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Improved screening programs may be necessary for elderly patients with HIV
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About half of patients with HIV aged 60 years and older may have cognitive dysfunction and problems with basic daily living, according to findings presented at the 2009 meeting of the International Association of Physicians in AIDS Care, held in New Orleans.
Marco Ruiz, MD, MPH,of the Louisiana State University Health Sciences Center presented the findings.
"There needs to be a dedicated screening program for elderly patients to deal with the synergistic effect of HIV and the aging process," Ruiz said. He said that many aspects of the process of acquiring and treating HIV in elderly patients may be incomplete.
"Individuals in this age range were not likely to have been taught about safe sex practices and condom use," he said. "These individuals are being exposed to the world in the absence of a spouse. Widows, widowers and divorcees have continuing sex lives. The result is the ongoing primary transmission of HIV in aging populations."
Ruiz said that aging populations often present late or with comorbid conditions associated both with HIV and with the aging process. Clinicians may be less likely to discuss topics related to sex with older patients or to screen those patients for sexually transmitted diseases.
Regarding patient management, Ruiz said that waning immune systems may allow HIV to progress more rapidly in elderly patients. The response to ART medications may also be different in aging patients. Elderly patients are more likely to be taking medications for a variety of other conditions. These factors should impact the choice of ART, according to Ruiz.
A program is currently being conducted in which elderly patients are being tested for functional capabilities, depression, cognitive dysfunction, nutrition, mobility and visual or hearing difficulties among patients older than 60. Ruiz said that more comprehensive testing for these conditions in this population may be beneficial.
Of particular concern was what Ruiz described as the "vulnerable group." "Aging patients who are extremely healthy or extremely frail seem to be surviving or getting the focused care they need to survive," Ruiz said. "But patients in the middle may be falling through the cracks. In addition to more thorough screening for a range of conditions which impact elderly populations, it may be beneficial to create a separate frailty index for patients with HIV." - by Rob Volansky