Older HIV-infected adults: complex patients— geriatric syndromes (II)
With the widespread adoption of highly active antiretroviral therapy (HAART), HIV infection starts to be considered one of the many chronic illnesses of advanced age. A growing proportion of the affected patients is presently older than 50. It has been suggested that HIV infection may today represent a model of accelerated and accentuated ageing. The need for a closer collaboration between geriatricians and HIV physicians is being growingly recognised to better address the priorities and needs of HIV patients. The final aim behind the generation of such synergies resides in the design of personalised plans of interventions. These plans should stem from the results of a comprehensive assessment of the individual spanning clinical, environmental, and psychosocial domains. Through the early identification of stressors and risk factors potentially disrupting the homeostatic balance of frail patients (including those living with HIV), it might be possible to protect the “biologically old” (but not necessarily “chronologically old”) HIV-infected people from developing detrimental geriatric syndromes. In this article, specific features making the ageing HIV population of special interest for geriatric medicine, and the importance of a multidisciplinary model of care are described. The final objective is to stress how the only way for adequately tackling the multifaceted frailty condition of people with HIV is to implement novel models of care based on the comprehensive geriatric assessment.
KeywordsHIV Geriatrics Ageing Comprehensive geriatric assessment Frailty Geriatric syndromes
Compliance with ethical standards
Conflict of interest
The authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript. This study is not under consideration or has not been previously published elsewhere, and its contents have not been anticipated by any previous publication/presentation. All the authors have read and agreed to the manuscript as written.
This article does not contain any studies with human participants or animals performed by any of the authors.
Not applicable since the article is a review of existing literature
- 1.Casau-Schulhof N (2018) In: Bartlett JG, Bloom A (eds) HIV infection in older adults. UpToDate. https://www.uptodate.com/contents/hiv-infection-in-older-adults. Accessed 17 Jan 2019
- 2.ECDC-WHO (2016) HIV/AIDS surveillance in Europe 2017. https://ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2017-2016-data. Accessed 17 Jan 2019
- 3.World AIDS Day (2017). https://ecdc.europa.eu/en/news-events/world-aids-day-2017. Accessed 17 Jan 2019
- 14.Rockwood K, Mitnitski A (2012) How might deficit accumulation give rise to frailty? J Frailty Aging 1(1):8–12Google Scholar
- 17.Guaraldi G, Brothers TD, Zona S, Stentarelli C, Carli F, Malagoli A, Santoro A, Menozzi M, Mussi C, Mussini C, Kirkland S, Falutz J, Rockwood K (2015) A frailty index predicts survival and incident multimorbidity independent of markers of HIV disease severity. AIDS 29(13):1633–1641. https://doi.org/10.1097/QAD.0000000000000753 CrossRefGoogle Scholar
- 20.Brothers TD, Kirkland S, Theou O, Zona S, Malagoli A, Wallace LMK, Stentarelli C, Mussini C, Falutz J, Guaraldi G, Rockwood K (2017) Predictors of transitions in frailty severity and mortality among people aging with HIV. PLoS One 12(10):e0185352. https://doi.org/10.1371/journal.pone.0185352 CrossRefGoogle Scholar
- 28.Weinberg M, Schambelan M (2018). In: Bartlett JG, Bloom A (eds) Bone and calcium disorders in HIV-infected patients. UpToDate. https://www.uptodate.com/contents/bone-and-calcium-disorders-in-hiv-infected-patients. Accessed 17 Jan 2019
- 31.Glesby MJ (2018) In: Bartlett JG, Bloom A (eds) Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy. UpToDate. https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-hiv-associated-lipodystrophy. Accessed 17 Jan 2019
- 33.Price RW (2017) In: Bartlett JG, Bloom A (eds) HIV-associated neurocognitive disorders: epidemiology, clinical manifestations, and diagnosis. UpToDate. https://www.uptodate.com/contents/hiv-associated-neurocognitive-disorders-epidemiology-clinical-manifestations-and-diagnosis. Accessed 17 Jan 2019