(4):409-16. doi: 10.1097/QAI.0b013e3182a6b20c.
OBJECTIVE: We investigated the current success of early HIV detection in Australia and the likely effectiveness of Treatment as Prevention. METHODS: HIV diagnoses data from the Australian National HIV/AIDS Registry were analyzed for CD4 T-cell counts at diagnosis and for prior HIV testing. Mathematical modeling based on these data estimated future HIV prevalence and incidence under different scenarios of antiretroviral therapy (ART) usage. RESULTS: CD4 T-cell counts significantly decreased with age (P < 0.0001) for men who have sex with men (MSM) and women in all HIV diagnoses, and for diagnoses at primary HIV infection (P < 0.02). This decrease with age meant that >50% of MSM aged 29 years and older are diagnosed with a CD4 T-cell count <500 cells per cubic millimeters. Diagnosis during primary HIV infection has stabilized at 15% for MSM, with a lower percentage for older individuals (P = 0.002), but only 5% of women were diagnosed at this early stage. MSM older than 50 years were significantly less likely to have had an HIV test before diagnosis (P < 0.0001), whereas women of all ages at HIV diagnosis were less likely to have been tested than MSM. Mathematical modeling indicated that current levels of ART would see a continuing increase in HIV diagnoses among MSM. A 90% ART enrollment would result in an almost immediate decline in prevalence and would be cost effective in terms of person-years on ART by 2028. CONCLUSION: Treatment as Prevention would be an effective intervention in Australia and other developed countries.
10Factors Influencing Survival Status of HIV/AIDS after HAART in Huzhou City, Eastern China.PubMed
Meihua Jin, Zhongrong Yang, Jing Li, et al.
Can J Infect Dis Med Microbiol. 2022 Oct 6;2022:2787731. doi: 10.1155/2022/2787731. eCollection 2022.
BACKGROUND: Highly active antiretroviral therapy (HAART) can effectively reduce the risk of death and opportunistic infections in patients with HIV/AIDS. The aim of this study was to analyse the survival status and its influencing factors in HIV/AIDS after HAART. METHODS: The data on patients' sociodemographic characteristics, treatment information, and follow-up results from the Information Management System of the Chinese Center for Disease Control and Prevention were obtained. Bivariate and stepwise multivariate Cox proportional hazards regression model analyses were performed. RESULTS: A total of 1812 participants were included in this study, of which 1716 were still alive (survival group) and 96 had died (death group). The results indicated that respondents who were elderly ( = 1.053, 95% : 1.037-1.069, < 0.01), who had heterosexual transmission ( = 2.422, 95% : 1.314-4.465, < 0.01) and whose current WHO clinical stage was stage III or IV ( = 2.399, 95% : 1.215-4.735, < 0.05) were more likely to have died; respondents whose baseline CD4 T-lymphocyte count was equal to or more than 200 cells/L ( = 0.412, 95% : 0.275-0.616, < 0.05) were unlikely to have died. CONCLUSIONS: It is recommended that HAART be provided to HIV/AIDS patients at an early clinical stage and that the health services for HIV/AIDS patients after taking medicines be strengthened, which will help promote adherence to therapeutic regimens and improve quality of life.
11Human immunodeficiency virus infection in elderly patients.PubMed
A A Butt, K K Dascomb, K B DeSalvo, et al.
South Med J. 2001 Apr;94(4):397-400.
BACKGROUND: The proportion of older individuals infected with the human immunodeficiency virus (HIV) is rising. METHODS: We performed a retrospective case-control study of 58 patients more than 60 years old at the time of diagnosis of HIV infection and compared them with 232 controls (matched by CD4+ lymphocyte count). Clinical and demographic data were obtained from the Adult Spectrum of Diseases (ASD) database at the Medical Center of Louisiana. RESULTS: Patients in the older age group were more likely to be male and African American or Hispanic. The most common risk factor for acquisition of HIV infection among the patients was homosexual contact (53%). Disease staging was similar in both groups as determined by CD4+ lymphocyte counts and history of opportunistic infections. There was no difference in the use of antiretroviral therapy. In a Cox proportional hazard model and regression models, age > or = 60 years was associated with shorter survival. CONCLUSION: Patients who are older than 60 years at the time of diagnosis of HIV infection have a shorter survival than younger patients.
12A systematic review of education for the prevention of HIV/AIDS among older adults.PubMed
Dorota Milaszewski, Elise Greto, Tanya Klochkov, et al.
J Evid Based Soc Work. 2012;9(3):213-30. doi: 10.1080/15433714.2010.494979.
Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.
13HIV sexual risk behavior in older black women: a systematic review.PubMed
Tanyka K Smith, Elaine L Larson
Womens Health Issues. 2015 Jan-Feb;25(1):63-72. doi: 10.1016/j.whi.2014.09.002. Epub 2014 Nov 12.
BACKGROUND: Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk? METHODS: CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus. RESULTS: Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies. CONCLUSION: Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal.
14Sexual Behavior and Attitudes Toward Sex of Older Adults Living with HIV.PubMed
Kriengkrai Srithanaviboonchai, Wathee Sitthi, Patou Masika Musumari, et al.
AIDS Behav. 2020 Jun;24(6):1825-1834. doi: 10.1007/s10461-019-02756-6.
The number of older adults living with HIV (OALHIV) is increasing rapidly due to effective antiretroviral therapy. The current research describes sexual behavior, attitudes toward sex, and HIV transmission risk among OALHIV. Participants were HIV-infected persons aged 50 years and older enrolled from community hospitals in Chiang Mai Province, Northern Thailand. Of the 328 participants, 57.6% were women, and the average age was 58.8 years. The majority of participants (93.9%) had undetectable viral load. Most participants (77.1%) thought that it is ok/acceptable for PLHIV to have sex. About one-third of OALHIV participants were sexually active. Being male, younger, married, a previous smoker or a non-smoker, having a positive attitude toward sex, and not having a chronic health condition were independent predictors of having had sex in the last 12 months. Risk of HIV sexual transmission was likely low due to consistent condom use, undetectable viral load, and low instances of extramarital sex.
15Social media support group: Implementation and evaluation.PubMed
Haley Cooper, Susan Reif, Sara Shilling, et al.
AIDS Care. 2021 Apr;33(4):502-506. doi: 10.1080/09540121.2020.1748171. Epub 2020 Apr 8.
Lack of social support and perceived HIV-related stigma increase the risk of negative health-related outcomes among people living with HIV (PLWH). This study examines the social media use of PLWH participating in a behavioral health treatment program, and the association of participation in a "secret" Facebook group with improved client social support, education, and overall behavioral health treatment experience. Eighteen individuals participated in a survey and eight individuals participated in a focus group regarding their familiarity with technology and experience with using social media. Mixed-method analysis revealed that the majority of "secret" Facebook group participants thought that participation in the group improved overall personal wellbeing and perceived social support. However, lack of technology and social media experience and privacy concerns may have contributed to lower levels of participation with the "secret" Facebook group. A majority of participants who found Facebook difficult to use and/or had less technology experience were over the age of 50. Incorporating additional technology training for individuals who lack technology experience has the potential to improve clients' overall proficiency with technology and social media, as well as build confidence that could translate into an increased willingness to participate in a social media-based intervention.
16Ageism, Aging and HIV: Community Responses to Prevention, Treatment, Care and Support.PubMed
Rosanna F DeMarco, Mark Brennan-Ing, Courtenay Sprague, et al.
Interdiscip Top Gerontol Geriatr. 2017;42:234-239. doi: 10.1159/000448567. Epub 2016 Nov 22.
Ageism, in the form of prejudice, stereotyping, and discrimination targeting older adults, represents a barrier to addressing the graying of the HIV epidemic. There is widespread misperception on the part of older adults themselves, as well as service providers and society in general that HIV risk is low as one ages. In addition, internalized ageism may play a role in poorer physical and mental health outcomes, as the negative stereotypes associated with aging become a self-fulfilling prophecy. A number of steps can be taken to address HIV and aging in the context of ageism with regard to: prevention, education, and outreach; treatment guidelines for older adults with HIV; funding to address the aging of the epidemic; engagement of communities, health and social service organizations, and other providers around mental health and social support, and addressing the needs of special populations. Caring for an aging population with HIV represents a challenge, which is exacerbated in low and/or middle-income countries that typically lack the infrastructure of high resource settings. How we address the aging-related issues of the HIV epidemic across regions and settings could serve as a model in dealing with aging in our society in general regardless of HIV status.
17Stigma in an Aging Context.PubMed
Charles A Emlet
Interdiscip Top Gerontol Geriatr. 2017;42:144-158. doi: 10.1159/000448560. Epub 2016 Nov 22.
Both the Joint United Nations Program on HIV/AIDS and the US National HIV/AIDS Strategy identify HIV stigma as a barrier to care, a barrier to service access, and deleterious to personal and social well-being. This chapter discusses the topic of HIV stigma from a conceptual basis, including the mechanisms of prejudice and discrimination, and defining anticipated, enacted, and internalized stigma. Stigma is then placed in a historical context of HIV and AIDS, and events exacerbating HIV stigma are discussed. The components of HIV stigma are then applied to the population of older adults (age 50 years and older) who are at-risk of or living with HIV infection. The importance of intersectionality is discussed with regard to race, ethnicity, gender, sexual orientation, gender identity, and in particular, age. Drawing upon the HIV and gerontological literature, the chapter outlines characteristics found to be protective against stigma and placing older adults at greater risk for HIV stigma. Stigma management strategies are outlined and finally, implications of working with older adults related to HIV stigma are provided.
18Loneliness and Frailty Among Middle-Aged and Aging Sexual Minority Men Living With or Without HIV: A Longitudinal Cross-Lagged Panel Analysis.PubMed
Paula Meireles, Deanna Ware, Ana Henriques, et al.
Innov Aging. 2023 Oct 21;7(9):igad113. doi: 10.1093/geroni/igad113. eCollection 2023.
BACKGROUND AND OBJECTIVES: Loneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study. RESEARCH DESIGN AND METHODS: We used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated. RESULTS: The estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23-3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI: .44-2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94-46) and loneliness (aOR = 13.94; 95% CI: 9.42-20.61) were large. DISCUSSION AND IMPLICATIONS: Men who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV.
