icon-folder.gif   Conference Reports for NATAP  
  Back grey_arrow_rt.gif
Coping with HIV/Aging: managing health & psychological factors & HCV
  A key to aging will be managing stressors of physical & psychological health which include the usual & expected stressors HIV-negative individuals face and in addition those due to having HIV. Many of the usual stressors of aging will be magnified among those with HIV including less money, loneliness, difficulty in mobility (shopping, getting out for social activities), managing one's home, of course managing one's increasing health issues, and keeping busy and satisfied. Although older people in general have at times difficulty with loneliness & companionship, people with HIV may be more acutely affected for many reasons, so more support services will be required. Research linked to below & other research find sleep is associated with health & HIV may be associated with sleep disorders. People with HIV already in general have financial limitations often living on very limited incomes, and as one gets older having to manage with less income often occurs. So housing will certainly become a problem for many, inadequate funds for food & transportation may limit the necessities of life including helpful social activities which address loneliness. But in addition people with HIV will of course have additional concerns: HAART adherence will become a problem for some with forgetfulness increasing, so how will HIV+ individuals remain dutifully adherent as they did when they were 20 years younger, what types of adherence support & reminders can we develop. HAART-aging friendly regimens may make a big difference. Researchers have yet to study which HAART regimen(s) may provide a more beneficial outcome for older patients. Benefits would include: less side effects, less abnormal lab tests, better cardiovascular side effects, less neuropsychological effects, certainly more convenience will add to that, less overall metabolic affects. Researchers have yet to compare HAART regimens to see if there is a difference for older patients between regimens. Of course key will be managing one's health including being vigilant with preventing & managing complications: does one have adequate care to properly address key health potential complications, either for prevention or care & management: regular bone evaluations, heart disease mgt, diet/exercise are major contributors to improving longevity, sustaining health & of critical importance minimizing stress, maintain kidney health, mental health, diabetes, hypertension etc. Since mobility becomes more problematic with aging & we can expect for some with HIV mobility will be an even bigger problem in due perhaps in part to neuropathy & greater cognitive impairment, one may be a greater risk for falling and breaking bones or even worse. The risk for increasing frailty & cognitive impairment & perhaps more severe psychiatric disorders require vigilance in remaining cognizant that these might occur. A patient may want to start developing a network of providers or perhaps they feel comfortable with their HIV provider or health system or hospital in referring them to specialists when needed. But either way it's important to stay on top of these concerns. One last point, hepatitis C (HCV). It is crucial to manage HCV if one is HCV-infected. HCV disease can progress more quickly in HIV+ individuals and severely impact health, mortality & quality of life. With the advent of many new drugs, much higher cure rates now, the expectation that peginterferon & ribavirin will likely be eliminated from therapy, and in the near future more additional new drugs raising the cure rates much higher & close to 100%, making intelligent evaluation & treatment decisions regarding one's HCV is crucial. We will have to educate patients, care providers & service providers to improve their skills & we may have to consider what services we will need to provide for older patients. Jules Levin

"acute stress may be associated with transient immune activation, chronic stress seems more consistently associated with immune downregulation or depression"

"Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life."

"Women who had chronic depressive symptoms were more than twice as likely to die compared with those who had limited or no symptoms, even after we controlled for clinical, substance use, and sociodemographic factors."

"psychological resources are potentially amenable to change, results can be applied to clinical interventions"

"Psychological resources also could contribute to differences in other health behaviors that impact immunity, such as exercise, diet, and consistency of healthcare"

"In many ways, HIV-positive people over 50 are like guinea pigs, says Chew: they are the first to age with HIV, and the first to experience that process truly out of the closet"

"Sleep disturbance and fatigue are highly prevalent and disabling symptoms in a majority of individuals infected with HIV......The prevalence of sleep disturbance in our sample was very high and related to significantly higher scores on anxiety and depression scales and to caffeine consumption. A trend towards higher B2M may indicate a relationship to progression of illness. The presence of a sleep disturbance in an HIV patient should alert the physician to investigate for comorbid psychiatric disorders."

"The good news is that the meds are great, and people are living longer. But now there's a whole new set of issues to be faced.".......Stigma related to disease and age-and, in many cases, sexual orientation, too-has been shown to cause depression and anxiety. (rates of depression in HIV survivors [are] higher than in the general population.) Many of those aging with HIV don't have social networks they can count on, either: gay seniors, who make up a big chunk of this group, are twice as likely as their straight counterparts to live alone. "People with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer-outside of HIV disease," says Charles Emlet, a social worker at the University of Washington who studies the virus and aging.

Growing old with HIV : The Lancet Infectious Diseases


by K Senior - 2005 - Cited by 7 - Related articles

Growing old with HIV. Original Text. Kathryn Senior. On World AIDS Day on Dec 1, people will wear a red ribbon as a symbol of hope and, in 2005

"An ageing HIV-positive population does, however, pose many medical challenges and Casau stresses that metabolic, neuropsychiatric, and cardiovascular morbidities could be exacerbated by the use of antiretrovirals or by HIV infection itself."

The combination of physiological and mental impairments in older HIV-positive patients will put severe pressure on medical and social resources. "HIV specialists have to become experts in other major conditions, and experts in other areas such as cardiovascular and neuropsychiatric disorders have to learn to work with patients who also have HIV and who are already on complex medications", observes Pitts. "There may also need to be some re-education concerning stigma and discrimination", she continues, stressing that "universal health precautions will need to be rigorously sustained". "Social assistance, empathic assistance and careful explanation of the therapeutic plan will be as important as the treatment itself", adds Manfredi.

