Ageing with HIV infection

Victoria Hall1, Matthew Skinner2, Jennifer Hoy3,4 Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, WA Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC Monash University, Melbourne, VIC Introduction The average age of people with HIV infection in Australia has increased substantially since 1986, due predominantly to …

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Early initiation of ART is still of utmost importance in older people with HIV infection and is probably of more significance, compared with younger people, due to the potential for poorer immune recovery on ART and a higher risk of serious non-AIDS events in older people with HIV infection. [28-30] This approach is supported by …

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There is clear evidence that the burden of HIV-associated non-AIDS co-morbidities has been increasing steadily in people with HIV infection, with an increasing prevalence of CVD, CKD, osteoporosis, cancer and type 2 diabetes mellitus. [4, 38] Bone disease The primary objectives of bone health programmes in healthy adults are to prevent bone loss occurring prematurely …

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Renal disease in ageing people with HIV infection, has important clinical implications, given the estimated prevalence of between 2.4% – 17%, and association with adverse long-term outcomes. [51-54] The expected physiological decline in renal function with ageing combined with increased comorbidities place older people with HIV infection at risk for polypharmacy and subsequent medication-related toxicity. …

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There is no evidence to support cancer screening at an earlier age in people with HIV infection. At each clinic visit, the opportunity should be taken to address cancer risk factors by advising smoking cessation, alcohol reduction, obesity management and treatment for HCV infection. Age-appropriate general population screening guidelines should be followed for all people …

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Liver disease has emerged as a major cause (up to 20%) of morbidity and mortality in ageing people with HIV infection on effective ART. [28, 61-63] Age-related declines in liver volume (20-40%) and blood flow (35-50%) and reduced cytochrome P450 content result in impaired drug elimination and increased drug exposure in the older general population. …

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Cardiovascular disease is of particular concern in people with HIV infection – with at least twice the risk of ischaemic heart disease and heart failure compared to non-HIV patients, even in the context of HIV viral suppression.[8] The rates of stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death are also higher.  …

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Cognitive impairment in people with HIV infection is an issue of increasing concern.  Prior to the widespread use of ART, HIV-associated dementia (HAD) occurred in almost 50% of people with HIV infection prior to death. [77, 78] Effective ART has resulted in a dramatic reduction, with HAD now occurring in <2% of individuals. [78, 79] …

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People with HIV infection can be expected to experience the usual age-related milestones in decline of sexual function but can also face additional challenges with regard to sexual function and sexuality. In terms of sexual function, sex hormone levels responsible for libido and secondary sexual characteristics, decline with age: testosterone drops from peak levels at …

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Physical, mental and psychosocial factors associated with HIV infection have shaped the lives of people affected. Episodic illness and treatment, anxiety and depression and threats to psychological wellbeing presented by HIV-related stigma have resulted in diminished health-related quality of life.  However, improved treatment, lifestyle and psychosocial interventions can mitigate detrimental impacts of HIV infection and …

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