HIV and aging: time to bridge the gap between clinical research and clinical care

Abstract

Considered separately, aging and HIV are unquestionably hot topics. The amount of scientific evidence focused on each one is huge, growing and unmanageable, because new fields to investigate are suggested daily and the knowledge we possess is probably just the tip of the iceberg. The more we know, the more still remains for us to learn. The study of HIV can help to better understand the process of aging, and the study of aging sheds light on the way HIV impacts the organism. However, putting them together (HIV and aging), interest has been triggered and a new horizon has been opened in terms of research and clinical care. Some special issues have been developed in recent years focused on different aspects of “HIV and aging,” all of them published in HIV-specialized journals. However, as far as we know, this is the first one in a geriatric medicine journal, which makes it unique. In this issue, European Geriatric Medicine invited experts on HIV, experts on aging and experts on HIV and aging to build this project specifically aimed at geriatricians. Through 12 special articles, the authors address how the HIV scenery has dramatically changed in developed countries, from survival to quality of life, from predominantly younger people to the predominantly older population, to focus on the complexity of older adults living with HIV. Comorbidity, polypharmacy and geriatric syndromes are significant new problems to take into account in the clinical management of these patients. Cognitive impairment and stigma were present from the beginning of the pandemic, so they are old problems that require a new approach in the era of the aging HIV population. One article reviews four European cohorts of older HIV adults and another the biomarkers of aging in HIV. However, two articles were written specifically to convince geriatricians to get involved in the care of older adults with HIV: “Why are people with HIV considered ‘older adults’ in their fifties?” is the first one [1]. The authors focus on the core concept of biological age instead of chronological age to consider someone as older or not. This is a very geriatric idea in theory. All geriatricians understand that there should not be an age cutoff point to make decisions in terms of health and that function and quality of life should be the key. However, they always think about the upper cutoff point—the oldest of older individuals—while sometimes being very restricted in terms of the lower cutoff point, and if the patient is not 75 years old or older, he or she is “too young for geriatricians” independently of his/her physical function, frailty status or health-adverse event risk—ultimately, independently of his/her biological age, centered on his/her chronological age. Two clinical cases should be useful to illustrate this issue (F.B. unpublished data 2017). A woman with breast cancer was referred for comprehensive geriatric assessment (CGA) to the geriatrician before surgery. She suffered from hypertension, chronic venous disease and pathology of the left rotator cuff tendon. She was under first-step analgesics and no more pills. In the CGA, she walked independently without any help and was able to perform basic, instrumental and advanced activities of daily living. Her walk speed was 1.29 m/s, her short physical performance battery (SPPB) score was 12 and her hand grip strength was 21.2 kg (BMI 25). From a cognitive point of view, her MOCA test score was 27, and her score on the Geriatric Depression Scale Short Form (GDS-SF) was 3. Her Mini-Nutritional Assessment Short Form (MNA-SF) score was 13. She lived alone. She was in touch with her children and took care of her grandchildren every day. The second clinical case is a man who was referred to a geriatrician for a global evaluation. He had been living with HIV for 18 years. He also suffered * Fátima Brañas [email protected]; [email protected]