Thanks to the many benefits of therapy potent anti-HIV combination (commonly called ART - Antiretroviral Therapy) more people with HIV in Canada and countries that have policies addressing the HIV / AIDS epidemic similar to that of Brazil are living longer. The power of HAART is so profound that researchers increasingly expect that some HIV-positive people have near normal life spans.
As people living with HIV enter their later years, changes will be necessary in the care they receive, they and their care providers will have to be more aware of aging issues. For the average HIV-positive people who start young and adults today, goals that will probably include a simple scheme with minimal side effects for the low viral load in the blood can be achieved and maintained. As people age, the goals may increase or change to include keeping thus a good quality of life, in the areas of physical, mental and emotional health. To enable successful aging, geriatric care information needs to be incorporated into regular medical appointments.
Doctors use the term Geriatric Syndromes Commons to consult conditions seen in older people who may have several causes. Examples of symptoms found in geriatric syndromes are:
- Fragile feeling
- Urinary incontinence
- Delirium-one consciousness disorder with several features, including problems with attention and awareness; memory difficulties; perception problems, such as seeing or hearing things that are not true (hallucinations); not be sure about the actual physical location (with risk of loss of sense of where your house); disorders of speech and speech. In cases of delirium a mental state of the person may suddenly change for hours or days. The Delirium can make people confused and disoriented. Some people may also become violent and disturbed. Delirium is not the same as dementia, that is.
In general, the (s) cause (s) underlying (s) of the 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
Since HIV-positive people with advanced age need care appropriate to their age, a team of researchers studying infectious diseases and their relationship with the diseases of aging at the University of Connecticut, proposed to physicians who care for people seropositiveincorporate the "geriatric assessment" in their regular visits. Such evaluations of patients had to evaluate the incidence of so-called "Specific conditions"Which may predispose patients to a less functional condition of life (sic)," as the following:
- Visual impairments - problems in this area may cause great impact on medication adherence.
- Inner ear infections and hearing problems - problems in this area can affect the balance, lead to falls and possible fractures, inhibiting the ability to understand the instructions received from their caregivers, increase the risk of traffic-related accidents (road kill, collisions ...).
In San Francisco
A team of researchers in San Francisco began to try 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 the 50 years of age receiving ART (antiretroviral therapy) and had kept a low or undetectable viral load for several years.
The study found that in 155 people analyzed were found geriatric syndromes. Participants with the highest number of coexisting conditions on health were at increased risk for developing geriatric syndromes.
Researchers recruited participants from two clinical important infectious diseases in San Francisco. Participants completed questionnaires, physical examination, and had blood samples taken. All data were analyzed together with their medical records.
The researchers focused on the following questions:
- Urinary incontinence
- Reduced ability to perform certain daily activities (including her household duties, such as administering medication, personal hygiene, care eat clothing, do housekeeping on important things like 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 the presence of the following symptoms:
Unintentional weight loss
Auto fatigue reports
Low physical activity
Low speed when walking
Physical weakness (assessed by gripping force of the hand)
The researchers classified as brittle if they had three or more of these symptoms and pre-brittle those who had one or two of the aforementioned symptoms.
Data 155 persons were available for analysis. The average profile of the participants were as follows:
- Age - 57 years.
- 94% Of men and 6% of women.
- Duration of HIV infection greater than 21 years.
- Lymphocyte count CD4 +/- 537 cells / mm3
On average, participants had four health conditions coexisting (comorbidities). The most common are:
- Abnormal levels of cholesterol and triglycerides in the blood (hyperlipidemia).
- Higher than normal blood pressure (hypertension).
- Wounds and / or painful sensations of the nerves of the hands, arms, legs or feet (peripheral neuropathy)
The participants made use, 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 in the past year; on average there were two falls per person per year. In about 13% of cases, the search for medical attention was required.
- Urinary incontinence - 25%
- Hearing impaired - 41%
- Visual impairment - 50%
- Parallel diseases - 22% of the 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 is largely captured at a point in time and the participants were not recruited at random. Such studies are good at finding associations between potential risk factors and the result (of the potential geriatric syndromes mentioned above), but they can not prove that a particular risk factor assumption causes to obtain a specific result determinedly. Their findings should be taken into consideration 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, researchers found that people who had low levels of CD4 + proved at higher risk of future development of geriatric syndromes. It was also found that people of color (...) would run greater risks 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 have been exposed to a group of former antiretroviral drugs - commonly called "d-drugs" -which can (???) is toxic to nerve cells.
- DDI (didanosine, Videx) [I took for six months, nineteen years ago.]
- D4T (stavudine, Zerit).
- The DDC (zalcitabine, Hivid).
Cross-sectional studies such as this are a good first step, and can be used to establish whether there is or not a health problem that may require further investigation with a larger number of subjects in the study and with a design more robust and thus more expensive.
This study may investigate other possible risk factors for geriatric syndromes. Based on the study findings, the researchers had predicted that the rapid onset (early in Brazil) of ART can be a way to delay or prevent the development of geriatric syndromes.
However, since the advice, treatment guidelines and clinical practicein high per capita income countries [Regardless Brazil maintains strict stance on the issue of HIV / AIDS with certain exceptions] is generally recommended starting ART early as possible in the course of HIV infection [In Brazil is immediately after diagnosis and a small routine blood tests].
The San Francisco researchers should be commended for doing the preliminary work necessary to document that geriatric syndromes are occurring even in HIV-positive people living in middle age. A future study should be a control group HIV negative and including a larger number of women of similar socioeconomic backgrounds so that relevant and meaningful comparisons can be made.
This 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 enjoyed this and I honestly do not know if there is a version for iPhone. But if you can have a simple cell (my still running Android © 2.2) that operates on Android © me who never recommend anything, I recommend this application.
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Translation adjustment and revision of the original in English Canada for the Portuguese of Brazil (it does not exist Brazil with "z" and "Brazil" is an idiomatic aberration created for persons Which only God knows why They do this ...) the original Geriatric syndromes found to be common in some HIV-positive peopleby Claudio Souza.
I'm not a "victim" of AIDS. I am a person living with AIDS.