HIV and Ageing

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (13/01/2022)

Original Editor - Habibu salisu Badamasi

Top Contributors - Habibu Salisu Badamasi and Kim Jackson

Introduction

Human immunodeficiency virus (HIV) is a major global public health issue and has become a manageable chronic health condition, enabling people living with HIV to live longer and healthy. There is a significant trend in the global HIV epidemic: the growing number of people aged 50 years and older, who are living with HIV. The life expectancy of people living with HIV has dramatically improved due to effective antiretroviral therapy (ART). With effective ART, people with HIV are living longer than previously and have far less life-threatening acute illnesses, but must confront issues related to the aging process. Aging is a result of biological events that progressively and irreversibly compromise the function of vital organs. Aging is faster in people living with HIV (PLWH) than in the general population. There is an increase in people living with HIV ( PLWH) and with age-related comorbidities

https://commons.wikimedia.org/wiki/File:Human_ageing.jpg

Prevalence of HIV among aged population

• Worldwide, an estimated 3.6 [3.2-3.9] million people aged 50years and older are living with HIV.

• there are 10% of the adult population living with HIV in low-and middle-income countries.ximately 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 population

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

Process of aging in HIV-patients

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. 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.

Management of older HIV-positive patients

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

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.
   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 management of HIV in aging

Effect of exercise on HIV and aging

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).