Increasingly, clinical care providers for people living with HIV are spending less time managing the drug resistance and toxicities associated with short-term HAART and more time managing diseases associated with aging. This change in care is underscored by reports that most of the deaths in this population are the result of unrelated diseases with AIDS. People are infected with HIV are aging faster? The words "accelerated aging (or aging)" is often used to describe the trajectory of aging in elderly adults with HIV. This perception was reinforced by several research reports that show older adults are developing typically associated diseases with aging and in some cases at an earlier age than how they might appear.
In 2010 Martin and Volberding remind us that the accelerated aging in HIV infection in older people is an "intriguing" hypothesis and that we should not allow IT to become rooted in HIV treatment culture before it has been unraveled. However, until 2015 the common perception that there is the accelerated aging is manifested in older adults with HIV.
To test the hypothesis"HIV does not cause premature aging," requires finding comparison groups which are suitable to produce valid results. Researchers should control as many variables as possible with the aim to isolate the effect of HIV. But as a group of adults infected with HIV evidence of one prolific constellation of features that are unique, everyone can have a significant impact on the health status of a person. These variables include: history of drug abuse, smoking and alcohol use, infection with HCV (hepatitis C virus), sexually transmitted infections, stigma leading to social isolation, chronic depression unmanaged or untreated, post-traumatic stress disorder (PTSD) , financial life, housing issues and / or accommodation in hostels (Editor's Note: Often preferred to sleep on the street to enter these traps) Accommodation and food insecurity, as well as care in sexual life, barriers of race / ethnicity and sexual identity.
HIV infection occurs with high incidence in disadvantaged minority communities economically where good nutrition and emphasis on regular exercise is virtually nonexistent. This array of variables and the state you reside in a patient are some examples of predictors of health disparities and outcomes. effectively controlling for these variables is a challenge whose resolution is often imperceptible.
In studies where these variables are perfectly controlled, including recent studies of Denmark as well as the large cohort studies VACS, there is little evidence to support the accelerated aging hypothesis (or early). But those studies controlled optimally, along with data from various research reports, evidence of morbidity in adults infected with HIV, older enough to be the rule rather than the exception. Likewise, in a Letter to the Editor inJAIDS 2015
The author concludes that "the 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,Pro LengthHIV 2015 review article concluded that the aging concept is not supported. A researcher on HIV and aging, Amy Caroline Justice, MD, PhD VACS using large cohorts have consistently recommended against the conclusion that the accelerated aging was occurring. An extensive review of this issue by the authors of this volume review concludes that accelerated aging is not supported.
Several research reports confirm that the older adult population living with HIV (US and globally) are exhibiting a significantly higher frequency of multimorbidity. Multimorbidity is defined as having two or more chronic diseases. The need to manage Multimorbidity adult aging population infected with HIV is causing inexorable tectonic changes in the way care is delivered. It is hypothesized that this increase is related to Multimorbidity inflammatory cascade that occurs due to HIV infection. Even in HIV patients with well managed with sustained undetectable viral loads, inflammatory biomarkers remained high. However, this high inflammatory condition is also influenced by co-infected with HCV (hepatitis C) 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 must be paired with a reduction of cardiovascular risk factors, especially the end of the smoking habit, and proper screening for cancers, kidney disease and osteoporosis.
Management of high risk for developing Multimorbidity is the big issue for older adults with HIV and their health care teams. The medical system must adapt in a more comprehensive manner to meet the needs of aging and growing population of older adults who will dominate the epidemic. Finally, the improvement of the current health-care system is needed to provide better treatment, prevention and comprehensive care for HIV-infected adults. Part of this improvement requires emphatic optimization principles for geriatric care, changing the misplaced perception that accelerated aging is occurring.
Translated from Original inHIV-Infected Older Adults Challenged by Multimorbidity but Not Accelerated Agingby Claudio Souza in 13 February 2015