19Social Support, Loneliness, Depressive Symptoms, and High-Risk Sexual Behaviors of Middle-Aged Hispanic Men Who Have Sex With Men.PubMed
Beatriz Valdes, Karina Gattamorta, Sande Gracia Jones, et al.
J Assoc Nurses AIDS Care. 2019 Jan-Feb;30(1):98-110. doi: 10.1097/JNC.0000000000000002.
Middle-aged and older Hispanic men who have sex with men (HMSM) are at risk of health disparities related to HIV infection risk. This study explored the effects of social support, loneliness, depressive symptoms, and sexual risk behaviors on middle-aged and older HMSM, which may result in HIV infection. A sample of 150 South Floridian HMSM, ages 40-65 years, completed instruments that measured social support, loneliness, depressive symptoms, and sexual behaviors. Participants who engaged in sex with a person living with HIV or unknown HIV status or those who had unprotected receptive anal sex reported decreased social support and higher levels of loneliness and depressive symptoms. Results of this study highlight the importance of addressing the intersection of mental health and sexual risk behaviors of middle-aged and older HMSM when developing behavioral interventions aimed at reducing sexual risk behaviors.
20Loneliness and HIV-related stigma explain depression among older HIV-positive adults.PubMed
Christian Grov, Sarit A Golub, Jeffrey T Parsons, et al.
AIDS Care. 2010 May;22(5):630-9. doi: 10.1080/09540120903280901.
Advances in the treatment of HIV have resulted in a large growing population of older adults with HIV. These aging adults face added social, psychological, and physical challenges associated with the aging process. Correlations between depression, loneliness, health, and HIV/AIDS-related stigma have been studied, but there is little evaluation of these associations among HIV-positive adults over the age of 50. Data for these analyses were taken from the Research on Older Adults with HIV study of 914 New York City-based HIV-positive men and women over the age of 50. In total, 39.1% of participants exhibited symptoms of major depression (CES-D > 23). Multivariate modeling successfully explained 42% of the variance in depression which was significantly related to increased HIV-associated stigma, increased loneliness, decreased cognitive functioning, reduced levels of energy, and being younger. These data underscore the need for service providers and researchers to assert more aggressive and innovative efforts to resolve both psychosocial and physical health issues that characterize the graying of the AIDS epidemic in the USA. Data suggest that focusing efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health.
21Loneliness in HIV-infected smokers.PubMed
Cassandra A Stanton, Alyson B Moadel, Ryung S Kim, et al.
AIDS Care. 2015;27(2):268-72. doi: 10.1080/09540121.2014.963017. Epub 2014 Oct 8.
Loneliness is common in persons living with HIV (PLWH). Lonely people smoke at higher rates than the general population, and loneliness is a likely contributor to the ongoing smoking epidemic among PLWH. We explored factors associated with loneliness in a cohort of 272 PLWH smokers enrolled in two separate tobacco treatment trials. Loneliness was independently associated with lack of a spouse or partner, lower educational attainment, "other or unknown" HIV exposure category, depression, anxiety, recent alcohol consumption, and higher daily cigarette consumption. Referral to group therapy reduced loneliness, whereas referral to an individual web-based tobacco treatment did not.
22Loneliness and social isolation in people with HIV aged ≥50 years. The No One Alone (NOA)-GeSIDA study conducted by the GeSIDA 12021 study group.PubMed
José-Ramón Blanco, Alicia Gonzalez-Baeza, Ana Martinez-Vicente, et al.
HIV Med. 2025 Mar;26(3):399-414. doi: 10.1111/hiv.13743. Epub 2024 Nov 22.
INTRODUCTION: There is a growing number of people with HIV who are aged 50 years or older, and the prevalence of loneliness and social isolation remains unknown. METHODS: A multicentre study was conducted across 22 GeSIDA centres. A survey was carried out to assess loneliness [UCLA 3-item Loneliness Scale-3 (UCLA-3)] and social isolation [Lubben Social Network Scale-Revised (LSNS-R)], along with sociodemographic aspects, HIV-related factors, comorbidities, tobacco, alcohol and drug consumption, quality of life, anxiety and depression, and stigma. The prevalence of loneliness (UCLA-3 ≥ 6) and evident social isolation (LSNS-R ≤ 20) was calculated, and multivariable multinominal logistic regression models were used to identify associated factors. RESULTS: A total of 399 people with HIV were included; 77.4% were men, of average age 59.9 years (SD 6.5); 45.1% were aged ≥60 years; 86% were born in Spain; 86.7% in urban areas; 56.4% with secondary or higher education; 4.5% living alone against their wishes. A total of 66.9% were infected through sexual transmission, with a median of 22.9 years since diagnosis [interquartile range (IQR): 12.6-29.5] and a median nadir CD4 count of 245 cells/μL (IQR: 89-440). Overall, 90.7% had viral load <50 copies/mL, 93.5% had adherence >95%, and 26.3% had a prior AIDS diagnosis. In all, 29.1% and 21% reported significant symptoms of anxiety and depression, respectively, 24.3% had mobility issues, and 40.8% reported pain. Overall, 77.7% of participants reported neither loneliness nor social isolation, 10.0% loneliness only, 5.8% social isolation only and 6.5% both. Multivariable analyses identified that being aged 50-59, unemployed or retired, living alone unwillingly, single, poor quality of life, anxiety, and HIV-related stigma were associated with loneliness. Meanwhile, lower education, living alone unwillingly, and depressive symptoms were associated with social isolation. Individuals living alone unwillingly, with depressive symptoms and experiencing HIV-related stigma were at higher risk for both loneliness and social isolation. CONCLUSIONS: There is a relatively high prevalence of loneliness and social isolation in our population. Living alone against one's wishes, being unmarried, and experiencing mobility issues could predispose individuals to feel lonely and socially isolated. Those with anxiety and stigma are more prone to loneliness, while individuals with depression are more predisposed to social isolation. It is necessary to develop strategies for the detection and management of loneliness and social isolation in people with HIV aged >50 years.
23Mechanisms of immune aging in HIV.PubMed
Manon Chauvin, Delphine Sauce
Clin Sci (Lond). 2022 Jan 14;136(1):61-80. doi: 10.1042/CS20210344.
Massive CD4+ T-cell depletion as well as sustained immune activation and inflammation are hallmarks of Human Immunodeficiency Virus (HIV)-1 infection. In recent years, an emerging concept draws an intriguing parallel between HIV-1 infection and aging. Indeed, many of the alterations that affect innate and adaptive immune subsets in HIV-infected individuals are reminiscent of the process of immune aging, characteristic of old age. These changes, of which the presumed cause is the systemic immune activation established in patients, likely participate in the immuno-incompetence described with HIV progression. With the success of antiretroviral therapy (ART), HIV-seropositive patients can now live for many years despite chronic viral infection. However, acquired immunodeficiency syndrome (AIDS)-related opportunistic infections have given way to chronic diseases as the leading cause of death since HIV infection. Therefore, the comparison between HIV-1 infected patients and uninfected elderly individuals goes beyond the sole onset of immunosenescence and extends to the deterioration of several physiological functions related to inflammation and systemic aging. In light of this observation, it is interesting to understand the precise link between immune activation and aging in HIV-1 infection to figure out how to best care for people living with HIV (PLWH).
24Immunosenescence and aging in HIV.PubMed
Chris Tsoukas
Curr Opin HIV AIDS. 2014 Jul;9(4):398-404. doi: 10.1097/COH.0000000000000077.
PURPOSE OF THE REVIEW: During this era of unprecedented antiretroviral therapeutic efficacy, there is hope for successfully treated individuals to achieve a longevity approaching that of the general population. However, the recent identification of a higher incidence of cardiovascular, bone, metabolic, neurocognitive and other aging comorbidities is of major concern and may compromise that ability. The purpose of this review is to focus on the dynamic process of immune remodelling, known as immune senescence, which occurs during HIV infection, and how it impacts on long-term comorbidities. RECENT FINDINGS: Early aging in those with HIV appears to stem from persistent chronic inflammation and residual immune activation despite successful antiretroviral therapy. Multiple similarities exist between the T-cell-senescent phenotypes found in many chronic autoimmune and inflammatory conditions, including HIV disease, and the elderly. The immune risk phenotype is linked to poor clinical outcomes in the elderly and may also have clinical consequences in those with HIV. SUMMARY: Immune senescence results in functional impairments of immunity and a reduced ability to adapt to metabolic stress. Understanding the factors driving the development of immune senescence is critical for the development of strategies to prevent early aging.
25Acquired immunodeficiencies and tuberculosis: focus on HIV/AIDS and diabetes mellitus.PubMed
Katharina Ronacher, Simone A Joosten, Reinout van Crevel, et al.
Immunol Rev. 2015 Mar;264(1):121-37. doi: 10.1111/imr.12257.
The spread of human immunodeficiency virus (HIV) infection within Africa led to marked increases in numbers of cases of tuberculosis (TB), and although the epidemic peaked in 2006, there were still 1.8 million new cases in 2013, with 29.2 million prevalent cases. Half of all TB cases in Africa are in those with HIV co-infection. A brief review of the well-documented main immunological mechanisms of HIV-associated increased susceptibility to TB is presented. However, a new threat is facing TB control, which presents itself in the form of a rapid increase in the number of people living with type II diabetes mellitus (T2DM), particularly in areas that are already hardest hit by the TB epidemic. T2DM increases susceptibility to TB threefold, and the TB burden attributable to T2DM is 15%. This review addresses the much smaller body of research information available on T2DM-TB, compared to HIV-TB comorbidity. We discuss the altered clinical presentation of TB in the context of T2DM comorbidity, changes in innate and adaptive immune responses, including lymphocyte subsets and T-cell phenotypes, the effect of treatment of the different comorbidities, changes in biomarker expression and genetic predisposition to the respective morbidities, and other factors affecting the comorbidity. Although significant gains have been made in improving our understanding of the underlying mechanisms of T2DM-associated increased susceptibility, knowledge gaps still exist that require urgent attention.
