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Sexual health and LGBT population
Living with HIV
Post-exposure prophylaxis (PEP)
Aging with HIV has become a hot topic at scientific conferences over the past few years. At the Actuel medical clinic, 34% of patients are over 50 years old, and 6% of them were infected after the age of 50. In 2010, the 45 to 54 age group represented 24% of new HIV infections; double that of 2007 (15%). This patient cohort will continue to grow over time. By 2017, about 50% of the clinic’s patients will be over 50 years old. The effectiveness of long-term antiretroviral therapy has enabled patients to live longer than they did ten years ago.
Aging with HIV comes with many problems. HIV appears to accelerate the process of aging in some patients, especially in those who have been infected for a long time. We also know that the lowest CD4 count (or the CD4 nadir) can also play a role in the development of diseases such as cardiac, neurological, and renal diseases. By starting treatment when the CD4 count is higher, this tendency can be reduced. Older patients under treatment with a controlled viral load will have a smaller increase in CD4 counts than younger patients, because the immune system’s ability to regenerate decreases with age, due to a reduction in the tissue capable of producing CD4. This demonstrates the importance of not waiting to initiate antiretroviral treatment.
In older patients infected with HIV, we observe an increase in certain comorbidities: cardiovascular, neurocognitive, renal and bone problems. We also note an increase in certain types of cancer: anal (often due to HPV, the human papilloma virus), and liver (especially if patients are infected by hepatitis B or C).
Cardiovascular manifestations may have a number of causes, of which HIV is one of the most significant. Being infected with HIV is a risk factor, but we do not know to what extent. Lipid problems and tobacco use are significant factors as well. Certain types of anti-HIV medication may also be associated, but we still do not know the importance of this role.
Neurocognitive manifestations can be more frequent in patients infected with HIV. They may take a number of forms, including concentration and memory disorders. More frequent in untreated patients, these conditions can improve with antiretroviral treatment, in some cases. According to the literature, not all drugs are equal in their ability to penetrate the central nervous system. However, this notion is controversial and has not yet been proved definitively.
Renal manifestations can also be due to HIV infection and can be reduced by initiating antiretroviral treatment. They can also be due to other health problems, such as diabetes, high blood pressure and cardiovascular problems, or by certain anti-HIV drugs.
Bone manifestations include osteopenia and osteoporosis. The exact cause for the higher incidence in HIV-infected patients is subject to debate. Hypogonadism, lack of vitamin D, the use of certain drugs and HIV infection can play a role. Here again, we do not know the importance of these different factors.
A great deal of research is being carried out on aging with HIV. Many questions still remain unanswered. However, as we learn more, we will be better able to care for this new cohort of patients.
— Dr. Junod