HIV and Ageing

Original Editors - Tolulope ADENIJI

Top Contributors - Habibu Salisu Badamasi and Kim Jackson  

Introduction[edit | edit source]

The Human Immunodeficiency Virus, HIV, attacks the immune system and, if not treated properly, can lead to Acquired Immunodeficiency Syndrome, AIDS.[1] AIDS is a condition in which an opportunistic infection takes control of the body's systems. Geriatric HIV is a type of HIV that affects older adults.[2] Ageing predisposes older adults to physiological declines in body systems, which HIV will exacerbate. As a result of improved technology and pharmaceutical practice, the global population of older adults is growing, as well as the number of adults with HIV transitioning from adulthood to the geriatric phase. As a result, it provides an overview as well as a possible role for physiotherapy in geriatric HIV.

Human ageing.jpg

Prevalence of HIV among aged population[edit | edit source]

  • Worldwide, an estimated 3.6 [3.2-3.9] million people aged 50years and older are living with HIV.[3]
  • there are 10% of the adult population living with HIV in low-and middle-income countries. approximately 30% of all adults living with HIV are aged 50years and above.
  • Since 2007, the proportion of adults living with HIV that are aged 50years and above has increased worldwide.

Factors that increase aged HIV-patients poulation[edit | edit source]

  • Successful antiretroviral therapy.
  • Decreased HIV incidence among younger adults.
  • Shift in the disease burden to older ages.

Process of aging in HIV-patients[edit | edit source]

Various risk factors linked to HIV, as well as those not linked to HIV, have an impact on the biology of aging and the emergence of coinfections. These phenomena are closely linked to sociodemographic factors as well as the severity of immune system damage caused by untreated infection, resulting in a range of comorbidity risks. In some instances, ART is associated with an increased risk of geriatric syndromes such as falls, fractures, and dementia in the elderly population.[4] The effect of HIV on aging is usually associated with increase on the development of age-associated comorbidities on people living with HIV (PWLH). The risk of developing this comorbidities in PLWH is higher compare to that of the general population. This comorbidities such as , anal cancer, osteoporosis and chronic kidney disease appear at earlier age in PWLH while others comorbidities such as cataracts or prostate hypertrophy are not associated with an earlier onset or increased risk in PLWH.  As a result, treating HIV can altered e aging process and increase commodities in PLWH, but this impact might not be uniform in accelerating aging.[5]

Geriatrics HIV[edit | edit source]

Important things to consider in an ageing population[6]:

  • HIV may accelerate ageing.
  • Commodities such as cardiovascular diseases, osteoporosis, metabolic syndrome etc are accelerated in people with HIV.
  • Geriatric syndrome and frailty are accelerated with Geriatrics HIV.
  • Quality of life is worsen in geriatric HIV

Management of Older HIV-Positive Patients[edit | edit source]

There are three stages to managing HIV-positive older people.

  1. Early care- The early or acute stage involves prevention, screening, diagnosis and early treatment. older adults should screened routinely for HIV infections, because most adult do not perceived self-risk for HIV infection unlike younger adults. clinicians should be aware of the atypical signs and symptom among older adults and educate them on transmission of HIV infection for early diagnosis. All older patients, regardless of CD4 T-lymphocyte level, should begin antiretroviral therapy.
  2. Chronic care- the stage involve maintaining the ART treatment and managing comorbid non-HIV medical conditions, risk reduction, and preventive care.
  3. Advance care- In older HIV-positive patients, palliative care is emerging as a critical component.

Preventing Comorbidities[edit | edit source]

  1. Since people living with HIV are now living longer, there are possibilities of an increased burden of comorbidities among PLWH as they get older.[5]
    1. Risk behaviors such as smoking and injectable drug use are likely to remain a major driver behind the development of comorbidities in the treated HIV population. Positive health promotion should be implemented among PLWH to minimize the development of comorbidities at old aged PLWH.
    2. Early treatment of HIV infection can reduced the effect of the infection on the early development of comorbidity in PLWH.
    3. Adherence to modern antiretroviral therapy that has proved to have minimal effect in causing comorbidities in PLWH.
    4. Preventive and screening procedures should be emphasized in vulnerable population and evaluated for commodities during their follow-up visit. The presence of comorbidities warrants management of PLWH by HIV and multidisciplinary team.
    5. Lifestyle modification factors associated with an increased risk of comorbidities such as fighting smoking should serve as an interventions in people living with HIV (PLWH)
    6. Due to the relationship between systematic inflammation and the development of comorbidities in HIV, aerobic exercise have be shown in some studies to be the intervention to significantly decrease markers of systemic inflammation in PLWH.

Physiotherapy in Geriatrics HIV[edit | edit source]

The goal of physiotherapy in the management of people with HIV, including Geriatric HIV, is to improve, restore, and maintain functions in order to support independent living as much as possible. In providing physiotherapy for geriatric cadre with HIV, the principles of geriatrics is essential to be observed.

The effect of exercise on HIV and aging have been shown to improve aerobic and muscular fitness, and metabolic risk profile and to a lesser extent systemic inflammation, a combined aerobic and resistance exercise training (CARET).[4]

Specifically, physiotherapy in geriatric HIV manage possible complications such as[7][8]:

  • Chronic pain,
  • Joint stiffness,
  • Balance disorders
  • Muscle weakness,
  • Neural impairment
  • Gait impairment etc

References[edit | edit source]

  1. Centers for Disease Control (US), Center for Infectious Diseases (US). Division of HIV/AIDS., National Center for Infectious Diseases (US) Division of HIV/AIDS.. HIV/AIDS Surveillance. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Infectious Diseases, Division of HIV/AIDS; 1994.
  2. Piot P, Bartos M, Ghys PD, Walker N, Schwartländer B. The global impact of HIV/AIDS. Nature. 2001 Apr;410(6831):968-73.
  3. UNAIDS H. aging: a special supplement to the UNAIDS report on the global AIDS epidemic. 2013.
  4. 4.0 4.1 Martínez-Sanz J, Serrano-Villar S, Vivancos MJ, Rubio R, Moreno S, HIV-associated comorbidities Study Group. Management of Comorbidities in Treated HIV Infection: A Long Way to Go: HIV, comorbidities and aging. International journal of antimicrobial agents. 2021 Dec 3:106493.
  5. 5.0 5.1 Kent SJ, Flexner C. Ageing in patients with chronic HIV infection: impact of hypercoagulation. AIDS research and therapy. 2018 Dec;15(1):1
  6. Wing EJ. HIV and aging. International Journal of Infectious Diseases. 2016 Dec 1;53:61-8.
  7. deBoer H, Andrews M, Cudd S, Leung E, Petrie A, Chan Carusone S, O’Brien KK. Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care. Disability and rehabilitation. 2019 Jul 17;41(15):1768-77.
  8. McClure J. The role of physiotherapy in HIV and AIDS. Physiotherapy. 1993 Jun 10;79(6):388-93.