26Are HIV-Infected Older Adults Aging Differently?PubMed
Stephen E Karpiak, Richard Havlik
Interdiscip Top Gerontol Geriatr. 2017;42:11-27. doi: 10.1159/000448539. Epub 2016 Nov 22.
With increasing success in treating HIV, infected persons are living longer, and a new challenge has emerged - the need to understand how HIV-infected adults are aging. What are the similarities with typical aging and what are the unique aspects that may have resulted from HIV infection, interacting with characteristic life style factors and other comorbid conditions? Are specific diseases and conditions (comorbidities), typically seen as part of the aging process, occurring at accelerated rates or with higher frequency (accentuated) in HIV-infected adults? At this juncture, conclusions should be tentative. Certainly, biological processes that correlate with aging occur earlier in the older adult HIV population. Clinical manifestations of these biological processes are age-associated illnesses occurring in greater numbers (multimorbidity), but they are not accelerated. Specifically cardiovascular disease, certain cancers, and renal disease are more common with other comorbidities less certain. Management of this elevated risk for developing multimorbidity is a major concern for patients and their health care teams. The medical system must respond to the evolving needs of this aging and growing older adult population who will dominate the epidemic. Adopting a more holistic approach to their health care management is needed to achieve optimal health and well-being in the HIV-infected older adult. Geriatric care principles best embody this approach.
27Epigenetics, HIV, and Cardiovascular Disease Risk.PubMed
Bertrand Fabien Ebner, Teresa Chueng, Claudia A Martinez
Curr Probl Cardiol. 2021 Mar;46(3):100615. doi: 10.1016/j.cpcardiol.2020.100615. Epub 2020 Apr 28.
Human immunodeficiency virus (HIV) is currently considered a risk factor for cardiovascular disease (CVD). With the advent of antiretroviral treatment and prevention, HIV-related morbidity and mortality rates have decreased significantly. Prolonged life expectancy heralded higher prevalence of diseases of aging, including CVD-associated morbidity and mortality, having an earlier onset in people living with HIV (PLHIV) compared to their noninfected counterparts. Several epigenetic biomarkers are now available as predictors of health and disease, with DNA methylation being one of the most widely studied. Epigenetic biomarkers are changes in gene expression without alterations to the intrinsic DNA sequence, with the potential to predict risk of future CVD, as well as the outcome and response to therapy among PLHIV. We sought to review the available literature referencing epigenetic markers to determine underlying biomechanism predisposing high-risk PLHIV to CVD, elucidating areas of possible intervention.
28Managing antiretroviral therapy in the elderly HIV patient.PubMed
Giovanni Guaraldi, Ines Pintassilgo, Jovana Milic, et al.
Expert Rev Clin Pharmacol. 2018 Dec;11(12):1171-1181. doi: 10.1080/17512433.2018.1549484. Epub 2018 Nov 26.
: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. : This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. : Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
29HIV infection and aging.PubMed
José R Blanco, Ana M Caro, Santiago Pérez-Cachafeiro, et al.
AIDS Rev. 2010 Oct-Dec;12(4):218-30.
The median age of HIV-infected patients is increasing all over the world. Age has a significant impact on some aspects of HIV-infection when compared to younger patients. Diagnostic delay and late presentation are more frequent in older patients because some of the initial symptoms are masked by age and because older people are not considered to be a risk group for HIV infection. Despite the clinical, immunological, and virologic benefits of HAART, most studies suggest that older patients have a poorer immunological and clinical response to HAART than younger patients, despite a similar virologic response. Other problems include the frequent presence of comorbid conditions and medications that can affect the efficacy and safety of HAART as well as its pharmacokinetics and pharmacodynamics. Because no guidelines recommend a specific HAART regimen for older people, specific clinical trials and pharmacological studies should be designed to optimize HAART in these patients.
30Antiretroviral Treatment Efficacy and Safety in Older HIV-Infected Adults.PubMed
Jacqueline Jourjy, Keelin Dahl, Emily Huesgen
Pharmacotherapy. 2015 Dec;35(12):1140-51. doi: 10.1002/phar.1670.
Highly active antiretroviral therapy (ART) and its widespread availability have revolutionized the landscape of HIV care and patient outcomes, transforming infection with HIV into a manageable chronic condition rather than a life-limiting disease. This transformation has created an older patient demographic. The effect that older age has on the outcomes of ART is not completely understood. Limited data are available in older individuals due to underrepresentation in clinical trials. To better understand this relationship, we conducted a literature search to assess the impact of older age on the outcomes of ART in the older HIV-infected population, including immunologic and virologic outcomes, mortality, disease progression, toxicity of ART, and pharmacokinetic considerations. In addition, package inserts of antiretroviral (ARV) medications were reviewed for efficacy, safety, and pharmacokinetic information pertaining to the older population. Most studies in older adults (50 yrs or older) demonstrated slower and blunted CD4 immune recovery but better virologic suppression in response to ART. Higher rates of mortality and faster disease progression have been observed in adults 50 years and older, particularly during the first year after ART initiation. HIV-infected patients aged 50 years and older appear to be at greater risk for certain ART-associated toxicities including nephrotoxicity, decline in bone mineral density and bone fracture, symptomatic peripheral neuropathy, and cardiovascular disease including myocardial infarction. The available literature suggests that clinicians should consider avoiding agents such as tenofovir disoproxil fumarate (TDF) in older patients with risk factors for renal impairment and/or osteoporosis. If TDF is used in patients aged 50 years or older, more frequent monitoring should be considered. Older age was a significant predictor for higher atazanavir exposure and higher lopinavir trough concentration at 24 weeks. The clinical implications of these findings are unknown. It is imperative that future development of novel ARV drug therapies includes a greater proportion of older subjects in clinical trials.
31HIV, aging, and adherence: an update and future directions.PubMed
Sarah Czarna Mann, Jose R Castillo-Mancilla
Curr Opin HIV AIDS. 2020 Mar;15(2):134-141. doi: 10.1097/COH.0000000000000615.
PURPOSE OF REVIEW: To highlight recent data on antiretroviral adherence in older people living with HIV (PLWH), describe the most relevant pharmacokinetic antiretroviral studies, and identify critical research gaps in this population. RECENT FINDINGS: Overall, studies have found that older PLWH are more likely to be adherent to antiretroviral therapy (ART). Although multiple methods to measure adherence are available (self-report, pharmacy refills, electronic device monitors, drug concentrations), there is currently no 'gold standard' adherence measure or sufficient evidence to suggest a preferred method in older patients. Recently, studies evaluating antiretroviral concentrations in hair and dried blood spots in older patients identified no major differences when compared with younger individuals. Similarly, although pharmacokinetic studies in older PLWH are scarce, most data reveal no significant pharmacokinetic differences in the aging population. Furthermore, no specific guidelines or treatment recommendations regarding ART dose modification or long-term toxicity in aging PLWH are available, mostly because of the exclusion of this population in clinical trials. SUMMARY: How aging influences adherence and pharmacokinetics remains poorly understood. As the population of older PLWH increases, research focusing on adherence, toxicity, drug--drug interactions, and the influence of comorbidities is needed.
32Morbidity in older HIV-infected patients: impact of long-term antiretroviral use.PubMed
Giovanni Guaraldi, Manyu Prakash, Christiane Moecklinghoff, et al.
AIDS Rev. 2014 Apr-Jun;16(2):75-89.
The introduction of HAART has represented a major advance in the care of people with HIV. By markedly increasing life expectancy, HAART has significantly changed the pattern of HIV infection in developed countries, the "graying" of the HIV-infected population being a powerful testament to its success. However, this has presented physicians with new challenges relating to the care of older patients with HIV, many of whom exhibit a "frailty syndrome" associated with increased comorbidity and chronic low-grade inflammation in a process which has recently been termed "inflammaging". This paper reviews the pattern of morbidity seen in older HIV-infected patients and examines the effects, both beneficial and deleterious, of antiretroviral therapy. The efficacy and tolerability of antiretroviral therapy is of particular importance in older patients, given the likelihood that increased frailty may magnify the consequences both of suboptimal viral suppression and of toxicity, and in view of the complications that may arise from the presence of comorbidities and resultant polypharmacy. The challenge is to maximize antiviral efficacy and minimize toxicity, while taking into account the often complex web of comorbidities that may be present in these patients. This challenge is being met through the refinement of existing antiretroviral therapy regimens, the development of new agents, and a growing focus on a more holistic approach to care, which acknowledges the importance of the overall "health picture" and of good communication and cooperation between treating physicians and patients.
33Comorbidities among the HIV-infected patients aged 40 years or older in Taiwan.PubMed
Pei-Ying Wu, Mao-Yuan Chen, Szu-Min Hsieh, et al.
PLoS One. 2014 Aug 13;9(8):e104945. doi: 10.1371/journal.pone.0104945. eCollection 2014.
BACKGROUND: With the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART. METHODS: We reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications. RESULTS: During the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log10 copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m2 (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%). CONCLUSIONS: Our findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.
34Polypharmacy in the HIV-infected older adult population.PubMed
Lauren J Gleason, Amneris E Luque, Krupa Shah
Clin Interv Aging. 2013;8:749-63. doi: 10.2147/CIA.S37738. Epub 2013 Jun 21.
The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
35[Human immunodeficiency virus infection in the elderly].PubMed
Johannes R Bogner
Z Gerontol Geriatr. 2020 Mar;53(2):179-191. doi: 10.1007/s00391-019-01669-2. Epub 2019 Dec 12.
Due to the excellent efficacy of antiretroviral treatment increasingly more people with human immunodeficiency virus (HIV) infections survive to old age. The national and international definition of older people with HIV infections comprises those aged 50 years and older. Practitioners caring for these patients have to take age-related comorbidities and polypharmacy into account. Cooperation between HIV caregivers and general practitioners as well as geriatric specialists should provide a network that covers topics such as vaccinations, early detection of malignancies and psychosocial aspects, such as loneliness and organization of nursing care. A schedule for preventive measures is presented in this article as well as practical approaches including access to drug interaction databases and HIV treatment guidelines.
36[Ifosphamide nephrotoxicity].PubMed
Gaël Ensergueix, Alexandre Karras
Nephrol Ther. 2018 Apr;14 Suppl 1:S125-S131. doi: 10.1016/j.nephro.2018.02.008.