Vance believes that future studies must incorporate the duration or chronicity of HIV on the overall quality of life, including an examination of long-term stress and coping, depression and anxiety, retirement and financial issues, sexual and familial relationships, loneliness and social networks, cognition and everyday functioning, and so on. "When considering ageing with HIV, we must keep in mind that this disease affects the whole person, not just one's immune function", he concludes.

Psychological Stress May Accelerate HCV Progression - (04/12/04)

While acute stress may be associated with transient immune activation, chronic stress seems more consistently associated with immune downregulation ordepression. Several studies have agreed that a lower number or activity of natural killer cells, which play a crucial role in the clearance of virus-infected cells, was associated with chronic stress, such as chronic professional stress, bereavement, loneliness, and distress after a hurricane.

"...The present study showed that the type 1 personality, as well as its elemental traits.....Each of the four type 1--related Stress Inventory scales-low sense of control, object dependence of loss, unfulfilled need for acceptance, an daltruism-was positively and significantly associated with hepatitis severity..."...."...While acute stress may be associated with transient immune activation, chronic stress seems more consistently associated with immune downregulation or depression. Several studies have agreed that a lower number or activity of natural killer cells, which play a crucial role in the clearance of virus-infected cells, was associated with chronic stress, such as chronic professional stress, bereavement, loneliness, and distress after a hurricane..."....Accumulating evidence has linked psychosocial factors to the onset, course, and outcome of chronic and latent viral infections, such as genital herpes virus, varicella-zoster virus, and human immunodeficiency virus......

For example, a low sense of control is thought to lead to a chronic negative mood, and the negative mood status was shown to be related to more frequent recurrences of genital herpes. Unfulfilled need for acceptance shares a common concept with repression of emotion, the relevant constructs of which were reported to be associated with the progression of HIV infection. This trait may also relate to the concept of social support, more specifically a lack of emotional support, which is suggested to be potentially important in the progression of HIV infection. It shouldalso be noted that the type 1 score, which was defined as the average of the type 1--related Stress Inventory scales, seemed even more strongly associated with the severity of chronic hepatitis C than any single elemental trait. This suggests that a combination rather than any one of the traits may be more relevant in accounting for the contribution of psychosocial factors to immunological regulation in chronic viral infection.

Psychological resources protect health: 5-year survival and immune function among HIV-infected women from four US cities - (09/12/06)

"The primary objective of this study was to determine whether psychological resources protect against HIV-related mortality and decline in CD4+ cell counts among women with HIV.....Psychological resources may protect against HIV-related mortality and immune system decline...Guided by Cognitive Adaptation Theory, the aim was to determine whether psychological resources (positive affect, positive expectancy regarding health outcomes, finding meaning in challenging circumstances) protect against HIV-related mortality and decline in CD4 lymphocyte counts among women with HIV..........Women with HIV are generally more vulnerable because they are disproportionately from racial/ethnic minority groups and face multiple socio-economic stressors [30]. This social vulnerability may diminish the extent to which women with HIV have and can utilize psychological resources....... psychological resources are potentially amenable to intervention, results can be applied to improve the health of women with HIV......."This study was limited by failure to measure factors that might explain the association between psychological resources and HIV-related mortality such as medication adherence......Women in this cohort [52] and others from studies with similar socio-economically-vulnerable populations [53-55] indicate that overall adherence is variable and generally low.......Psychological resources may have direct effects on immunity through partial preservation of CD4+ lymphocytes, expected to decline over time among persons with HIV. This association may operate through 'muting' adverse effects of stress [45], which result in immunosuppression......Although not examined, we acknowledge potential indirect effects. For example, psychological resources could contribute to increased adherence, which could affect immunity and mortality. Psychological resources also could contribute to differences in other health behaviors that impact immunity, such as exercise, diet, and consistency of healthcare. The results do not eliminate the possibility of mediating factors; however, findings suggest that psychological resources play an important role in physical health of women with HIV beyond many relevant clinical and sociodemographic factors. Whether this role is direct or indirect is an area for future inquiry.

Psychological Stress and Disease (HIV/AIDS) (10/11/07)
Dementia and marital status at midlife and late life - Editorials - (07/15/09)

Risk is increased in people who are unmarried, especially if they are widowed

Marital status late in life has been related to the risk of dementia or cognitive decline in the next 3-10 years. People who were classified as unmarried,1 single,2 3 and single living alone4 are at increased risk of dementia or cognitive decline. This association was true even after adjustment for activities, social engagement, and living conditions and was independent of other risk factors for dementia.

Depression & No HAART Increases Risk for AIDS-Death Among ...

First, do depressive symptoms predict time to AIDS-related mortality among a cohort of HIV-seropositive women? Second, does use of mental health services

Sleep and HIV illness.-
OBJECTIVE: To assess the severity and prevalence of sleep disturbances in patients attending an urban AIDS clinic and to determine the correlation to the ... www.natap.org/2008/HIV/041108_03.htm-

Depression Raises Risk of Diabetes, Study Finds The incidence rate of diabetes was 4.4 per 1000 person-years.-
.... calories ( energy) (2 items), concentration (1 item), and sleep (1 item). ...

Depression in the United States Household Population, 2005-2006
Depression is characterized by changes in mood, self-attitude, cognitive functioning,sleep, appetite, and energy level (2). The World Health Organization ... www.natap.org/2008/HIV/091608