Thanks to the many benefits of potent anti-HIV therapy combination (commonly referred to as ARV therapy) plus HIV-positive people in Canada and countries that have HIV / AIDS epidemic policies similar to Brazil's are living longer. The power of HAART is so deep that researchers increasingly expect that some people who are HIV positive will have close to normal life extends.
As people living with HIV enter their last years, changes in the care they receive will be needed, they and their caregivers will have to be more attentive to the issues of aging. For the average HIV-positive people who start youngsters and adults today, goals will likely include a simple scheme with minimal side effects so that low blood viral load can be achieved and maintained. As the individual ages, the goals can increase or change to include, thus maintaining a good quality of life in the areas of physical health, mental and emotional health. To enable successful aging, elements of geriatric care will need to be incorporated into the regular medical visit.
Doctors use the term Common Geriatric Syndromes to look at conditions seen in older people who can have several causes. Examples of symptoms found in geriatric syndromes are as follows:
- Fragile feeling
- Urinary incontinence
- Delirium– a multi-resource disorder, including problems with attention and awareness; memory difficulties; perception problems, such as seeing or hearing things that are not true (hallucinations); not being sure about their physical location (at risk of losing their sense of where their home is); disorders of speech and language. In cases of delirium a person's mental state may change suddenly for hours or days. Delirium can make people confused and disoriented. Some people can also become violent and upset. Delirium is not the same as dementia, that is.
In general, the underlying cause (s) of problems related to geriatric syndromes may involve multiple organs and systems, and each element of the process "called geriatric syndrome " arising implements the vulnerability of older people to new health problems, whether or not the syndromes, deserving, so special care with HIV positive people over fifty years or over 20 years of ART.
Aging and HIV
Given that HIV positive people with advanced age will need care appropriate to their age, a team of researchers studying infectious diseases and their relationships with aging diseases at the University of Connecticut, we have proposed to physicians who care for people seropositive the "geriatric assessment" in their regular care. These patient evaluations had the objective of evaluating the incidence of so-called "Specific conditions"Which may predispose patients to a less functional life condition (SIC)," such as the following:
- Visual difficulties - problems in this area can have a great impact on adherence to medication.
- Inner ear infections and hearing problems - problems in this area can affect balance, lead to falls and possible fractures, inhibit the ability to understand instructions received from your caregivers, increase the risk of traffic-related accidents (run over, collisions ...).
In San Francisco
A team of researchers in San Francisco began trying to understand the effect of aging on people with HIV. The team sought to assess the presence of geriatric syndromes in people who lived beyond 50 years of age receiving ART (antiretroviral therapy) and who had maintained a low or undetectable viral load for several years.
The study determined that in 155 people analyzed were found geriatric syndromes. Participants with the highest number of coexisting health conditions were at increased risk for developing geriatric syndromes.
The researchers recruited participants from two major infectious disease clinics in San Francisco. Participants completed questionnaires, a physical examination and had blood samples taken. All data were analyzed together with your medical records.
The researchers focused on the following questions:
- Urinary incontinence
- Reduced ability to perform certain daily activities (including your household chores such as medication administration, personal hygiene, clothing care, home maintenance on important things such as grocery shopping ...)
- Problems with hearing and vision
- Difficulty thinking clearly and memory lapses
- Fragility (see below)
The research team defined "fragility" and "pre-fragility" during the evaluation process as the presence of the following symptoms:
Unintentional weight loss
Auto fatigue reports
Low physical activity
Low speed when walking
Physical weakness (assessed by the prehensile force of the hand)
Researchers classified as fragile if they had three or more of these symptoms and pre-frail those who had one, or two, of the previously mentioned symptoms.
Data from 155 people were available for review. The average profile of the participants was as follows:
- Age - 57 years.
- 94% of men and 6% of women.
- Duration of HIV infection greater than 21 years.
- CD4 lymphocyte count +/- 537 cells / mm3
On average, participants had four health conditions coexisting conditions (comorbidities). The most common are as follows:
- Abnormal levels of cholesterol and triglycerides in the blood (dyslipidemia).
- Higher than normal blood pressure (hypertension).
- Wounds and / or painful sensations of the nerves of the hands, arms, legs or feet (peripheral neuropathy)
Participants used, on average, nine drugs (drugs) not directly related to HIV as part of their daily therapy.
