Health Maintenance in the Aging HIV population

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Health Maintenance in the Aging HIV population

• Tom Norton
• July 2008

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Background

• HIV is still primarily thought of as a young
  persons disease, however, the face of the
  HIV/AIDS epidemic has changed as we enter its 3rd
  decade
• With the advent of HAART in 1996, patients with
  HIV/AIDS are living longer
• The incidence of opportunistic infections and
  AIDS defining illnesses is decreasing, while
  death and illness secondary to both
  disease-related and age-related comorbidities
  continues to escalate.

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Epidemiology

• From 1990 to 2001 the number of AIDS cases
  reported in adults aged 50 years or older showed
  more than a fivefold increase, namely from 16,288
  to 90,513 patients. (Mack and Ory, JAIDS, 2003)
• The CDC estimates that in 2006, more than 138,000
  patients aged 50 years or older were living with
  HIV/AIDS.
• This subset comprised over 31 of the HIV/AIDS
  cases in 2006, up roughly 9 from 2002 estimates.

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Epidemiology

• Concurrently, the incidence of newly diagnosed
  HIV/AIDS patients over the age 50 is also on the
  rise, thought partly secondary to
• poor awareness among older adults engaging in
  high risk behavior
• less frequent/delay screening.

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HIV and the Elderly

• Survival for adults 50 with AIDS is shorter
  than younger adults
• Lower CD4 counts at time of diagnosis
• Worse stage at initial diagnosis
• More comorbidities
• More aggressive clinical course
• Wellons, M., Sanders, L., et al., HIV Infection
  Treatment and Outcomes in Older and Younger
  Adults, JAGS 50603-607, 2002

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Project background

• Previously reported, physicians are poor at
  addressing health maintenance in the aging HIV
  population
• Georgetown IRB study performed in 2007 (S.
  Nasser, J. Timpone, P. Ryscavage, J. Kolter, M.
  Spinelli)
• Health Maintenance Data

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HM Data
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HM Data

• 209 patients (44 women, 165 men)
• Women
• 34.3 mammogram
• 25 papsmears
• 50 lipids
• 28.1 colonoscopy
• Men
• 64.8 lipids
• 40.7 colonoscopy

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Project background

• Contracting and managing HIV is likely to be a
  different process for those aged 50 years or
  older than it is for younger people (Mack and
  Ory, JAIDS 2003)
• HAART tx
• Disease overlaps with other illnesses (fever,
  weight loss, anemia, neuropathy, memory loss)
• Social support

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Project Background

• While preventative health care and screening
  guidelines are well established for aging adults,
  the aging HIV/AIDS population presents a unique
  subset of patients with distinct comorbidities
  and pharmacologic complications.

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Project background

• With the advent of HAART, the incidence of AIDS
  defining cancers and infections is decreasing,
  while more chronic conditions are on the rise,
  namely
• Lipodystrophy, metabolic syndrome, osteopenia,
  cardiovascular disease, and non-AIDS defining
  malignancies

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Project Question

• Given the importance of health maintenance in
  screening, preventing and treating potential
  comorbidities in the general public, how should
  physicians tailor their practices for the
  increasing aging HIV population?

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Project Goal

• To help engender uniformity and increase
  awareness via specific recommendations, we are
  conducting an extensive literature review, with
  special attention to four major areas, namely
  malignancy, cardiovascular disease, insulin
  resistance/diabetes, and bone disease.
• Our goal, therefore, is to provide a literature
  based compendium for preventive health care in
  the growing, aging HIV population.

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Literature Review

• Malignancy
• Prostate Cancer
• Anal/Colorectal cancer
• Breast Cancer
• Cervical Cancer
• Bone Density
• Hyperlipidemia/Hypertension/CV disease
• Diabetes
• Vaccinations
• Depression
• Substance Abuse/Risk Behavior

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Food for thought

• HIV infection vs. Medications vs. social
  situations vs. substance abuse vs. co-infections

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