Thanks to the many benefits of combining potent anti-HIV therapy (commonly called art or HAART) more HIV-positive people in Canada and similar countries are living longer. The power of art is so profound that researchers increasingly expect that some HIV-positive patients the people will have almost normal life.
As people with HIV to enter his last years, changes will be needed in the care they receive; they and their health care providers need to be more attentive to issues of aging. For the average adult HIV-positive patients younger starting art today, probably targets include a simple scheme with minimal side effects so that a low viral load in blood can be achieved and maintained. As people age, goals can increase or change to include maintaining a good quality of life as well as physical, mental and emotional health. To enable successful aging, geriatric care elements must be incorporated into regular medical care.
Doctors use the termgeriatric syndromesto see the common conditions seen in older people who may have several underlying causes. Examples of symptoms found in geriatric syndromes include the following:
- Which gives
- Fragile feeling
- Urinary incontinence
- Delirium-a disturbance of consciousness with various features, including problems with attention and awareness; memory difficulties; perception problems such as seeing or hearing things that are not real (hallucinations); We are sure of physical location; disorders of speech and language. In cases of delirium of a mental state of the person can suddenly change over hours or days. Delirium can make people confused and disoriented. Some people may also become violent and disturbing. deliriumnotthe same as dementia.
In general, the underlying cause (s) of the problem in geriatric syndromes may involve multiple organ systems and each element geriatric syndrome increases the vulnerability of the elderly more problems.
The aging and HIV
Understanding that HIV-positive people will need proper care for his age, a team of researchers who study aging and infectious diseases at the University of Connecticut has proposed that doctors caring prematurely aging of HIV-positive people entered the "Geriatric Assessment" in regular service. Such procedures to evaluate patients for which the researchers called "specific conditions which may predispose patients to become less functional," such as the following:
- visual impairments - problems in this area could have an impact on falls and medication adherence
- Infections of the inner ear and hearing difficulties - problems in this area could affect the balance, falls, ability to understand the instructions and communication with health care providers
- Problems with balance and movement on foot - this could increase the likelihood of a person to suffer falls
In San Francisco
A team of researchers in San Francisco began trying to understand the effect of aging on HIV positive people. The team looked specifically to evaluate the presence of geriatric syndromes in people who spent the fifty years of life and who had been on HAART and who had a low viral load for several years.
The study 155 people found geriatric syndromes present. Participants with a larger number of co-existing health conditions were at increased risk for the development of geriatric syndromes.
Study Details of Geriatric Syndromes
Researchers recruited participants from two major clinical centers of infectious disease in San Francisco. Participants completed questionnaires, underwent a physical examination and blood samples were collected. All these data were analyzed together with their medical records.
The researchers focused on the following issues:
- Urinary incontinence
- Ability to perform certain daily activities (including housework, administration of medications, bathing, dressing, shopping) affected
- Problems with hearing and vision
- Difficulty thinking clearly and memory problems
- Fragility (see below)
The research team pre-defined brittleness and fragility assess the presence of the following:
- The loss of unintentional weight
- Self-reported exhaustion
- Low physical activity
- Slow walking speed
- The physical weakness (assessed by hand gripping force had three or more of these issues and pre-weakness was present in one or two.
Data 155 persons were available for analysis. The average profile of these subjects was as follows:
- Age - 57 years
- 94% men, 6% women
- Duration of HIV infection - 21 years
- Count CD4 + - 537 cells / mm3
On average, participants had four health co-existing conditions (comorbidities). The most common were as follows:
- abnormal levels of cholesterol and triglycerides in the blood
- Higher blood pressure than normal
- Wounded and painful nerves in the hands, arms, legs or feet (peripheral neuropathy)
Participants had an average of nine drugs unrelated to treatment dainfecção for HIV as part of their daily regimen and medication.
The researchers found that 54% of the participants had at least two geriatric syndromes, such as the following:
- Pre-fragility - 56%
- Difficulty with one or more activities of daily living - 47%
- Forgetfulness and problems trying to think clearly - 47%
Other problems were the following:
- Qudas - 26% reported that they had fallen in the past year; on average there were two falls per person per year. In about 13% of such cases medical care was sought.
- Urinary incontinence - 25%
- Hearing impaired - 41%
- Visual impairment - 50%
- The disease - 22% of the participants had mild depression and 18% moderate to severe depression
Keep in mind that the study was observational and cross-sectional in nature. Since the data have been captured to a large extent at a point in time and the participants were not recruited at random. Such studies are good at finding associations between potential risk factor and an outcome (one of geriatric syndromes mentioned above), but can not prove that an alleged risk factor causes a specific result. Their findings should be taken with caution.
In the study, researchers found that people who had low counts CD4 + Pre-HAART were at higher risk for the future development of geriatric syndromes. They also found that the darker color of skin people were at increased risk for these syndromes.
It is likely that participants who reported cases of peripheral neuropathy were exposed to a group of old anti-HIV drugs commonly called "d-drugs" - which may be toxic to nerve cells:
- DdI (didanosine, Videx) Translator's Note: I took
- D4T (stavudine Zerit) Translator's Note - I took
- The ddC (zalcitabine, Hivid)
Cross-sectional studies such as this are good first steps and can be used to establish what is not a health problem that requires further investigation in a larger study and more expensive and more robust statistical concepts.
Such studies could investigate other potential risk factors for geriatric syndromes. Based on the findings obtained in this study, the researchers recommended that early initiation of antiretroviral therapy may be a way to delay or prevent the development of care these geriatric syndromes. However, since the consulting services in treatment guidelines and clinical practice in high-income countries is generally move the start ART to be initiated early in the course of HIV infection, a recommendation of the researcher may not be as important in the era current.
The San Francisco researchers should be commended for doing the preliminary work required to document that geriatric syndromes are occurring in people REALLY middle-aged HIV-positive. A future study will enroll HIV-positive peopleenegative - including more women of similar types and socioeconomic backgrounds really relevant that may be made as valid comparisons. This study needs to explore a combination of other potential risk factors for geriatric syndromes, including the following (as well mentioned by the researchers):
- Psychosocial factors (social isolation, substance use)
- The presence of multiple comorbidities
- The burden of multiple medications for various conditions
- Chronic inflammation