Ifosfamide is a cytotoxic drug usually used in malignant sarcomas. The nephrotoxicity of this agent has been described essentially among children, revealed by renal failure and proximal tubulopathy. We recently conducted a retrospective multicentre study, describing 34 adult patients admitted for ifosfamide nephrotoxicity. More than 80% of them presented with renal failure, diagnosed up to 48 months after ifosfamide administration. A Fanconi syndrome with hypophosphoremia, hypokaliemia, glucosuria and low-molecular weight proteinuria, was present in two third of all cases. Median estimated glomerular filtration rate was 31mL/min 1 month and 38mL/min 3 months after ifosfamide infusion, versus 67mL/min at baseline. Renal biopsy, performed in 14 of these patients, showed acute tubular necrosis with vacuolization of proximal tubular epithelial cells with marked nuclear modifications, whereas electron microscopy revealed major changes of mitochondrial structure inside those cells, suggesting a tenofovir-like mechanism of nephrotoxicity. After a median follow-up of 31 months, ten patients out of 34 reached stage 5 chronic kidney disease, requiring dialysis in five cases. Poor renal prognosis was associated with concomitant cisplatin use (P=0.02) and with older age at presentation (P=0.04). In conclusion, ifosfamide nephrotoxicity is often severe and irreversible, leading to proximal tubulopathy and sometimes-severe chronic kidney failure, that can be immediate or delayed, sometimes diagnosed months after chemotherapy completion.
37Tenofovir-induced osteomalacia.PubMed
D P Wanner, A Tyndall, U A Walker
Clin Exp Rheumatol. 2009 Nov-Dec;27(6):1001-3.
We present an HIV-infected woman in whom antiretroviral treatment with tenofovir disoproxil fumarate (TDF) induced severe skeletal pain, synovial effusions and multiple fractures secondary to a Fanconi syndrome with hypophosphatemia and osteomalacia. TDF interferes with the replication of mitochondrial DNA in the proximal tubules of the kidney, which can explain the delayed onset of this form of renal phosphate loss. Nephrotoxicity had been precipitated by cotreatment with lopinavir/r, an HIV protease inhibitor which increases tenofovir serum levels and inhibits the tubular multidrug resistance protein 4, which is responsible for the efflux of tenofovir from tubular cells.Awareness is needed to link the typically prolonged onset of clinical symptoms with TDF exposure and then establish the correct diagnosis.
38Tenofovir-associated proteinuria.PubMed
Mark D Kelly, Abby Gibson, Harry Bartlett, et al.
AIDS. 2013 Jan 28;27(3):479-81. doi: 10.1097/QAD.0b013e32835883bf.
Proteinuria was observed in 27% of 153 patients taking tenofovir for more than 1 year. Concomitant protease inhibitor therapy and cumulative tenofovir exposure were independently associated with proteinuria in this cohort. Proteinuria was reversible in 11 of 12 patients who ceased tenofovir because of proteinuria without altering other medications. Clinicians should be aware that tenofovir can cause reversible proteinuria in patients with HIV.
39Necessity and concerns beliefs and HIV medication adherence: a systematic review.PubMed
Luke D Mitzel, Peter A Vanable
J Behav Med. 2020 Feb;43(1):1-15. doi: 10.1007/s10865-019-00089-2. Epub 2019 Aug 8.
According to the Necessity-Concerns Framework, beliefs about medication necessity and concerns are two core themes from diverse patient medication beliefs across chronic illnesses that may directly influence adherence. Past work has supported associations of necessity and concerns to adherence in the chronic disease literature and in HIV research. However, there has not been a focused review of the literature on associations of necessity and concerns to HIV medication adherence, nor on what variables may influence these associations. This systematic review synthesized findings from 26 studies regarding associations of necessity and concerns to HIV medication adherence. Both beliefs showed small, clinically significant effects on adherence. A subset of studies identified perceptions of healthcare providers as determinants of necessity and concerns beliefs with indirect effects on adherence. Overall, necessity and concerns demonstrated clinically significant associations to adherence among people with HIV.
40Related factors to non-adherence to antiretroviral therapy in HIV/AIDS patients.PubMed
Juan Andrés Arrieta-Martínez, Jorge Iván Estrada-Acevedo, Carlos Alberto Gómez, et al.
Farm Hosp. 2022 Nov 24;46(6):319-326.
OBJECTIVE: To identify sociodemographic, clinical, and pharmacological factors associated with nonadherence to antiretroviral treatment in patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020 in four cities in Colombia. METHOD: An observational, cross-sectional, retrospective study was conducted of a population of patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020. The Morisky-Green scale, the simplified medication adherence questionnaire, and the simplified scale to detect adherence problems to antiretroviral treatment were applied to determine patient adherence. A binomial multiple logistic regression was performed to evaluate the factors that best explain nonadherence. RESULTS: A total of 9,835 patients were evaluated, of whom 74.4% were men, 71.1% were aged between 18 and 44 years, 76.0% had attended at most secondary school, 78.1% were single, and 97.6% resided in an urban area. After applying three different scales to each patient, 10% of the study population were identified as nonadherent to treatment. The risk of nonadherence was significantly higher in patients who presented any drug- related problem or had an adverse reaction to antiretroviral drugs. CONCLUSIONS: The variables most strongly associated with nonadherence to antiretroviral treatment were drug-related problems, adverse drug reactions, a history of nonadherence to treatment, and psychoactive substance use.
41Aging with HIV.PubMed
Giovanni Guaraldi, Jovana Milic, Cristina Mussini
Curr HIV/AIDS Rep. 2019 Dec;16(6):475-481. doi: 10.1007/s11904-019-00464-3.
PURPOSE OF REVIEW: This review points out unmet medical needs and open research questions of older adults living with HIV. Starting from the definition of aging in HIV, it explores the mosaic of this condition at epidemiological, pathophysiological, and clinical level. Antiretroviral management and diverse models of care are critically discussed. RECENT FINDINGS: Aging cohorts suggest HIV as a paradigm of chronic inflammation and immune activation with specific aging trajectory patterns in which antiretroviral therapy may play a role. In the absence of randomized clinical trials, observational cohorts show that therapy is driven by duration of HIV infection and burden of non-infectious comorbidities. This review suggests that geriatric approach should be used to recognize the complexity of aging goes beyond the viro-immunological success and management of progressive accumulation of non-communicable diseases. This requires recognition of frailty and geriatric syndromes to stratify patients' diversity by using comprehensive geriatric assessment tools.
42HIV and aging.PubMed
Edward J Wing
Int J Infect Dis. 2016 Dec;53:61-68. doi: 10.1016/j.ijid.2016.10.004. Epub 2016 Oct 15.
With the wider availability of antiretrovirals, the world's HIV population is aging. More than 10% of the 34.5 million HIV-positive individuals worldwide are over the age of 50 years and the average age continues to increase. In the USA more than 50% of the 1.3 million people with HIV are over 50 years old and by the year 2030 it is estimated that 70% will be over the age of 50 years. Although the life expectancy of HIV-positive people has increased dramatically, it still lags behind that of HIV-negative individuals. There is controversy about whether HIV itself accelerates the aging process. Elevated rates of inflammation seen in people with HIV, even if their viral loads are suppressed and their CD4 counts are preserved, are associated with greater rates of cardiovascular, renal, neurocognitive, oncological, and osteoporotic disease. These conditions increase exponentially in the elderly and will represent a major challenge for HIV patients. In addition, conditions such as geriatric syndromes including frailty are also seen at higher rates. Management of the aging HIV patient includes an emphasis on early diagnosis and treatment, preventative measures for co-morbidities, and avoiding polypharmacy. Finally, the issue of quality of life, prioritization of medical issues, and end of life care become increasingly important as the patient grows older.
43Ageing and inflammation in patients with HIV infection.PubMed
M Nasi, S De Biasi, L Gibellini, et al.
Clin Exp Immunol. 2017 Jan;187(1):44-52. doi: 10.1111/cei.12814. Epub 2016 Aug 9.
Nowadays, HIV patients have an expected lifespan that is only slightly shorter than healthy individuals. For this reason, along with the fact that infection can be acquired at a relatively advanced age, the effects of ageing on HIV people have begun to be evident. Successful anti-viral treatment is, on one hand, responsible for the development of side effects related to drug toxicity; on the other hand, it is not able to inhibit the onset of several complications caused by persistent immune activation and chronic inflammation. Therefore, patients with a relatively advanced age, i.e. aged more than 50 years, can experience pathologies that affect much older citizens. HIV individuals with non-AIDS-related complications can thus come to the attention of clinicians because of the presence of neurocognitive disorders, cardiovascular diseases, metabolic syndrome, bone abnormalities and non-HIV-associated cancers. Chronic inflammation and immune activation, observed typically in elderly people and defined as 'inflammaging', can be present in HIV patients who experience a type of premature ageing, which affects the quality of life significantly. This relatively new condition is extremely complex, and important factors have been identified as well as the traditional behavioural risk factors, e.g. the toxicity of anti-retroviral treatments and the above-mentioned chronic inflammation leading to a functional decline and a vulnerability to injury or pathologies. Here, we discuss the role of inflammation and immune activation on the most important non-AIDS-related complications of chronic HIV infection, and the contribution of aging per se to this scenario.
44CNS Neurotoxicity of Antiretrovirals.PubMed
Tyler Lanman, Scott Letendre, Qing Ma, et al.
J Neuroimmune Pharmacol. 2021 Mar;16(1):130-143. doi: 10.1007/s11481-019-09886-7. Epub 2019 Dec 10.
The development of novel antiretroviral treatments has led to a significant turning point in the fight against HIV. Although therapy leads to virologic suppression and prolonged life expectancies, HIV-associated neurocognitive disorder (HAND) remains prevalent. While various hypotheses have been proposed to explain this phenomenon, a growing body of literature explores the neurotoxic effects of antiretroviral therapy. Research to date brings into question the potential role of such medications in neurocognitive and neuropsychiatric impairment seen in HIV-positive patients. This review highlights recent findings and controversies in cellular, molecular, and clinical neurotoxicity of antiretrovirals. It explores the pathogenesis of such toxicity and relates it to clinical manifestations in each medication class. The concept of accelerated aging in persons living with HIV (PLWH) as well as potential treatments for HAND are also discussed. Ultimately, this article hopes to educate clinicians and basic scientists about the neurotoxic effects of antiretrovirals and spur future scientific investigation into this important topic. Graphical Abstract.
45Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis.PubMed
Anoop S V Shah, Dominik Stelzle, Kuan Ken Lee, et al.
Circulation. 2018 Sep 11;138(11):1100-1112. doi: 10.1161/CIRCULATIONAHA.117.033369.
BACKGROUND: With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV. METHODS: We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV. RESULTS: In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8-83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68-2.77). Over the past 26 years, the global population-attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%-0.56%) to 0.92% (95% CI, 0.55%-1.41%), and DALYs increased from 0.74 (95% CI, 0.44-1.16) to 2.57 (95% CI, 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43-1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23-0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho. CONCLUSIONS: People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions. CLINICAL TRIAL REGISTRATION: URL: https://www.crd.york.ac.uk/prospero . Unique identifier: CRD42016048257.
46HIV infection and coronary heart disease: mechanisms and management.PubMed
Priscilla Y Hsue, David D Waters
Nat Rev Cardiol. 2019 Dec;16(12):745-759. doi: 10.1038/s41569-019-0219-9. Epub 2019 Jun 10.
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
47HIV-associated neurocognitive disorder.PubMed
Ruaridh Cameron Smail, Bruce James Brew
Handb Clin Neurol. 2018;152:75-97. doi: 10.1016/B978-0-444-63849-6.00007-4.
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects roughly half the HIV-positive population. The symptoms of cognitive slowing, poor concentration, and memory problems can impact on everyday life. Its diagnosis is validated where possible by identifying deficits in two cognitive domains on neuropsychologic testing in patients either with or without symptoms. Corroborating evidence may be found on imaging, blood tests, and cerebrospinal fluid analysis, though sensitive and specific biomarkers are currently lacking. The introduction of combined antiretroviral therapy in the 1990s has generated a therapeutic paradox whereby the number of severe cases of HAND has fallen, yet milder forms continue to rise in prevalence. New emphasis has been placed on identifying the cause of apparent ongoing HIV infection and inflammation of the central nervous system (CNS) in the face of durable systemic viral suppression, and how this equates to the neuronal dysfunction underlying HAND. The interaction with aging and comorbidities is becoming increasingly common as the HIV-positive population enters older adulthood, with neurodegenerative, metabolic, and vascular causes of cognitive impairment combining and probably accelerating in the context of chronic HIV infection. Therapies targeted to the CNS, but without neurotoxic side-effects, are being investigated to attempt to reduce the likelihood of developing, and improving, HAND.
48Pathogenesis of age-related HIV neurodegeneration.PubMed
Miroslaw Mack Mackiewicz, Cassia Overk, Cristian L Achim, et al.
J Neurovirol. 2019 Oct;25(5):622-633. doi: 10.1007/s13365-019-00728-z. Epub 2019 Feb 21.
People over the age of 50 are the fastest growing segment of the HIV-infected population in the USA. Although antiretroviral therapy has remarkable success controlling the systemic HIV infection, HIV-associated neurocognitive disorder (HAND) prevalence has increased or remained the same among this group, and cognitive deficits appear more severe in aged patients with HIV. The mechanisms of HAND in the aged population are not completely understood; a leading hypothesis is that aged individuals with HIV might be at higher risk of developing Alzheimer's disease (AD) or one of the AD-related dementias (ADRD). There are a number of mechanisms through which chronic HIV disease alone or in combination with antiretroviral therapy and other comorbidities (e.g., drug use, hepatitis C virus (HCV)) might be contributing to HAND in individuals over the age of 50 years, including (1) overlapping pathogenic mechanisms between HIV and aging (e.g., decreased proteostasis, DNA damage, chronic inflammation, epigenetics, vascular), which could lead to accelerated cellular aging and neurodegeneration and/or (2) by promoting pathways involved in AD/ADRD neuropathogenesis (e.g., triggering amyloid β, Tau, or α-synuclein accumulation). In this manuscript, we will review some of the potential common mechanisms involved and evidence in favor and against a role of AD/ADRD in HAND.
49Neurobiology of HIV.PubMed
Britta Hult, Gursharan Chana, Eliezer Masliah, et al.
Int Rev Psychiatry. 2008 Feb;20(1):3-13. doi: 10.1080/09540260701862086.
The importance of HIV cognitive impairment, including HIV associated dementia (HAD) and minor cognitive/motor disorder, has continued in the era of highly active antiretroviral therapy (HAART). Despite the relative efficacy of HAART in controlling HIV disease, there is no treatment which specifically targets the cause of HAD nor promotes neuronal protection from the effects of the virus. Much work has been done to elucidate the complex signalling pathways, effects of virus and viral proteins, and dysregulation of endogenous targets which lead to HIV associated neurotoxicity, but the concise mechanism remains elusive. It is widely accepted that the majority of viral replication in the brain occurs in monocyte derived macrophages (MDM) and microglia, and immune activation of these cells, along with astrocytic cells, may be the most important cause of neurotoxicity in the central nervous system (CNS). Additional complications arise when co-factors such as drug use, age related neuropathology, and other viruses are present. Further exploration of the molecular mechanisms leading to HIV neurotoxicity and neurodegeneration may reveal targets for prophylactic neuroprotective or other CNS-specific drugs. Given the variable success of the current HAART drugs against virus in the CNS, such therapies would greatly benefit the HIV infected population as they live longer and more productive lives.
50Global HIV neurology: a comprehensive review.PubMed
Kiran T Thakur, Alexandra Boubour, Deanna Saylor, et al.
AIDS. 2019 Feb 1;33(2):163-184. doi: 10.1097/QAD.0000000000001796.
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
51Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm.PubMed
Lucette A Cysique, Bruce J Brew
J Neurovirol. 2019 Oct;25(5):710-721. doi: 10.1007/s13365-018-0706-5. Epub 2019 Jan 11.
In this review, we propose that vascular cognitive impairment (VCI), with relevance for the global HIV population, is fundamentally and clinically linked to the persistence of mild forms of HIV-associated neurocognitive disorders (HAND) in ageing people living with HIV infection (PLWH). After placing our review within the context of the general literature on HIV and ageing, we review non-VCI risks for dementia in ageing PLWH. We then present the recently updated VCI nomenclature and show that the neuropsychological and neuroimaging phenotypes of VCI and HAND are largely overlapping, suggesting that further research is needed to accurately distinguish them. We further link VCI and HAND at the mechanistic level by advancing the innovative proposal that the neuro-vascular unit (NVU) may represent the primary target of HIV-related brain injury in treated HIV infection. To this, we add the fundamental impact of mild and major VCI on the NVU. Importantly, we show that the potential contribution of vascular damage to overall brain damage in ageing PLWH is probably much higher than currently estimated because of methodological limitations, and because this research is only emerging. Finally, because all VCI risk factors are more prevalent, premature, and sometimes accelerated in the HIV population at large, we conclude that the probable total burden of VCI in the global HIV population is higher than in the general population and would need to be compared to chronic conditions such as type I diabetes and multiple sclerosis to account for the disease chronicity and lifelong treatment effects. Therefore, this review is also a call to action. Indeed, it is fully established that this amount of VCI burden is a major risk factor for dementia at aged 60+.
52Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review.PubMed
Yamnia I Cortés, Michael T Yin, Nancy K Reame
J Assoc Nurses AIDS Care. 2015 Jul-Aug;26(4):387-98. doi: 10.1016/j.jana.2015.03.005. Epub 2015 Apr 3.
With the development of effective antiretroviral therapy, HIV-infected women are living longer and transitioning through menopause. The purpose of our study was to systematically examine the evidence that menopause is an additional risk predictor for osteoporosis and fractures in HIV-infected women. Electronic databases were searched for studies of low bone density or fractures in HIV-infected postmenopausal women. Studies that met the inclusion criteria (n = 10) were appraised using a validated quality assessment tool. The majority of studies were rated as good quality and the remaining were fair. The prevalence of osteoporosis reported in these studies ranged from 7.3% to 84% and 0.7% to 23% in HIV-infected and uninfected postmenopausal women, respectively. In the two qualifying studies, postmenopausal status was not a predictor of fractures in HIV-infected women. Findings suggest that HIV care providers should accurately assess postmenopausal status and modifiable risk factors for osteoporosis in all older HIV-infected women.
53More than osteoporosis: age-specific issues in bone health.PubMed
Kristine M Erlandson, Giovanni Guaraldi, Julian Falutz
Curr Opin HIV AIDS. 2016 May;11(3):343-50. doi: 10.1097/COH.0000000000000258.
PURPOSE OF REVIEW: The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls. RECENT FINDINGS: The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. SUMMARY: Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.
54NASH in HIV.PubMed
Adriana Cervo, Mohamed Shengir, Keyur Patel, et al.
Curr HIV/AIDS Rep. 2020 Dec;17(6):601-614. doi: 10.1007/s11904-020-00531-0.
PURPOSE OF REVIEW: Aging-related comorbidities, including liver disease, represent the main drivers of morbidity and mortality in people with HIV (PWH). Nonalcoholic fatty liver disease (NAFLD) seems a frequent comorbidity in aging PWH nowadays. NAFLD results from a fat deposition into the liver parenchyma that may evolve to nonalcoholic steatohepatitis (NASH), a state of hepatocellular inflammation and injury in response to the accumulated fat leading to liver fibrosis and cirrhosis. We here review the current status of knowledge regarding this emerging comorbidity in PWH. RECENT FINDINGS: Recent studies suggest that PWH are at higher risk for both NASH and NASH-related liver fibrosis. Several hypothesized pathogenic mechanisms may account for this finding, including increased metabolic comorbidities, hepatotoxic effect of lifelong antiretroviral therapy, and chronic HIV infection. In clinical practice, non-invasive diagnostic tests, such as serum biomarkers and elastography, may help identify patients with NASH-related fibrosis, thus improving risk stratification, and enhancing clinical management decisions, including early initiation of interventions such as lifestyle changes and potential pharmacologic interventions. Clinicians should remain informed of the frequency, significance, and diagnostic and management approach to NASH in PWH.
