Aging with HIV CoChairs Sharon Walmsley Adrian Betts Disclosure - - PowerPoint PPT Presentation

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Dec 16, 2022 378 likes •556 views

Aging with HIV CoChairs Sharon Walmsley Adrian Betts Disclosure Served as an advisor, and spoken at CME events for Viiv, Merck, Bristol Meyers, Abbvie, Gilead, and Jannsen Plenary Speakers Julian Falutz McGill University Alice

SLIDE 1

Aging with HIV

Co‐Chairs Sharon Walmsley Adrian Betts

SLIDE 2

Disclosure

Served as an advisor, and spoken at CME events for

Viiv, Merck, Bristol Meyers, Abbvie, Gilead, and Jannsen

SLIDE 3

Plenary Speakers

Julian Falutz‐ McGill University Alice Tseng‐ University Health Network Richard Harding‐ King’s College, London, UK

SLIDE 4

Objectives

Using a case to discuss

– The impact of aging with HIV on frailty and function – Considerations of polypharmacy in the elderly – Helping the aging person with HIV retain function, support and dignity

SLIDE 5

The HIV population is aging

SLIDE 6

Narrowing the Gap in Life Expectancy for HIV+ vs HIV‐ Individuals: Kaiser Permanente HIV Cohort

8 year gap with ART initiation at CD4 ≥ 500. Life expectancy  Blacks & IVDU.  Hispanics Gap narrowed if no hepatitis, drug/alcohol, or smoking

Marcus J, et al. 23rd CROI; Boston, MA; February 22‐25, 2016. Abst. 54.

2000 4000 6000 8000

1996‐1997 1998‐1999 2000‐2001 2002‐2003 2004‐2005 2006 2007 2008 2009 2010 2011

Deaths per 100,000 person‐ years (lines)

Year of Study Follow‐Up 7077 19 53 1054 P<0.001 P=0.062 381 439 63 65 20 40 60 80

13‐Year Gap

Expected years of life remaining at age 20 (dots)

SLIDE 7

The aging HIV Population

Active HIV patients, University Health Network, 2015

SLIDE 8

Chronic liver di Cognitive disorders Non-AIDS cancers

Chronic renal disease

Osteoporosis CVD Frailty Depression Diabetes mellitus

COPD

SLIDE 9

Case Presentation- Mr LF

 71 year old MSM  Diagnosed with HIV in 1990  Worked in advertising, moved to T

ronto

with his partner in 1994

 At that time; CD4 163/mm3  Participated in many of the early ARV

studies

 Viral load undetectable since 2000  CD4 count 400-500/mm3 for years

SLIDE 10

Mr LF

 No HIV related complications  Comorbidities

mixed lipodystrophy
dyslipidemia
COPD
cataracts
benign prostatic hypertrophy
cognitive decline

SLIDE 11

Functional status

 Complains of fatigue for years  Increasing memory loss  Lightheaded and balance issues with

frequent falls

 Decreased participation in activities of

daily living and social encounters

 Pill bottles “everywhere”  MOCA 16/30

SLIDE 12

Dr. Falutz

Is LF typical of a person aging with HIV? What may be the reasons for his functional and cognitive decline? What would you recommend?

SLIDE 13

Mr LF Medications

 ARV- SQV/r + Truvada  Atorvastatin  Spiriva and onbrez inhalers  GP wants to start Flomax  Neurology wants to try Sinemet  Psychiatry wants to try Citalopram

SLIDE 14

Dr. Tseng

 What are some of the drug interaction

issues to consider?

 How does polypharmacy impact the

person aging with HIV?

SLIDE 15

Social status

 Number of long term relationships,

utlived several partners

 Current partner 20 years  Mom in Palm Springs  Lives in apartment with partner and dog  Gave up his fitness membership  Relies on partner for cooking, cleaning  Needs help to use the subway