75 years, male, and HIV positive

Antiretroviral therapies (ART) are enabling HIV+ people to have an almost unaffected life expectancy and the need for elderly care. Elderly HIV+ patients suffer from particular comorbidities that need to be addressed.

Depression and cognitive disorders are frequent companions

Modern antiretroviral therapies (ART) are now reliably pushing HIV below the detection limit. People with HIV thus have an almost unimpaired life expectancy, including the possible need for elderly care. A recent study from France has taken a closer look at the health status of people with HIV in the age group of > 75 years. Many of those affected suffer from particular comorbidities that need to be addressed in care strategies.

In their multicenter observational study, the researchers included a total of 51 people with HIV at the median age of 78.7 years. Almost 75% of the participants were male, in 41.2% of these cases the original HIV infection occurred through homosexual contact and was on average about 19 years ago. The median CD4 nadir was 181 cells/mm3. All patients received an ART, as a result of which 98% of the men reached a viral load below the detection limit (HIV-RNA < 50 c/ml).

A high-rate of mental and cognitive concomitant diseases

Although men over the age of 75 suffer from increasing fragility and various comorbidities even without HIV infection, it seems that for people of this age, if HIV infection is added to this, there is an accumulation of mainly cognitive and psychological diseases.

For example, 82% of men with HIV suffered from at least one comorbidity, as expected. Every second person affected (58%) even lived with two comorbidities. One in five (21.6%) showed an increased risk of old-age frailty, and the condition of about 4% was already considered "fragile". 61% of men with HIV also suffered from cognitive impairment, while 35% were depressed. Malnutrition affected as many as one in four participants, 46% lacked sufficient vitamin D.

Implications for medical practice

Overall, the results showed that older people with HIV are also well supplied with HIV via modern ART and in the majority of cases reach a virus load below the detection limit. However, there is a high degree of concomitant diseases, especially in the cognitive and psychological areas, which require regular monitoring and treatment. At CROI 2020, the mental health of people with HIV will also be a topic of particular focus.

Original publication: 
Bernaud C et al, HIV-infected patients aged above 75 years / Patients de plus de 75 ans vivant avec le VIH, Médecine et Maladies Infectieuses 2020; 50(1): 43-48

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