55Behavioral Health.PubMed
David W Pantalone, Stephanie E Czajkowski, S Wade Taylor
Interdiscip Top Gerontol Geriatr. 2017;42:85-100. doi: 10.1159/000448546. Epub 2016 Nov 22.
In this chapter, we will describe the state of the literature on behavioral health, which includes mental health and substance use problems, and the available treatment interventions to ameliorate these problems, for older adults living with HIV (OALH). The scientific literature on the behavioral health of OALH is highly underdeveloped, especially in terms of the creation of empirically supported interventions to alleviate psychological distress. From the literature that does exist, there are a number of salient factors that emerge, including stereotypes (i.e., older adults are not sexually active), stigmatization (of those who are HIV-positive), social isolation, unique psychosocial needs for newly-infected OALH, and elevated rates of emotional distress and concomitant disorders - especially, depression. These factors persist alongside findings that OALH have fewer sources of social or institutional support, fewer surviving peers, and a lack of family to care for them. Additionally, many OALH report problems with substance use, both as a function of their 'baby-boomer' generational status (i.e., people born between 1946 and 1964) and in terms of the life experiences associated with their HIV-positive status. Overall, it is unclear how mental health and substance use problems affect combination antiretroviral therapy adherence, multimorbidity, polypharmacy, or treatment outcomes in this population, and further study is needed.
56Psilocybin-assisted therapy and HIV-related shame.PubMed
Nicky J Mehtani, Mallory O Johnson, Peter S Hendricks, et al.
Sci Rep. 2024 Aug 2;14(1):17919. doi: 10.1038/s41598-024-68908-4.
As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of - 5.5 (- 6.5, - 3.5) points from baseline to 3-months follow-up (Z = - 2.6, p = 0.009, r = - 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.
57Social aspects of HIV/AIDS and aging: a thematic review.PubMed
Kerstin Stieber Roger, Javier Mignone, Susan Kirkland
Can J Aging. 2013 Sep;32(3):298-306. doi: 10.1017/S0714980813000330. Epub 2013 Aug 13.
Little research can be found describing social aspects of aging with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) in Canada specifically, despite an overall increase in an aging population and increased numbers of those aging with HIV/AIDS. A systematic literature review was conducted with a selective focus on social aspects related to older adults who are living with or at risk for contracting HIV/AIDS. The primary themes that emerged in the literature are ageism and stigma, gender, mental health, and social supports. Recommendations for future research regarding prevention and education of risks for older adults and programming suitable for a wide range of audiences are presented.
58HIV/AIDS-related stigma and discrimination among health care workers at Tanta University Hospitals, Egypt.PubMed
Ibrahim Ali Kabbash, Ehab A Abo Ali, Mostafa Mahmoud Elgendy, et al.
Environ Sci Pollut Res Int. 2018 Nov;25(31):30755-30762. doi: 10.1007/s11356-016-7848-x. Epub 2016 Oct 18.
HIV/AIDS-related stigma and discrimination among health care professionals is one of the most important factors of this disease expansion. This study aimed to assess the stigmatized attitude among health care providers toward people living with HIV (PLHIV) at Tanta University Hospitals. The study is a cross-sectional survey. Data was gathered from randomly selected 310 health care workers at Tanta University Hospital using a structured questionnaire. Among studied participants, only 24.0 % had previous contact with HIV patients during work and 21.3 % felt worried to touch cloths of HIV patients, 26.4 % were worried to dress the wounds of HIV patients and 27.4 % were afraid to get blood sample from HIV patients. Those who were unwilling to care for HIV patients represented 40 % and only 36 % reported that if discriminating against HIV patients, they may get in trouble. Less than one half (42 %) reported having enough supply for reducing risk of nosocomial infection with HIV and 86 % reported having no guidelines to deal with HIV patients. Out of the participants, 78.7 % reported that HIV patients should be ashamed of themselves. Among the participants, 35, 48, and 43 % preferred not to provide medical services to injecting drug users, men having sex with men and sex workers suspected to have HIV infection, respectively. Infection control is defective in the supplies and procedures. There is absence of policy and protocols with regard to dealing with PLHIV. Health care providers showed high levels of stigma and discrimination against PLHIV.
59The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV.PubMed
Andrew E Cressman, Chanelle J Howe, Amy S Nunn, et al.
AIDS Behav. 2020 Jan;24(1):151-164. doi: 10.1007/s10461-019-02522-8.
Receiving regular HIV care is crucial for maintaining good health among persons with HIV. However, racial and gender disparities in HIV care receipt exist. Discrimination and its impact may vary by race/ethnicity and gender, contributing to disparities. Data from 1578 women in the Women's Interagency HIV Study ascertained from 10/1/2012 to 9/30/2016 were used to: (1) estimate the relationship between discrimination and missing any scheduled HIV care appointments and (2) assess whether this relationship is effect measure modified by race/ethnicity. Self-reported measures captured discrimination and the primary outcome of missing any HIV care appointments in the last 6 months. Log-binomial models accounting for measured sources of confounding and selection bias were fit. For the primary outcome analyses, women experiencing discrimination typically had a higher prevalence of missing an HIV care appointment. Moreover, there was no statistically significant evidence for effect measure modification by race/ethnicity. Interventions to minimize discrimination or its impact may improve HIV care engagement among women.
60Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis.PubMed
Wei Ai, Chengxin Fan, Gifty Marley, et al.
HIV Med. 2023 Nov;24(11):1093-1105. doi: 10.1111/hiv.13523. Epub 2023 Jul 5.
BACKGROUND: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. METHODS: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. RESULTS: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9-43%, I = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12-74%, I = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician-patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. CONCLUSION: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.
61Anxiety, depression, and quality of life among HIV positive injection drug users in Ukraine, 2017.PubMed
Marta Vasylyev, Hayk Davtyan, Olga Denisiuk, et al.
J Infect Dev Ctries. 2019 Jul 31;13(7.1):111S-117S. doi: 10.3855/jidc.11295.
INTRODUCTION: People who inject drugs (PWID) are one of the key populations most vulnerable to HIV infection, with 28 times higher prevalence compared to the rest of the population. PWID are known to have many physical, psychological and lifestyle challenges that can influence access to care. Depression is common among PWID living with HIV. It has major effect on health-related quality of life (HRQoL) and is influencing adherence to antiretroviral therapy. This study was conducted to explore how anxiety and depression affect HRQoL among HIV-positive PWID in Ukraine. It will provide knowledge for the further policy development. METHODOLOGY: A descriptive cross-sectional study using data from interviewer- administrated questionnaires was performed. The questionnaire was based on the Hospital Anxiety and Depression Scale. The questionnaire on HRQoL was based on the SF-36. RESULTS: Among the 90 HIV positive PWID 74% (67) and 61% (55) had anxiety and depression scores higher than 7 respectively, indicating that most patients had mental health problems. Average scores for general health (40), role limitations due to physical (44) and emotional health (34), vitality (41) and mental health (45) had mean scores less than 50 along with total physical (43) and mental health scores (35). Having an HIV positive partner or partner with unknown HIV status increases anxiety in HIV positive PWID. CONCLUSION: There are increased depressive and anxiety symptoms and poorer QoL among HIV-positive PWID in Ukraine. Strategies focusing on psychosocial support addressing QoL as part of HIV care could improve health outcomes for these comorbid and debilitating conditions.
62Depression and anxiety mediate perceived social support to predict health-related quality of life in pregnant women living with HIV.PubMed
Wang Xiaowen, Guo Guangping, Zhou Ling, et al.
AIDS Care. 2018 Sep;30(9):1147-1155. doi: 10.1080/09540121.2018.1456640. Epub 2018 Apr 1.
Pregnant women living with HIV represent one of the most high-priority groups for HIV treatment and health assessment. Although social support has been shown to be a protective factor for improved health-related quality of life (HRQoL), and depression and anxiety have been identified as two major causes of psychological distress among people living with HIV, it is still unclear how social support, anxiety, and depression interact to influence HRQoL. The objective of our study was to demonstrate the nature of predictors, direct effects and mediator effects among social support, anxiety, depression symptoms and HRQoL in pregnant women living with HIV. We investigated a total of 101 pregnant women living with HIV in Yunnan province in China from April 2016 to June 2016. All participants completed the Social Support Rating Scale (SSRS), the Chinese version of the Hospital Anxiety and Depression Scales (HADS) and Quality of Life instruments (EuroQoL Five Dimensions Questionnaire, EQ-5D). The relationships between the variables were examined by Pearson's or Spearman's correlation analysis. Predictor effects were tested using separate multiple regressions, controlling for demographic variables and HIV diagnosis variables. Direct and mediation effects of social support on HRQoL were tested using a structural equation model (SEM). Anxiety and depression symptoms were negatively correlated with subjective social support, support utilization, social support and HRQoL. Social support significantly predicted better HRQoL, and anxiety and depression symptoms significantly predicted poorer HRQoL. Anxiety and depression symptoms partially mediated the associations between social support and HRQoL. Anxiety and depression symptoms completely mediated the associations of objective support and support utilization with HRQoL. Interventions to improve HRQoL in pregnant women living with HIV must consider the mediation effect of anxiety and depression symptoms on the association between social support and HRQoL. Social support interventions are valid only when anxiety and depression symptoms are managed effectively.
63Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS.PubMed
Victoria Seffren, Itziar Familiar, Sarah M Murray, et al.
AIDS Care. 2018 Jul;30(7):888-895. doi: 10.1080/09540121.2018.1441969. Epub 2018 Feb 22.
Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.
64Depression symptoms, social support and overall health among HIV-positive individuals in Kenya.PubMed
Caroline Kingori, Zelalem T Haile, Peter Ngatia
Int J STD AIDS. 2015 Mar;26(3):165-72. doi: 10.1177/0956462414531933. Epub 2014 Apr 22.
