Special Patient Populations

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.  …

Cardiovascular disease and associated risk factors Read More »

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 …

Sexual function and sexuality Read More »

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 …

Mental health and psychosocial functioning Read More »

Major reductions in HIV-associated mortality have increased the median life expectancy of adults with HIV infection. However, immunodeficiency and illnesses involving inflammatory processes e.g. cardiovascular, bone, renal and liver disease, cancers and neurocognitive decline are clustering in older people with HIV infection leading to a “geriatric syndrome” not usually seen in individuals without HIV infection …

The Geriatric Syndromes: Frailty, Multimorbidity and Polypharmacy Read More »

“Ageing with HIV” is associated with a higher frequency of (1) multimorbidity, possibly attributable to previous toxic exposure to ART and lifestyle factors; (2) polypharmacy due to ART and other medications for co-morbidities, compared with “typical” ageing.[10] It is clear a structural and cultural change in standard patient assessment and transition in care, needs to …

Comprehensive geriatric assessment and a change in approach to the care of ageing people with HIV infection Read More »

End-of-life planning is important and relevant for all people with HIV infection. Planning and advance care directives have been shown to improve care for patients and psychosocial outcomes in surviving relatives. [139, 140] HIV infection can complicate care at the end of life but past research in other contexts has indicated that people with HIV …

End-of-life care Read More »

  Lagathu C, Cossarizza A, Bereziat V, Nasi M, Capeau J, Pinti M. Basic science and pathogenesis of ageing with HIV: potential mechanisms and biomarkers. AIDS 2017; 31 Suppl 2: S105-S19. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2018. Available at: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Annual-Surveillance-Report-2018.pdf. Accessed December 14th. Guaraldi G, Palella …

References Read More »