Thanks to the many benefits of potent anti-HIV combination therapy (commonly called ART - Antiretroviral Therapy) more people living with HIV in Canada and countries that have policies to cope with the HIV / AIDS epidemic similar to Brazil are living longer. The power of ART is so profound that researchers increasingly expect that some HIV-positive people will have close to normal life stretches.
As people living with HIV enter their last years, changes in the care they receive will be needed, they and their caregivers will need to be more attentive to the issues of aging. For the average HIV-positive person who start young and adults today, goals that will likely include a simple regimen with minimal side effects so that the low viral load in the blood can be achieved and maintained. As the individual ages, the goals may increase or change to include maintaining, in this way, a good quality of life, in the spheres of physical health, mental and emotional health. To enable successful aging, elements of geriatric care will need to be incorporated into the regular medical visit.
Doctors use the term Common Geriatric Syndromes to refer to conditions seen in older people who can have various causes. Examples of symptoms found in geriatric syndromes are as follows:
- Fragile feeling
- Urinary incontinence
- Delirium- a disorder of consciousness with several resources, including problems with attention and awareness; memory difficulties; perception problems, such as seeing or hearing things that are not true (hallucinations); not being sure about the physical location itself (with the risk of losing the notion of where your home is); speech and language disorders. In cases of delirium a mental state of the person can change suddenly in hours or days. Delirium can make people confused and disoriented. Some people can also become violent and disturbed. Delirium is not the same as dementia, that is to say.
In general, the underlying cause (s) of problems related to geriatric syndromes can involve several organs and systems, and each element of the process “called geriatric syndrome " arising implements the vulnerability of older people to new health problems, whether or not the syndromes, deserving, so special care with HIV positive people over fifty years or over 20 years of ART.
Aging and HIV
Given that HIV positive people with advanced age will need care appropriate to their age, a team of researchers studying infectious diseases and their relationship with diseases of aging at the University of Connecticut, we proposed to doctors who care for people seropositive incorporate “geriatric assessment” in their regular visits. Such patient assessments aimed to assess the incidence of so-called “Specific conditions”That may predispose patients to a less functional condition of life (SCI),“ such as the following:
- Visual difficulties - problems in this area can have a major impact on medication adherence.
- Inner ear infections and hearing problems - problems in this area can affect balance, lead to falls and possible fractures, inhibit the ability to understand instructions received from your care providers, increase the risk of traffic-related accidents (pedestrian accidents, collisions…).
In San Francisco
A team of researchers in San Francisco started trying to understand the effect of aging on HIV-positive people. The team sought to assess the presence of geriatric syndromes in people who lived beyond 50 years of age receiving ART (antiretroviral therapy) and who had maintained a low or undetectable viral load for several years.
The study determined that in 155 people analyzed, geriatric syndromes were found. Participants with the highest number of coexisting health conditions were at increased risk for developing geriatric syndromes.
The researchers recruited participants from two major infectious disease clinics in San Francisco. Participants completed questionnaires, a physical exam and had blood samples taken. All data was analyzed together with your medical records.
The researchers focused on the following questions:
- Urinary incontinence
- Reduced ability to perform certain daily activities (including household chores, such as administering medications, personal hygiene, caring for clothing, doing household maintenance on important things, such as shopping at the supermarket ...)
- Problems with hearing and vision
- Difficulty thinking clearly and memory lapses
- Fragility (see below)
The research team defined “frailty” and “pre-frailty” during the evaluation process the presence of the following symptoms:
Unintentional weight loss
Self reports of tiredness
Low physical activity
Low speed when walking
Physical weakness (assessed by prehensile hand strength)
The researchers classified as fragile if they had three or more of these symptoms and pre-fragile to those who had one, or two, of the previously mentioned symptoms.
Data from 155 people were available for analysis. The average profile of the participants was as follows:
- Age - 57 years.
- 94% of men and 6% of women.
- Duration of HIV infection greater than 21 years.
- CD4 lymphocyte count +/- 537 cells / mm3
On average, participants had four health conditions coexisting (comorbidities). The most common are the following:
- Abnormal levels of cholesterol and triglycerides in the blood (dyslipidemia).
- Higher than normal blood pressure (hypertension).
- Wounds and / or painful sensations of the nerves of the hands, arms, legs or feet (peripheral neuropathy)
Participants used, on average, nine drugs (medications) not directly related to HIV as part of their daily therapy.
The researchers found that 54% of the participants had at least two geriatric syndromesSuch as the following:
- Pre-frailty - 56%
- Difficulty with one or more activities of daily living - 47%
- Memory lapses and problems and problems cognitivos- 47%
Other problems include also the following:
- Falls - 26% of patients in the study revealed that they had suffered at least one fall in the past year; on average, there were two falls per person per year. In about 13% of cases, it was necessary to seek medical attention.