In Kenya, there was a reported decline in HIV incidence and prevalence among those aged 15 to 64 years and children. Despite the decline, closer assessment of psychosocial issues like depression, contextual factors (family and community), and social support is necessary given the likely impact on overall health and HIV prevention. This paper examines an association between symptoms of depression and social support on overall health among HIV-positive participants recruited from an HIV clinic in Kenya. Descriptive statistics and logistic regression analyses were utilized. Findings reveal that compared to those with minimal depression (referent category) participants with mild, moderate, moderately severe/severe depression had higher odds of having poor health. For social support, compared with participants with no social support (referent category), participants with high social support had lower odds of having poor overall health in both unadjusted and multivariable-adjusted models. In conclusion, this study suggests that HIV clinics and interventions need to focus more on the psychological and/or mental health status of HIV-infected individuals while providing avenues such as social support groups that can be a buffer against the negative impact of HIV infection and depression on overall health outcomes.
65Social support as a mediator between mental health and stigma among newly HIV-positive men who have sex with men.PubMed
Yafang Zhao, Kaveh Khoshnood, Yu Sheng
Int J STD AIDS. 2024 May;35(6):477-486. doi: 10.1177/09564624241227653. Epub 2024 Feb 5.
OBJECTIVES: The sociocultural context of China gives rise to unique experiences of HIV-related stigma and adverse impacts on mental health among men who have sex with men (MSM) living with HIV. However, few studies have explored the stigma among families in the cultural context of China and the role of social support as a mediator to explain how HIV-related stigma results in poor psychological well-being. This study aims to test the mediating effect of social support between HIV-related stigma and family stigma on the mental health of MSM. METHODS: This cross-sectional study recruited newly MSM with HIV in two cities (Beijing and Wuhan) in China as participants from February 2021 to August 2022. A total of 257 MSM with HIV were recruited for the study. The mediating effects were examined using mediation models (SAS PROC CAUSALMED). RESULTS: The overall total effect of HIV-related stigma on mental health was = -1.483 (bootstrap 95% CI = -1.881, -1.104 < 0.001), and the mediating effect of social support was = -0.321 (bootstrap 95% CI = -0.571, -0.167 = .001). A higher level of stigma from family predicts lower mental health with an overall total effect of = -1.487 (bootstrap 95% CI = -1.823, -1.101 < 0.001), while the indirect effect (mediation effect) of social support on mental health is = -0.281 (bootstrap 95% CI = -0.477, -0.142 = .003). CONCLUSIONS: Given the mediating effect of social support on mental health, programs enhancing social support and decreasing stigmatization should be designed to improve the mental health of MSM with HIV, the interventions are needed at both the family and community levels. Public health campaigns in China that frame HIV and same-sex behavior as chronic issues and normal phenomena can correct misinformation related to HIV and MSM that leads to stigma and negative emotional reactions.
66Prevalence and Correlates of Frailty Among Older Adults Living With HIV in the CHANGE HIV Cohort.PubMed
Alice Zhabokritsky, Marina Klein, Marianne Harris, et al.
J Acquir Immune Defic Syndr. 2024 Nov 1;97(3):226-231. doi: 10.1097/QAI.0000000000003485. Epub 2024 Oct 7.
BACKGROUND: Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 count. METHODS: We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV aged 65 years or older. Participants were assessed using the Fried Frailty Phenotype at cohort entry, and those meeting ≥3 criteria were characterized as frail. We used Poisson regression with robust standard errors to estimate the association between nadir CD4 count and frailty, as well as age, gender, time since HIV diagnosis, comorbidities, marital status, and loneliness. RESULTS: Among 439 participants included in this analysis (median age 69 years, interquartile ranges 67-73), prevalence of frailty was 16.6%. Frailty was not associated with nadir CD4 count. Not being in a relationship (aRR 2.09, 95% CI 1.01 to 4.30) and greater degree of loneliness (aRR 1.25 per 10 point increase on UCLA loneliness scale, 95% CI 1.09 to 1.44) were associated with frailty. CONCLUSIONS: Frailty occurred in 16.6% of older adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV.
67Barriers to older adults seeking sexual health advice and treatment: A scoping review.PubMed
I Ezhova, L Savidge, C Bonnett, et al.
Int J Nurs Stud. 2020 Jul;107:103566. doi: 10.1016/j.ijnurstu.2020.103566. Epub 2020 Mar 10.
BACKGROUND: Sexual health is an integral part of overall health in older age. Research consistently reports that heterosexual and queer older people tend not to disclose sexual concerns and difficulties which increases the risks for sexually transmitted diseases. Older people are often absent from policies and information programmes and healthcare providers experience difficulties in initiating conversations around sexual health and history. OBJECTIVES: To identify what are the barriers that stop older people seeking sexual health advice and treatment. DESIGN AND METHOD: A scoping review methodology was employed. Published and unpublished literature was scoped through development of a research question, identification of potentially relevant studies, selection of relevant studies using an iterative team approach, charting data, collating, summarising and reporting findings, and considering the implications of study findings for further research. DATA SOURCES: Electronic databases searches were run to identify published and unpublished literature, including Medline, Embase, PsycINFO, CINAHL, ASSIA, Social Sciences, RCN and Cochrane Libraries. Additional studies were located through hand searching. RESULTS: Twelve studies from: the USA (n = 6); the UK (n = 3); Australia (n = 2); and one shared paper between New Zealand and UK met the inclusion criteria. Four barriers that stop older people seeking sexual health advice and treatment were identified, including (1) Cultural and societal views and beliefs toward sexual health; (2) Stigma, embarrassment and discrimination; (3) Lack of education and training of healthcare professionals; (4) Quality of relationship between patients and health professionals. CONCLUSION: Barriers to seeking and receiving advice and treatment for sexual health in later life clearly exist and are both related to cultural and social factors. Overall, the papers reviewed in this scoping review indicate that healthcare providers are reluctant to initiate conversations around sexual health or offer appropriate advice or clinical tests, and that older people tend to be hesitant to seek medical help. Later life age groups independently from their sexual orientation represent a hidden population and are absent from sexual health campaigns and government policies. Efforts need to be made by influential institutions and healthcare providers to recognise sexuality in older age and give older people the opportunity to open up regarding their sexual health and experiences.
68HIV/AIDS knowledge among Iranian Health Care Workers.PubMed
Mehdi Mirzaei-Alavijeh, Farzad Jalilian, Mohammad Esmaiel Motlagh, et al.
J Prev Med Hyg. 2020 Oct 6;61(3):E386-E391. doi: 10.15167/2421-4248/jpmh2020.61.3.1474. eCollection 2020 Sep.
BACKGROUND: HIV/AIDS remains a major public health concern globally and Health Care Workers (HCWs) are in the frontline of preventing and providing care in the health care system. The aim of this study was to evaluate HIV/AIDS knowledge among Iranian HCWs. METHODOLOGY: This cross-sectional study was conducted among 200 HCWs who were randomly selected from health care centers in Kermanshah city, west of Iran, 2018. HCWs filled out a self-administered questionnaire including the socio-demographic characteristics and HIV/AIDS knowledge items. Data were analyzed by SPSS version 16 using bivariate correlations, t-test, and ANOVA statistical tests. RESULTS: The mean score of HIV/AIDS knowledge was 29.73 [95% CI: 28.79, 30.67], ranged from 0 to 40 (74.3% of total percent). There was no significant association and correlation between HIV/AIDS knowledge and sex, education level, marital status, age and job history. Up to 50% had inadequate knowledge about HIV/AIDS status and transmission in Iran. CONCLUSIONS: HCWs HIV/AIDS knowledge was average and it seems need to be educating regarding HIV/AIDS status and transmission in Iran.
69Sex Differences in HIV Testing among Older Adults in Sub-Saharan Africa: A Systematic Review.PubMed
Akalewold T Gebremeskel, Nathali Gunawardena, Olumuyiwa Omonaiye, et al.
Biomed Res Int. 2021 Aug 21;2021:5599588. doi: 10.1155/2021/5599588. eCollection 2021.
BACKGROUND: Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. METHODS: A systematic search of four databases, namely, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Global Health, was conducted from 2000 to January 2020. The primary outcome of interest for this study was gender differences in HTC among older adults in SSA. Observational studies including cross-sectional, retrospective, and prospective cohort studies were included. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. RESULTS: From the database search, 4143 articles were identified. Five studies were ultimately included in the final review. Of the 1189 participants, 606 (51.1%) and 580 (48.9%) were female and male, respectively. The review findings suggested that both men and women preferred HTC providers that are the same sex as them with women additionally preferring a provider who is also of a similar age. Men and women differed in their pathways to getting tested for HIV. The review documented mixed results with regard to the associations between sex of older adults and uptake of HTC. Older adult HTC uptake data are limited in scope and coverage in sub-Saharan Africa. CONCLUSION: This review revealed shortage of evidence to evaluate optimum HTC utilization among older adults. Few studies examined sex differences in HIV testing among older adults in the region. There is a need for stakeholders working in the area of HIV prevention and treatment to focus on older adult health utilization evidence organization, disaggregated by age and sex. Hence, high-quality research designs are needed on the topic in order to generate good quality evidence for targeted interventions to improve HTC among older adults in sub-Saharan Africa.
70Nursing diagnoses for elderly women vulnerable to HIV/AIDS.PubMed
Márcia Cristina de Figueiredo Santos, Maria Miriam Lima da Nóbrega, Antonia Oliveira Silva, et al.
Rev Bras Enferm. 2018;71(suppl 3):1435-1444. doi: 10.1590/0034-7167-2017-0086.
OBJECTIVE: Classify the diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; Elaborate operational definitions of nursing diagnoses for elderly women vulnerable to HIV/AIDS. METHOD: A descriptive exploratory study, developed from March to December 2016 in the stages: 1. Classification of diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; 2. Operational definition of nursing diagnoses. RESULTS: 70 nursing diagnoses were classified in the conceptual framework of vulnerability of Ayres and Orem's self-care theory, and their operational definitions were constructed, where 75.7% of these were validated. FINAL CONSIDERATION: Diagnoses represent conditions that make older women vulnerable to HIV/AIDS and are linked to their self-care practices. Operational definitions contribute to a systematic approach to care and greater clarity in its implementation.
