Increased Prevalence of Age-Related Comorbidities in HIV-Positive Individuals

Due to advancements made in treatment efforts, those infected with HIV are living longer lives. In fact, 45% of HIV-positive individuals living in the United States are those aged 50 or older. However, their lifespans are still about 5 years shorter than those of the general population.

As HIV becomes a disease of older Americans, it is time for all health care professionals to recognize the age-associated comorbidities unique to this population. In a recent article published in the journal Infectious Disease Clinics of North America, Case Western Reserve University School of Medicine cover key points regarding accentuated risks for age-associated comorbidities in those living with HIV.

The authors explained that HIV infection and some of its treatments use mechanisms that normal cells use to age; thus, cellular senescence may be accelerated. Genetic instability and altered intracellular communication also increase the likelihood of comorbidities.

Pharmacists in all types of practice should be especially familiar with this population because they are likely to see them as patients, if not specifically for HIV, then for age-associated comorbidities. Consider this:

• Individuals with HIV are twice as likely to develop cardiovascular disease than the general population.
• Fracture is 3 times more likely in HIV-positive individuals than it is in others.
• Individuals with HIV are as likely to develop chronic kidney disease as individuals who have diabetes.
• A full 84% of individuals with HIV will have at least one comorbidity by 2030.
• Liver disease is more likely to develop in older individuals with HIV, especially if co-infection with hepatitis B or C is/was present; alcohol consumption also increases the likelihood of liver disease.
• HIV-positive individuals are at higher risk of neurocognitive impairment than others, probably due to inflammation and endovascular disease.

The authors recommended early and aggressive treatment with antiretroviral therapy, followed by careful screening for age-associated comorbidities. Clinicians should order cancer screenings following the guidelines, with heightened vigilance in patients who smoke.

“Effective care of older HIV-infected adults that focuses on quality of life will need to span from effective treatment of HIV to preventing and managing polymorbidity to appraisal of social determinants of health and more seamlessly integrate community and social services into health care delivery,” the study authors conclude.