Pharmacists Help Aging HIV Population

Most people who have HIV in the United States are older than 50. Research has significantly improved the lifespan of individuals with the disease. However, their lifespans are still about 5 years shorter than those of the general population.

As HIV becomes a disease of older Americans, it is time for all health care professionals to recognize the age-associated comorbidities unique to this population. The journal Infectious Disease Clinics of North America has published an article that addresses this very issue. In it, researchers from Case Western Reserve University School of Medicine cover key points about the over-50 population with HIV.

Pharmacists in all types of practice need to be familiar with this population because they are likely to see them, if not for HIV, then for age-associated comorbidities. Consider this:

• Individuals with HIV are twice as likely to develop cardiovascular disease than the general population.
• Fracture is 3 times more likely in individuals with HIV than it is in others.
• Individuals with HIV are as likely to develop chronic kidney disease as people who have diabetes.
• A full 84% of individuals with HIV will have at least 1 comorbidity by 2030.
• Liver disease is more likely in older individuals with HIV, especially if co-infection with hepatitis B or C is or was present; alcohol consumption also increases the likelihood of liver disease.
• Individuals with HIV are at higher risk of neurocognitive impairment than others, probably due to inflammation and endovascular disease.

The authors explained that HIV infection and some of its treatments use mechanisms that our own normal cells use to age. Thus, cellular senescence may be accelerated. Genetic instability and altered intracellular communication also increases the likelihood of comorbidities.

The authors recommended early and aggressive treatment with ART, followed by careful screening for age-associated comorbidities. Clinicians should order cancer screenings following the guidelines, with heightened vigilance in patients who smoke. The authors concluded that these patients need polypharmacy management, which provides a perfect role for pharmacists.

Reference

Van Epps P, Kalayjian RC. Human immunodeficiency virus and aging in the era of effective antiretroviral therapy. Infect Dis Clin North Am. 2017;pii:S0891-5520(17)30061-2. doi: 10.1016/j.idc.2017.07.007.