71Switch to bictegravir/emtricitabine/tenofovir alafenamide in people living with HIV aged 65 years or older: BICOLDER study - IMEA 057.PubMed
Minh P Lê, Clotilde Allavena, Véronique Joly, et al.
J Infect Public Health. 2025 Nov;18(11):102946. doi: 10.1016/j.jiph.2025.102946. Epub 2025 Sep 1.
BACKGROUND: Polymedication and comorbidities are frequent in aging people with HIV (PWH) and often associated with elevated incidences of adverse events (AEs) and drug-drug interactions (DDIs). The objective of this study was to evaluate the efficacy, safety and practicality of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), an antiretroviral (ARV) therapy with limited DDIs, in an elderly virologically-controlled PWH population. MATERIALS AND METHODS: This study was prospective, multicentric, single-arm conducted in HIV-1 controlled PWH aged over 65 years who switched from a ritonavir- or cobicistat-boosted containing regimen to B/F/TAF. The primary outcome was the proportion of participants maintaining plasma HIV-1 RNA < 50 copies/mL at Week24. Secondary endpoints included biological endpoints and co-morbidity (Charlson) and frailty (Fried) scores. Median (IQR) results are presented. RESULTS: 24 participants aged 69 years (67-73), 79.2 % Caucasian, were analyzed in the intention-to-treat analysis. 75 % of participants were receiving an elvitegravir/cobicistat based regimen. At week24 and week48, 91.7 % of participants maintained a plasma HIV-1 RNA < 50 copies/mL. Study treatment was discontinued in one participant due to virologic failure at week12, possibly related to adherence issues following AE. Drug-related AEs were reported in 6 participants, with one discontinuation at week4 (nightmare/mood disorder). No life-threatening AEs or deaths were reported. No significant modifications from baseline were reported in weight, co-morbidities, kidney parameters, cardiovascular risk or frailty scores at W48. A mild decrease of total cholesterol and triglycerides was reported. CONCLUSIONS: The findings indicate that B/F/TAF is both safe and effective for elderly PWH patients with a prolonged and documented history of HIV infection, multiple co-morbidities and concomitant medication.
72Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence.PubMed
Linlin Lindayani, Irma Darmawati, Heni Purnama, et al.
Creat Nurs. 2020 Feb 1;26(1):9-16. doi: 10.1891/1078-4535.26.1.9.
Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.
73Policy-maker attitudes to the ageing of the HIV cohort in Botswana.PubMed
Kabo Matlho, Refelwetswe Lebelonyane, Tim Driscoll, et al.
SAHARA J. 2017 Dec;14(1):31-37. doi: 10.1080/17290376.2017.1374879.
BACKGROUND: The roll out of antiretroviral therapy in Botswana, as in many countries with near universal access to treatment, has transformed HIV into a complex yet manageable chronic condition and has led to the emergence of a population aging with HIV. Although there has been some realization of this development at international level, no clear defined intervention strategy has been established in many highly affected countries. Therefore we explored attitudes of policy-makers and service providers towards HIV among older adults (50 years or older) in Botswana. METHODS: We conducted qualitative face-to-face interviews with 15 consenting personnel from the Ministry of Health, medical practitioners and non-governmental organizations involved in the administration of medical services, planning, strategies and policies that govern social, physical and medical intervention aimed at people living with HIV and health in general. The Shiffman and Smith Framework of how health issues become a priority was used as a guide for our analysis. RESULTS: Amidst an HIV prevalence of 25% among those aged 50-64 years, the respondents passively recognized the predicament posed by a population aging with HIV but exhibited a lack of comprehension and acknowledgement of the extent of the issue. An underlying persistent ageist stigma regarding sexual behaviour existed among a number of interviewees. Respondents also noted the lack of defined geriatric care within the provision of the national health care system. There seemed, however, to be a debate among the policy strategists and care providers as to whether the appropriate response should be specifically towards older adults living with HIV or rather to improve health services for older adults more generally. Respondents acknowledged that health systems in Botswana are still configured for individual diseases rather than coexisting chronic diseases even though it has become increasingly common for patients, particularly the aged, to have two or more medical conditions at the same time. CONCLUSIONS: HIV among older adults remains a low priority among policy-makers in Botswana but is at least now on the agenda. Action will require more concerted efforts to recognize HIV as a lifelong infection and putting greater emphasis on targeted care for older adults, focussing on multimorbidity.
74The cost of comorbidities in treatment for HIV/AIDS in California.PubMed
David S Zingmond, Kodi B Arfer, Jennifer L Gildner, et al.
PLoS One. 2017 Dec 14;12(12):e0189392. doi: 10.1371/journal.pone.0189392. eCollection 2017.
BACKGROUND: Antiretroviral therapy has increased longevity for people living with HIV (PLWH). As a result, PLWH increasingly experience the common diseases of aging and the resources needed to manage these comorbidities are increasing. This paper characterizes the number and types of comorbidities diagnosed among PLWH covered by Medicare and examines how non-HIV comorbidities relate to outpatient, inpatient, and pharmaceutical expenditures. METHODS: The study examined Medicare expenditures for 9767 HIV-positive Californians enrolled in Medicare in 2010 (7208 persons dually covered by Medicare and Medicaid and 2559 with Medicare only). Costs included both out of pocket costs and those paid by Medicare and Medicaid. Comorbidities were determined by examining diagnosis codes. FINDINGS: Medicare expenditures for Californians with HIV averaged $47,036 in 2010, with drugs accounting for about 2/3 of the total and outpatient costs 19% of the total. Inpatient costs accounted for 18% of the total. About 64% of the sample had at least one comorbidity in addition to HIV. Cross-validation showed that adding information on comorbidities to the quantile regression improved the accuracy of predicted individual expenditures. Non-HIV comorbidities relating to health habits-diabetes, hypertension, liver disease (hepatitis C), renal insufficiency-are common among PLWH. Cancer was relatively rare, but added significantly to cost. Comorbidities had little effect on pharmaceutical costs, which were dominated by the cost of antiretroviral therapy, but had a major effect on hospital admission. CONCLUSIONS: Comorbidities are prevalent among PLWH and add substantially to treatment costs for PLWH. Many of these comorbidities relate to health habits that could be addressed with additional prevention in ambulatory care, thereby improving health outcomes and ultimately reducing costs.
75Home-based long-term care.PubMed
World Health Organ Tech Rep Ser. 2000;898:i-v, 1-43.
Life expectancy is increasing in many parts of the world. Not only are more people living to old age, but more are also being enabled to live with disabling conditions that once might have been fatal. People who are chronically ill, those with serious disabilities, people with HIV/AIDS, mentally ill individuals, the victims of accidents and disasters, the elderly--many of these, and others, need continuing care and support. As the number of people in need of long-term care continues to grow worldwide, consideration of the best way to meet this need is receiving much more focus. The aim of such care is not simply to look after the sick but to enable those with long-term illnesses or disabilities to live their lives as fully and as rewardingly as possible. Such care is not just a social responsibility; it is a vital element in development. Institutionalization is often not the most suitable form of long-term care. The home, where the patient lives with family members, and where friends and other members of the community are not far away, is frequently more appropriate. This report by an international WHO Study Group examines the options. It points clearly to the benefits that home-based care offers to the patient, while stressing that the personal and health needs of caregivers in the home must not be compromised. Home-based long -term care has been practised by families for centuries, and family members will always remain a valuable resource for care. This report argues that it is time for health systems to take responsibility for providing caregivers in families and communities with the support they need both to help make their tasks more bearable and to bring a greater share of benefit to the patient.
76Reducing HIV-Associated Post-Hospital Mortality Through Home-Based Care in South Africa: A Randomized Controlled Trial.PubMed
Christopher J Hoffmann, Kate Shearer, Boitumelo Kekana, et al.
Clin Infect Dis. 2024 May 15;78(5):1256-1263. doi: 10.1093/cid/ciad727.
BACKGROUND: Twenty-three percent of people with human immunodeficiency virus (HIV, PWH) die within 6 months of hospital discharge. We tested the hypothesis whether a series of structured home visits could reduce mortality. METHODS: We designed a disease neutral home visit package with up to 6 home visits starting 1-week post-hospitalization and every 2 weeks thereafter. The home visit team used a structured assessment algorithm to evaluate and triage social and medical needs of the participant and provide nutritional support. We compared all-cause mortality 6 months following discharge for the intervention compared to usual care in a pilot randomized trial conducted in South Africa. To inform potential scale-up we also included and separately analyzed a group of people without HIV (PWOH). RESULTS: We enrolled 125 people with HIV and randomized them 1:1 to the home visit intervention or usual care. Fourteen were late exclusions because of death prior to discharge or delayed discharge leaving 111 for analysis. The median age was 39 years, 31% were men; and 70% had advanced HIV disease. At 6 months among PWH 4 (7.3%) in the home visit arm and 10 (17.9%) in the usual care arm (P = .09) had died. Among the 70 PWOH enrolled overall 6-month mortality was 10.1%. Of those in the home visit arm, 91% received at least one home visit. CONCLUSIONS: We demonstrated feasibility of delivering post-hospital home visits and demonstrated preliminary efficacy among PWH with a substantial, but not statistically significant, effect size (59% reduction in mortality). Coronavirus disease 2019 (COVID-19) related challenges resulted in under-enrollment.
77Aging With HIV: Health Policy and Advocacy Priorities.PubMed
Mark Brennan-Ing, Jesus Ramirez-Valles, Aaron Tax
Health Educ Behav. 2021 Feb;48(1):5-8. doi: 10.1177/1090198120984368.
The aging of people with HIV (PWH) is a major public health accomplishment and a social and cultural phenomenon. It highlights the human capacity to overcome adversity, the effectiveness of public health strategies (e.g., prevention and treatment), and the new challenges as well. Our societies are not well prepared to address the needs of older PWH and the changes they are creating. Stigma toward HIV, older age, and homosexuality, along with racism, have kept PWH largely invisible, resulting in limited investment in prevention and medical and social services. It is imperative that we develop an effective policy response to address the unique needs of PWH. The purpose of this article is to highlight current knowledge and emerging issues in HIV and aging to serve as a foundation on which to develop policy and program recommendations that will meet the new challenge.