iconstar paper   HIV Articles  
Back grey arrow rt.gif
What is Frailty in HIV?: Geriatric Syndrome to Physiologic Process
  Reported by Jules Levin, NATAP
from Jules: this is an interesting & well done presentation, it reviews what is frailty? How is frailty different in HIV? You will see 2 slides of note below "Frailty Index" which lists numerous specific health issues, mental status, and comorbidities associated with being frail, and studies associating frailty with mortality, a 2nd slide "What about HIV and frailty?" lists comorbidities & HIV measures associated with frailty. The research to me is clear HIV+ experience greater inflammation & immune activation - suppressing HIV viral load to undetectable levels significantly reduces inflammation, which is a major reason the HHS ART Guidelines recommend considering HAART as son as one knows they have HIV - compared to HIV-negative individuals & immune activation as well, but even with this beneficial affect HIV+ individuals still have residual inflammation & activation - exercise & proper diet can significantly reduce further inflammation & immune activation - HIV accelerates the aging process but so do other factors most likely like a history of drug abuse, poor diet, lack of exercise, being sedentary, of course genes; as well, HIV+ individuals are at greater risk for developing comorbidities more often & sooner than HIV-negatives & this is part of the acceleration aspect, that HIV can accelerate some comorbidities to occur more often & sooner in HIV+, like bone disease, heart disease, mental & cognitive decline. PREVENTING COmorbidities - Its important to note that evaluating & monitoring for these comorbidities can help in preventing them & delaying their onset. Identifying heart disease developments like monitoring lipids, evaluating heart function by doctor can go a long way in preventing heart disease. Checking for bone loss with a DEXA test can detect the level of bone loss & testing your vitamin D levels can suggest to you if you need vitamin D supplements & calcium supplements & if one has osteoporosis & perhaps its time to begin treatment such as Fosamax & their are new bone treatments in phase 3 studies. There was a poster at CROI 2014 that had a graph depicting the slope of decline/aging decline in HIV+ & HIV-neg and after 60 yrs old & the slope of decline of the line for HIV+ have a steeper decline compared to HIV-negatives, suggesting that after 60 yrs old HIV+ individuals may experience, perhaps at least some not all, accelerated decline compared to hiv-neg. At this time the old saw remains very true - EXERCISE & GOOD DIET remain crucial to preventing & delaying the aging process & the onset of comorbidities. WHAT is good diet? Well, there are numerous studies on diets, many on the NATAP website, studies find repeatedly that the mediterranean diet reduces inflammation & improves health. One study found vegetarian protein reduced risk for disease compared to animal diets. One study found vegetarian diet/protein (http://www.natap.org/2013/HIV/061213_01.htm) reduced risk for disease compared to animal food diets. Meanwhile federal and state governments need to act to address the needs of aging HIV+ individuals. Over 50% of HIV+ will be over 50 yrs old within 2 years & a high percent will soon be over 60 yrs old, I think 30%. The federal govt did respond to increased research, I started the education & advocacy effort about 6 years ago & the OAR, Office of AIDS Research responded & now many millions of dollars are dedicated to research, but we have not found good interventions test. STILL, the issue is that aging/older HIV+ individuals will need increased services & specialized services & care, and the federal govt & state govts need to begin devising strategies to address this serious concern. There are many concerns including older HIV+ will face greater stigma & discrimination, losing income & pensions, housing loss, worsening mobility & frailty, more comorbidities & need for increased testing & care & treatment, increased cognitive & mental concerns, increased risk for falls & bone fractures, increased risk for diabetes & heart disease & vascular disease, perhaps increased rates of certain cancers. We need to beef up the HIV healthcare system to address these needs. We need HIV/Aging Clinics in every major HIV hospital clinic to address special healthcare & personal issues. In every major city and state we could begin with an HIV Aging Czar who can serve as a liaison between patients & the healthcare system to address these needs. In every major HIV hospital & clinic there can be an Aging Counselor who can help patients secure their benefits, address housing & income issues, address care in their homes etc. All the stakeholders in HIV can participate in expanding this discussion & to help discussion surrounding forging solutions, this includes the drug/pharmacuetical companies, they have an obligation to participate in & help support & forge solutions!
Presented at
October 2-3, 2014 · Decatur, Georgia, Emory University
HIV & Aging:
From Mitochondria to the Metropolis
A translational science meeting to address the basic science, clinical
and socio-behavioral aspects of Aging with HIV/AIDS
October 3, 2014
Kris Ann Oursler, MD
Director, Geriatric Research and Education
Salem VA Medical Center
Associate Professor, Virginia Tech Carilion SOM
Adjunct Faculty, University of Maryland SOM





























  iconpaperstack View Older Articles   Back to Top   www.natap.org