The researchers found that 54% of participants had at least two geriatric syndromesSuch as the following:
- Pre-fragility - 56%
- Difficulty with one or more activities of daily living - 47%
- Memory lapses and problems and problems cognitivos- 47%
Other problems include also the following:
- Falls - 26% of patients in the study revealed that they had suffered at least one fall last year; on average there were two falls per person per year. In about 13% of cases, it was necessary to seek medical attention.
- Urinary incontinence - 25%
- Hearing impairment - 41%
- Visual impairment - 50%
- Parallel diseases - 22% of participants had mild depression and 18% had moderate to severe depression
Keep in mind that the study was observational and cross-sectional in nature.
That is, the data were captured largely at one point in time and participants were not recruited randomly. Such studies are good for finding associations between a potential risk factor and the outcome (one of the potential geriatric syndromes mentioned earlier), but they can not prove that a given risk factor assumption will result in a determinate specific outcome. Its conclusions should be taken with relative caution.
[Translator's note: Although this alert and my personal admission of possible somatization, I identified with at least 3 these factors / consequences and found this text after having tasted of certain symptoms - in short, I translated on behalf of themselves and held of course, to all who read me, finding or following this site for search engines and / or in different social networks]
In the study, the researchers found that people who had low CD4 + counts were at increased risk for future development of geriatric syndromes. It was also found that people of color (...) would be at greater risk for these syndromes.
[Translator's Note: Since I started my ART've been keeping (this for over ten years) CD4 above 800 in the penultimate analysis was in about 1200 and last approximately 900) and, not being a person of *** color (orange? pumpkin? Green? *** you given that on my birth certificate says ___pardo___ and I do not know what that means, even by at night all cats are gray, I have serious geriatric syndrome of signs and I confess act, that's what moved me in finding these answers and I refuse to let that without observing a possible demonstration of Canadian racism]
It is likely that participants who reported peripheral neuropathy were exposed to a group of antiretroviral drugs - commonly called "d-drugs" -that may be (?) Toxic to nerve cells.
- IDD (didanosine, Videx) [I took it for six months, nineteen years ago.]
- D4T (stavudine, Zerit).
- DDC (zalcitabine, Hivid).
Cross-sectional studies such as the present are a good first step, and can be used to establish whether or not there is a health problem that may require further investigation, with a greater number of subjects in the study, and with a more robust design and therefore more expensive.
Such a study could investigate other possible risk factors for geriatric syndromes. Based on the findings of the current study, the researchers predicted that the rapid (immediate in Brazil) initiation of ART may be a way of delaying or preventing the development of geriatric syndromes.
However, given that the advice, treatment guidelines and clinical practice in high per capita income countries [Regardless Brazil maintains strict stance on the issue of HIV / AIDS with certain exceptions] has, in general, recommended the initiation of HAART early in the course of HIV infection [In Brazil is immediately after diagnosis and a small routine blood tests].
Researchers in San Francisco should be praised for doing the preliminary work needed to document that geriatric syndromes are occurring even in seropositive people living in middle age. A future study should a control group HIV negative and include a greater number of women of similar socioeconomic backgrounds so that relevant and meaningful comparisons can be made.
Such a study needs to explore a combination of other possible risk factors for geriatric syndromes including the following (as mentioned by the researchers):
- Psychosocial factors (social isolation, substance use).
- The presence of multiple comorbidities.
- The burden of taking multiple medications for various conditions
- Chronic inflammation
Translator's note. This text was revised ten times and I do not feel safe about it. If you, the reader, to note something, even a simple typo, please send an email to firstname.lastname@example.org and show me even having to draw, the error in question. thanks in advance.
A note from the Editor: I know how complex and how discipline is required, memory, and attention to maintain, consistently, a treatment like ours.
fortunately I discovered, quite recently, but already incorporated into my routine, an application for Android called © *** *** MEDISAFE. It is, literally, a nurse (nurses truth can never be replaced, away from me, I have received and I receive them, for almost twenty years, affection, care, respect, attention, love ...) especially for your day to day .
Takes some work to set up, because you have to feed the application the medicines you take (and can set up to facilitate the tablet is round or if it is long, one way or another, green, blue (this is good link. There are others there but I really enjoyed this and honestly, I do not know if there is a version for Iphone. But if you can have a simple cell phone (my still runs Android © 2.2) that operate with Android © eu, I never recommend anything, I recommend this app.
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English translation for the Portuguese of Brazil (it does not exist Brazil with "z" and "BraZil" is an idiomatic aberration created for persons that only God knows why they do this ...) of the original in Geriatric syndromes found to be common in some HIV-positive people by Claudio Souza.
I'm not a "victim" of AIDS. I am a person living with AIDS.