Geriatric conditions common in middle-aged and older HIV-positive men

Geriatric conditions were common in middle-aged and older HIV-positive adults in a San Francisco clinic, investigators report in the June 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. Common conditions included pre-frailty, difficulties with activities of daily living and cognitive impairment. A quarter of patients reported falls or urinary incontinence. The authors were concerned that these conditions of older age were occurring earlier in their HIV-positive patients – who had a median age of just 57 years -  compared to individuals in the general population.

“Our findings suggest that even in middle-aged HIV-infected adults with controlled HIV, the burden of geriatric syndromes is important and will need to be addressed clinically to minimize age-related complications in this population,” comment the investigators.

Improvements in treatment and care mean that many HIV-positive patients now have an excellent life expectancy and are living well into old age. But there’s now a considerable corpus of research showing that HIV-infection is associated with a number of co-morbidities -  such as cardiovascular disease and reduced bone mineral density – normally associated with older age.

Geriatric syndromes such as frailty, falls and functional impairment are multifactorial conditions used to identify vulnerable older adults. Little is known about the prevalence and risk factors for these syndromes in patients with HIV. Investigators from the University of California San Francisco therefore designed a cross-sectional study to determine how common these factors are in older (aged 50 plus) HIV-positive individuals and to see if any HIV- and non-HIV-related factors increased the risk of these syndromes.

Their study population comprised 155 patients enrolled in the SCOPE study (an ongoing study of HIV infection in adults). All were taking antiretroviral therapy with viral suppression for a median of three years; median CD4 count was over 500 cells/mm³.

Using questionnaires and physical examinations, the patients were assessed for geriatric syndromes including falls, urinary incontinence, functional and mobility impairment, impaired hearing and vision, depression, cognitive impairment and frailty. Data were also gathered on co-morbid conditions and use of medication to treat these ailments.

Participants had been living with HIV for a median of 21 years. Almost all (94%) were men. Co-morbid conditions were highly prevalent, with a median of four per patient, and individuals were taking a median of nine non-antiretroviral medications to control these conditions. The most common co-morbidities were elevated lipids (63%), hypertension (50%) and peripheral neuropathy (40%).

The majority of patients (54%) had two or more geriatric syndromes. The most common conditions were pre-frailty (56%), difficulty with one or more functional tasks (47%) and cognitive impairment (47%). At least one fall was reported by a quarter of patients and a similar proportion reported urinary incontinence. Mild depression was reported by a fifth of patients with 18% meeting the criteria for the diagnosis of moderate-to-severe depression.

A lower nadir CD4 count (IRR = 1.16; 95% CI, 1.06-1.26) and increasing number of co-morbidities (IRR = 1.09; 95% CI, 1.03-1.15) were associated with an increased risk of geriatric syndromes.

The authors were concerned that the prevalence of problems such as frailty, falls and incontinence observed in their patients was similar to or higher than that recorded in HIV-negative men living in a community for individuals aged 65 years or older. Geriatric conditions therefore seemed to be occurring earlier in patients with HIV.

‘The association with lower CD4 nadir suggests that earlier antiretroviral treatment initiation may help to prevent aging-related complications, and the association with increasing number of co-morbidities suggests that treatment and prevention of other co-morbid conditions are equally important to the management of HIV in the aging HIV population,” conclude the authors. “Consideration of how to incorporate assessment of geriatric syndromes into HIV care and development of targeted interventions for risk factors of geriatric syndromes is needed as the HIV-infected population continues to age.”