Expert tips for treating older HIV patients
Look for comorbities, depression
AIDS-defining conditions and risks are different for HIV-positive patients who are older, usually defined as age 50 and above, experts say.
Older HIV patients often have higher risks of CMV disease, Kaposi sarcoma, oral candidiasis, wasting syndrome, HIV encephalopathy, and AIDS dementia complex.1
Also, older patients typically underreport symptoms such as diarrhea, pain, and depression, but will focus on weight loss, hair loss, and peripheral neuropathy.
"We found that patients who are older and have HIV infection have a higher prevalence of hypertension, hypertriglyceridemia, and low bone mineral density, suggestive of osteoporosis and abnormalities in distribution of body fat," says Nur Onen, MBChB, an instructor in internal medicine in the infectious diseases division of Washington University School of Medicine in St. Louis, MO.
"This problem of accelerated bone loss has been defined in younger HIV patients, as well," Onen notes. "Just when antiretroviral therapy (ART) first is started patients' bone density goes down, and then it stabilizes, so we think it's caused predominantly by HIV infection."
The changes in body fat put HIV patients at greater risk of diabetes, she says.
Since HIV physicians also are often their patients' primary care doctors, they should screen patients for clinical depression, which also is common in older patients, Onen suggests.
"We should talk with them about it and have colleagues who are counselors meet with them," she says.
Another issue concerns the compounding of HIV and lifestyle choices, including smoking, substance abuse, and exposure to other viral infections.
"We have to be very aggressive with our older HIV population and tell them to stop smoking and try our best to address any alcohol and substance use issues that may impact their health and their ability to stay on their HIV medications," Onen says. "We should be aggressive in recognizing and treating depression because it also can impact their medication use."
Clinicians also should encourage patients to maintain good diabetic control, when this is an issue, and check for malignancies, she adds.
"We need to keep HIV patients as healthy as possible for as long as possible," she says.
- Onen NF, Overton ET. HIV and aging: two converging epidemics. Missouri Medicine. 2009; July/August:227-231.