CATIE News

29 June 2021 

Study uncovers health issues and concerns of some aging HIV-positive people

  • Many HIV-positive people are living longer and some are dealing with issues related to aging
  • Aging is likely accentuated in HIV-positive people, so more attention to this issue is needed
  • A study found that a comprehensive geriatric assessment can uncover health issues in older HIV-positive people

HIV infection is a chronic viral condition that can be well controlled with antiretroviral treatment (ART). HIV infection is associated with excess inflammation that is only partially reduced with ART. Some researchers think that excess inflammation associated with HIV infection may, over many years, contribute to accentuated aging in this population.

As HIV-positive people are living longer, they have to deal with the issues that accompany aging. One way that doctors can begin to help aging HIV-positive people is to make a referral for a comprehensive geriatric assessment (CGA) when necessary.

Doctors who specialize in the care of older people can perform a CGA and, in so doing, they can administer tests, conduct assessments and observe patients. All of these approaches help to form an overall picture about health issues faced by an aging person. Doctors can also ask questions and engage in discussion with patients to better understand their concerns.

A team of researchers at Weill Cornell University in New York City conducted a study in which they reviewed the results of CGAs from 105 older HIV-positive people. The researchers found that the CGAs uncovered many issues related to health and function in this population. The researchers also found that CGAs “offer an important window into the psychosocial concerns and needs of older people with HIV.”

Study details

The study took place before the onset of the COVID-19 pandemic.

During the CGA, doctors took notes about each participant’s medical history and concerns about aging. They then administered tests and assessments that screened for the presence of or otherwise explored the following issues:

  • anxiety and depression
  • difficulty walking
  • hearing and visual loss
  • falls
  • fracture risk

After doing these assessments and tests, doctors collected and analysed the data on each participant and then made a presentation to a team consisting of the following healthcare workers:

  • gynecologist (when women were involved)
  • dietician
  • internal medicine specialist
  • nurse
  • social worker
  • psychiatrist

The team provided feedback to the doctors about potential interventions to help patients.

The average profile of the 105 participants who were referred for a CGA was as follows:

  • age – 67 years (ranging from 50 to 84 years)
  • 75% men, 24% cisgender women and one transgender woman
  • major ethno-racial groups: Black – 40%; white – 31%; Hispanic – 27%
  • duration of HIV infection – 22 years
  • CD4+ cell count – 600 cells/mm3
  • CD4/CD8 ratio – 0.9 (the normal range is 1.0 or greater)
  • HIV viral load – 75% had a viral load of less than 20 copies/mL
  • 18% smoked tobacco

For the purpose of comparison, researchers used health-related information collected from more than 1,100 HIV-positive people of similar age and HIV-related variables who were not referred for a CGA.

Results

Commonly reported issues by participants were as follows:

  • memory difficulties – 66%
  • fatigue – 55%

Overall and specific complaints

A total of 41% of participants described their health as fair or poor.

Researchers found that the following proportions of people had the following issues:

  • 51% reported moderate or severe pain
  • 47% had some difficulty with vision
  • 33% had some difficulty with hearing

The need for assistance

Most participants did not need assistance with activities associated with daily living. However, some people reported that they needed help with the following activities:

  • bathing – 14%
  • climbing stairs – 14%
  • getting dressed – 11%

When researchers asked participants about their need for assistance with instrumental activities of daily living, participants reported the following:

  • 42% needed help with housework
  • 42% needed help with doing laundry
  • 31% needed help with shopping
  • 29% needed help with cooking
  • 24% needed help with transportation
  • 19% needed help organizing and taking daily medications

Overall, researchers found that only 49% of participants were able to do such activities without the need for help.

Conversations between doctors and patients

As part of screening participants, doctors and patients engaged in a wide range of topics. As these conversations often led to a discussion of patients’ goals, doctors subsequently asked about such goals as part of the CGA and presented data from 90 participants on this topic.

The researchers stated that most participants offered “one or two” goals, which usually involved the following themes:

  • staying alive
  • maintaining health
  • financial stability

The researchers also found that many participants had spiritual and emotional goals (no details were provided).

Fifteen participants did not mention any goals.

The researchers found that participants who articulated goals were less likely to be depressed than those who did not mention goals. Reflecting on this finding, the researchers proposed that “the inability to plan for the future is a significant manifestation of depressed mood,” at least in their group of study participants.

Bear in mind

In the present study, the researchers found the following:

  • CGA uncovered deficits in functioning along with many health and social concerns.
  • Participants who were referred for a CGA had a greater burden of health conditions than people of similar age and HIV-related factors who were not referred for a CGA.
  • An assessment of goals “can provide insight into patients’ aspirations and mood.”

According to the researchers, “older HIV-positive people have many unmet needs, and CGA can provide opportunities for patients to identify concerns that are important to them but may not relate directly to HIV care.”

They also stated: “While not every older HIV-positive person may welcome CGA, this study demonstrates that many want to learn about aging issues and have not had the opportunity to articulate their apprehension about growing older.”

Note well

Readers should note that participants were not randomly selected for a CGA and inclusion in the study. Therefore, the proportions of people with different aging-related health issues are not generalizable to all older HIV-positive people outside of this study. Still, the study’s findings are interesting and pave the way for future studies that focus on interventions that can address health issues and concerns uncovered by CGA.

—Sean R. Hosein

Resources

A Practical Guide to a Healthy Body for People Living with HIV -- CATIE

Studying patterns of healthy aging among HIV-positive people in CanadaCATIE News

British Columbia study finds higher levels of age-related issues in HIV-positive peopleCATIE News

Factors affecting frailty in middle-aged HIV-positive peopleCATIE News

Traditional risk factors have a big impact on bone thinning in HIV-positive peopleCATIE News

Calgary doctors find that more older people are getting HIVCATIE News

High rates of frailty seen among middle-aged and older HIV-positive people in AlbertaCATIE News

Problems with movement and muscle coordination found in some HIV-positive peopleCATIE News

REFERENCES:

  1. Siegler EL, Moxley JH, Glesby MJ. Aging-related concerns of people living with HIV referred for geriatric consultation. HIV/AIDS – Research and Palliative Care. 2021 Apr 30;13:467-474.
  2. Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine. 2019 Dec;25(12):1822-1832.
  3. Babu H, Ambikan AT, Gabriel EE, et al. Systemic inflammation and the increased risk of inflamm-aging and age-associated diseases in people living with HIV on long-term suppressive antiretroviral therapy. Frontiers in Immunology. 2019 Aug 27;10:1965.
  4. Cesari M, Marzetti E, Canevelli M, et al. Geriatric syndromes: How to treat. Virulence. 2017 Jul 4;8(5):577-585.
  5. Gabuzda D, Jamieson BD, Collman RG, et al. Pathogenesis of aging and age-related comorbidities in people with HIV: Highlights from the HIV Action Workshop. Pathogens and Immunity. 2020 Jun 17;5(1):143-174.
  6. Pathai S, Bajillan H, Landay AL, et al. Is HIV a model of accelerated or accentuated aging? The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2014 Jul;69(7):833-42. 
  7. Sehl ME, Rickabaugh TM, Shih R, et al. The Effects of Anti-retroviral Therapy on Epigenetic Age Acceleration Observed in HIV-1-infected Adults. Pathogens and Immunity. 2020 Oct 22;5(1):291-311.