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Chaminuka AS, Prybutok G, Prybutok VR, Senn WD. Systematic Review: HIV, Aging, and Housing-A North American Perspective, 2012-2023. Healthcare (Basel) 2024; 12:992. [PMID: 38786403 PMCID: PMC11121341 DOI: 10.3390/healthcare12100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Advances in anti-retroviral therapy (ART) have decreased mortality rates and subsequently led to a rise in the number of HIV-positive people living longer. The housing experiences of this new population of interest-older adults (50 years and older) living with HIV-are under-researched. Understanding the housing experiences and unmet needs of older people with HIV can better provide comprehensive care services for them. This study's systematic review evaluated the peer-reviewed literature reporting housing access/insecurity/assistance/options, housing impact, and unmet needs of older individuals living with HIV in North America from 2012 to 2023. Furthermore, Latent Semantic Analysis (LSA), a text-mining technique, and Singular Value Decomposition (SVD) for text clustering were utilized to examine unstructured data from the abstracts selected from the review. The goal was to allow for a better understanding of the relationships between terms in the articles and the identification of emerging public health key themes affecting older adults living with HIV. The results of text clustering yielded two clusters focusing on (1) improvements to housing and healthcare services access and policies and (2) unmet needs-social support, mental health, finance, food, and sexuality insecurities. Topic modeling demonstrated four topics, which we themed to represent (1) a holistic care approach; (2) insecurities-food, financial, sexuality, and other basic needs; (3) access to housing and treatment/care; and (4) homelessness and HIV-related health outcomes. Stable housing, food, and healthcare services access and availability are critical elements to incorporating comprehensive, holistic healthcare for older adults living with HIV. The aging population requires high-priority policies for accessible and equitable healthcare. Clinicians and policymakers should address individual barriers, adopt a patient-centered approach, increase doctor visits, provide competency training, ensure long-term follow-up, involve families, and improve patient education in care management, contributing to HIV/AIDS geriatric care models.
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Affiliation(s)
- Arthur S. Chaminuka
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX 76205, USA;
| | - Gayle Prybutok
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX 76205, USA;
| | - Victor R. Prybutok
- G. Brint Ryan College of Business and Toulouse Graduate School, University of North Texas, Denton, TX 76205, USA
| | - William D. Senn
- Dr. Sam Pack College of Business, Tarleton State University, Stephenville, TX 76401, USA;
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Schrock JM. Accelerated aging in people living with HIV: The neuroimmune feedback model. Brain Behav Immun Health 2024; 36:100737. [PMID: 38356933 PMCID: PMC10864877 DOI: 10.1016/j.bbih.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
People living with HIV (PLWH) experience earlier onset of aging-related comorbidities compared to their counterparts without HIV. This paper lays out a theoretical model to explain why PLWH experience accelerated aging. Briefly, the model is structured as follows. PLWH experience disproportionately heavy burdens of psychosocial stress across the life course. This psychosocial stress increases risks for depressive symptoms and problematic substance use. Depressive symptoms and problematic substance use interfere with long-term adherence to antiretroviral therapy (ART). Lower ART adherence, in turn, exacerbates the elevated systemic inflammation stemming from HIV infection. This inflammation increases risks for aging-related comorbidities. Systemic inflammation also reduces connectivity in the brain's central executive network (CEN), a large-scale brain network that is critical for coping with stressful circumstances. This reduced capacity for coping with stress leads to further increases in depressive symptoms and problematic substance use. Together, these changes form a neuroimmune feedback loop that amplifies the impact of psychosocial stress on aging-related comorbidities. In this paper, I review the existing evidence relevant to this model and highlight directions for future research.
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Affiliation(s)
- Joshua M. Schrock
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, United states
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Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
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Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
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Yamada Y, Kobayashi T, Condo A, Sangarlangkarn A, Ko F, Taniguchi Y, Kojima G. Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022; 9:ofac129. [PMID: 35415198 PMCID: PMC8995074 DOI: 10.1093/ofid/ofac129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, hospitalization, and mortality. However, there is a paucity of large studies assessing its prevalence in people with HIV (PWH) aged 50 or older. Methods PubMed was systematically searched for studies published between January 2000 and August 2020 reporting the prevalence of frailty in PWH aged 50 or older. The pooled prevalence of frailty and prefrailty was synthesized using a random-effects meta-analysis. Results Of the 425 studies identified, 26 studies were included in the analysis, with a total of 6584 PWH aged 50 or older. The included studies were published between 2012 and 2020, and all studies used the Fried frailty phenotype to define frailty. The overall pooled prevalence of frailty and prefrailty was 10.9% (95% confidence interval [CI], 8.1%–14.2%) and 47.2% (95% CI, 40.1%–54.4%), respectively. A high degree of heterogeneity was observed (I2 = 93.2%). In the subgroup analysis, HIV-related variables and other demographic variables were examined, and heterogeneity disappeared only in the group of a longer duration since HIV diagnosis (I2 = 0%). Conclusions The pooled prevalence of frailty and prefrailty defined by the Fried frailty phenotype was assessed in PWH aged 50 or older. Findings from this study quantified the proportion of this specific population with this common geriatric syndrome. Future studies identifying effective strategies for frailty screening and intervention are required for this vulnerable population.
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Affiliation(s)
- Yuji Yamada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela Condo
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Gotaro Kojima
- Department of Research, Dr. AGA Clinic, Minato-ku, Tokyo, Japan
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Ruiz EL, Greene KY, Galea JT, Brown B. From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV. Curr Opin HIV AIDS 2022; 17:55-64. [PMID: 35102052 DOI: 10.1097/coh.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV. RECENT FINDINGS Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary. CONCLUSION To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.
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Affiliation(s)
- Erik L Ruiz
- University of South Florida, College of Public Health
| | - Karah Y Greene
- University of South Florida, School of Social Work, Tampa, Florida
| | - Jerome T Galea
- University of South Florida, College of Public Health
- University of South Florida, School of Social Work, Tampa, Florida
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California, USA
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Abstract
PURPOSE OF REVIEW The HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated. RECENT FINDINGS The prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50+ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV. SUMMARY Whilst the prevalence of frailty differs between countries, with the addition of prefrailty, this represents a large proportion of people living with HIV. Services must ensure strategies are in place to support those living with HIV and frailty. Further longitudinal studies are required.
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Affiliation(s)
- Howell T Jones
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Tom Levett
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Tristan J Barber
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, UCL, London, Institute of Child Health, London, UK
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