Increasingly, clinical care providers for people living with HIV are spending less time managing drug resistance and toxicities associated with short-term ART and more time managing age-related diseases. This shift in care is underlined by reports that most of the deaths for this population are the result of non-AIDS-related illnesses. Are people infected with HIV getting older faster? The words "accelerated aging (or premature aging)" are often used to describe the aging trajectory of older adults with HIV. This perception was reinforced by several research reports that show older adults are developing diseases typically associated with aging and in some cases at an early age than how they might appear.
In 2010 Martin and Volberding remind us that accelerated aging in HIV infection in older people is an "intriguing" hypothesis and that we should not allow IT to become entrenched in the culture of HIV treatment before it has been unleashed. However, until 2015 the common perception that there is accelerated aging is manifested in older adults with HIV.
Test the hypothesis of "HIV does not cause premature aging," requires finding matching groups that are appropriate to produce valid results. Researchers should control as many variables as possible in order to isolate the effect of HIV. But as a group of HIV-infected adults proves a prolific constellation of characteristics that are unique, all of which can have a significant impact on a person's health status. These variables include: history of drug addiction, smoking and alcohol use, HCV infection, sexually transmitted infections, stigma leading to social isolation, chronic unmanaged or treated depression, posttraumatic stress disorder (PTSD) , financial life, housing issues and / or hostel accommodation (Editor's Note: Often preferred to sleep on the street to enter these traps) housing and food insecurity, as well as care in the sex life, barriers of race / ethnicity and sexual identity.
HIV infection occurs with great incidence within communities of economically disadvantaged minorities where good nutrition and emphasis on regular exercise is virtually nonexistent. This panoply of variables as well as the state in which a patient resides are some examples of predictors of health disparities and outcomes. Controlling effectively for these variables is a challenge whose resolution is often imperceptible.
In studies where these variables are perfectly controlled, including recent studies from Denmark as well as large VACS cohort studies, there is little evidence to support the hypothesis of accelerated (or precocious) aging. But in those ideally controlled studies, along with data from various research reports, evidence of morbidity in older HIV-infected adults becomes the rule rather than the exception. Similarly, in a Letter to the Editor of JAIDS 2015
The author concludes that "current data are not consistent with an accelerated aging hypothesis" and that cumulative data do not support the view that an increased risk of age-related comorbidities occurs. Besides that, the Body Pro HIV in review article of 2015 concluded that the concept of early aging is not supported. A researcher on HIV and aging, Amy Caroline Justice, MD, PhD using the large VACS cohorts, has consistently advised against the conclusion that accelerated aging was occurring. An extensive review of this issue by the authors of this volume of commentary concludes that accelerated aging is not supported.
Several research reports confirm that older adults living with HIV (US and globally) are exposing a significantly higher frequency of multimorbidity. Multimorbidity is defined as having two or more chronic diseases. The need to manage Multimorbity in the aging adult population infected with HIV is causing inexorable tectonic changes in the way care is provided. It is hypothesized that this Multimorbity increase is related to the inflammatory cascade that occurs due to HIV infection. Even in well-managed HIV patients with sustained undetectable viral loads, the inflammatory biomarkers remained elevated. However, this elevated inflammatory state is also influenced by the co-infected by HVC (hepatitis C virus) and the presence of other risk factors listed above. With this current state of knowledge, there is no doubt that ART should be initiated in all HIV positive patients early to reduce the cumulative effects of chronic inflammation. This aggressive action should be paired with reduction of cardiovascular risk factors, especially end of smoking habit, and appropriate screening for cancers, kidney disease, and osteoporosis.
Managing this high risk for Multimorbity development is the big issue for older adults with HIV and their health care teams. The medical system must adapt in a more comprehensive way to respond to the needs of aging and the growing population of older adults who will dominate the epidemic. Finally, the improvement of the current health care system is necessary to provide better treatment, prevention and comprehensive care for HIV-infected adults. Part of this improvement requires emphatic optimization of principles regarding gerontological care, altering the misperception that accelerated aging is occurring.
Translated from Original in HIV-Infected Older Adults Challenged by Multimorbidity but Not Accelerated Aging by Cláudio Souza on 13 in February of 2015
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