- Urinary incontinence - 25%
- Hearing impairment - 41%
- Visual impairment - 50%
- Parallel illnesses - 22% of participants had mild depression and 18% had moderate to severe depression
Keep in mind that the study was observational and cross-sectional in nature.
That is, the data was captured largely at one point in time and the participants were not recruited at random. Such studies are good for finding associations between a potential risk factor and the outcome (one of the potential geriatric syndromes mentioned above), but they cannot prove that a certain risk factor assumption results in a determined specific result. Their conclusions must be taken into account with relative caution.
[Translator's note: Although this alert and my personal admission of possible somatization, I identified with at least 3 these factors / consequences and found this text after having tasted of certain symptoms - in short, I translated on behalf of themselves and held of course, to all who read me, finding or following this site for search engines and / or in different social networks]
In the study, the researchers found that people who had low CD4 + counts were at increased risk for future development of geriatric syndromes. It was also discovered that people of color (...) would be at greater risk for these syndromes.
[Translator's Note: Since I started my ART've been keeping (this for over ten years) CD4 above 800 in the penultimate analysis was in about 1200 and last approximately 900) and, not being a person of *** color (orange? pumpkin? Green? *** you given that on my birth certificate says ___pardo___ and I do not know what that means, even by at night all cats are gray, I have serious geriatric syndrome of signs and I confess act, that's what moved me in finding these answers and I refuse to let that without observing a possible demonstration of Canadian racism]
It is likely that participants who reported peripheral neuropathy were exposed to a group of old antiretroviral drugs - commonly called "d-drugs" - which can (???) be toxic to nerve cells.
- DDI (didanosine, Videx) [I took it for six months, nineteen years ago.]
- D4T (stavudine, Zerit).
- DDC (zalcitabine, Hivid).
Cross-sectional studies, such as the present, are a good first step, and can be used to establish whether or not there is a health problem that may require further investigation, with a larger number of subjects in the study and with a more robust and therefore more expensive design.
Such a study may investigate other possible risk factors for geriatric syndromes. Based on the findings of the present study, the researchers predicted that the rapid (immediate in Brazil) start of ART can be a way to delay or prevent the development of geriatric syndromes.
However, given that advice, treatment guidelines and clinical practice in high per capita income countries [Regardless Brazil maintains strict stance on the issue of HIV / AIDS with certain exceptions] has generally recommended starting ART early in the course of HIV infection [In Brazil is immediately after diagnosis and a small routine blood tests].
San Francisco researchers should be commended for doing the necessary preliminary work to document that geriatric syndromes are occurring even in HIV-positive people living in middle age. A future study should have a control group HIV Negative and include a greater number of women from similar socioeconomic backgrounds so that relevant and meaningful comparisons can be made.
Such a study needs to explore a combination of other possible risk factors for geriatric syndromes including the following (as mentioned by the researchers):
- Psychosocial factors (social isolation, substance use).
- The presence of multiple comorbidities.
- The burden of taking various medications for various conditions
- Chronic inflammation
Translator's note. This text has been revised ten times and I don't feel sure about it. If you, reader, notice something, even if it is a simple typo, please send an email to [email protected] and show me, even if you need to draw, the error in question. thanks in advance.
A note from the Editor: I know how complex and how discipline is required, memory, and attention to maintain, consistently, a treatment like ours.
fortunately I discovered, not long ago, but already incorporated into my routine, an application for Android © called *** MEDISAFE ***. It is, literally speaking, a nurse (real nurses can never be replaced, far from me, who I received and receive from them, almost twenty years ago, affection, care, respect, attention, love…) particular, for their day to day .
It takes some work to configure, because you have to feed the application the medicines you take (and you can configure to facilitate if the tablet is round or if it is long, like this or roasted, green, blue (this is good 😊), determine a time of tolerance for you to be late, you can insert the dosage in milligrams, spoons, drops, blah, blah blah and, finally, establish your entire medical routine, including the alert for the acquisition (in those cases that we always hear the phrase funesta: “it is missing”) and, in order not to screw you, tell the saint, explain the miracle and not show the church I put this link. There are others there, but I really liked this one and, honestly, I don't know if there is an iPhone version. But, if you can have a simple phone (mine still runs Android © 2.2) that works with Android © I, who never recommend anything, I recommend this application.
This information was provided by CATIE (Canada Exchange of AIDS treatment information). For more information, contact CATIE, 1.800.263.1638 or Catie. The credit must appear on any online publication, with a link back to the original.
The translation into Portuguese of Brazil can not be used without prior permission in writing of those responsible for Seropositive Web Site, subject to the offender, the possible implications of the laws be charging intellectual property rights.
Translation adaptation and revision of the original in Canadian English into Brazilian Portuguese (it does not exist Brazil with “z” and “BraZil” is an idiomatic aberration created for persons which only God knows why they do this…) from the original in Geriatric syndromes found to be common in some HIV-positive people by Claudio Souza.
I am not a "victim" of AIDS. I am a person living with AIDS.