Older HIV-Infected Adults are Geriatricians’ Business

Fátima Brañas is a consultant geriatrician and the clinical lead for orthogeriatrics at the Infanta Leonor University Hospital in Madrid (Spain). She holds a PhD, specializing in HIV infection in older adults, and is working hard in this field—from both a clinical and a research point of view—to provide all the benefits of a geriatric assessment for older HIV-infected adults. She recently co-authored ‘Frailty and physical function in older HIV-infected adults‘ @FatimaBranas

The HIV-infected population is aging due to the success of combination antiretroviral therapy, which prolongs survival, and also because of the growing number of newly diagnosed cases in older adults. Nowadays, over half of people infected with HIV are older than fifty years, which is the age cutoff accepted by the scientific community to consider someone an HIV-infected older adult. Fifty is only their chronological age, but biologically they are older, as accelerated aging in this population has been demonstrated. So, it seems that in the coming years, HIV care is going to be focused on a growing group of older adults and their specific problems. This means more than only survival, infection control, or avoiding the adverse events caused by antiretroviral drugs; it also includes consideration of comorbidities, polypharmacy, functional decline, and geriatric syndromes.

We performed a study to define the frailty phenotype in the older population infected with HIV, because frailty is a syndrome that identifies those at risk of adverse health events being more vulnerable to stressors than others. We hypothesised that prevalence of frailty in this population would be at least as high as it has been described in the uninfected population, and we wanted to assess physical function in this population too. Our findings have been really interesting. We evaluated 117 HIV-infected older adults and we found a prevalence of frailty of 15.4%, twice as high as that of the most representative studies on frailty performed on the general population, who were at least ten years older. We found that depressive symptoms were associated with a 9.2-fold increase in the risk of frailty, and we found the CD4/CD8 ratio to be independently associated with the risk of frailty (OR 0.11 [0.02–0.61]). We also found a high prevalence of functional impairment with one in five older HIV-infected patients showing a slow gait (<0.8 m/s) and more than half having an SPPB (Short Physical Performance Battery) score of <9.

Consequently, the management of HIV-infected patients has to change, and we geriatricians have to be involved in HIV care for older adults, working together with our HIV-specialist colleagues in a collaborative way and providing our global approach and knowledge to their specific HIV assessments. I’m enthusiastic, and I’m sure that we’re going to be talking about “HIV-geriatric clinics” very, very soon.

Read the full Age & Ageing paper ‘Frailty and physical function in older HIV-infected adults‘