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Post-Congress Activity Expert Review on the EACS, HIV & Aging and the AASLD Meetings With Dr. Mark Wainberg (moderator) and Dr. Fred Crouzat, Dr. Alice.

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Presentation on theme: "Post-Congress Activity Expert Review on the EACS, HIV & Aging and the AASLD Meetings With Dr. Mark Wainberg (moderator) and Dr. Fred Crouzat, Dr. Alice."— Presentation transcript:

1 Post-Congress Activity Expert Review on the EACS, HIV & Aging and the AASLD Meetings With Dr. Mark Wainberg (moderator) and Dr. Fred Crouzat, Dr. Alice Tseng, and Dr. Stephen Shafran

2 2 nd International Workshop on HIV and Aging October 27-28, 2011 Baltimore, Maryland

3 Immune Dysfunction and Senescence. Microbial Translocation “Leaky Gut” Chronic Inflammation and Platelet Hypercoagulability HIV and Non-HIV Treatment Toxicity Oxidative Stress. Associated Comorbid Disease Incremental Depletion in Organ System Reserve Death Presenting Conditions Interacting Pathophysiologic Processes Organ System Injury Advanced Clinical Disease AGING VACS Risk Index Health Care Outcomes Repeated Hospitalization/ Nursing Home Placement Functional Decline Organ System Failure Conceptual Model for Aging with HIV Infection HIV Viral Hepatitis Alcohol and Other Substance Abuse Adapted from Justice A et al. Alcohol Res Health 2010;33:

4 Guaraldi G, et al. Clin Infect Dis. 2011;53(11): Epub 2011 Oct 13.

5 Untreated Cerebrovascular Disease May Have Implications for Cognitive Impairment (CI) in HIV MACS cohort: – n = 207 HIV- & 428 HIV+ men, median ~50 yo, CD4 535, no history of CVD –  carotid intima media thickness (IMT) and fasting glucose were predictors of poor psychomotor speed performance (p=0.04 & 0.037) – AIDS, detectable VL and CD4 were not significant predictors SMART study: – n=292, median CD4 536, 88% VL<400, 92% on cART – Risk of cognitive impairment higher in pts with pre-existing CVD (OR 6.2, CI 1.4–26.4); use of HTN agents,  cholesterol & HBV also risk factors – Current/nadir CD4, CPE scores not associated with impairment Results suggest that risk of CI more strongly related to CV & metabolic disease profiles than HIV serostatus or disease Becker JT, et al. Neurology 2009;73: Wright EJ, et al. Neurology 2010 ;75:

6 Treatment of Vascular Risk Factors Impacts Neurocognitive Function in HIV n=98 HIV+ adults – mean 44 yo, 81% male, 70% AA, 62% prior AIDS 23 pts with CVS risk factors (DM, HTN) – 13 treated, 10 untreated Pts with untreated CVS risk demonstrated  processing speed, learning/memory and executive functioning vs. those on medication (p=0.01, 0.04, 0.09) Foley J, et al. Clin Neuropsychol 2010;24:

7 Strategies to Improve Cognition Mindfulness-Based Cognitive Therapy (MBCT) – 40 HIV+ subjects randomized to participate in MBCT (2-hr class/wk x 8) or continue with routine care mean 50 yo, 20 yrs since HIV Dx, 16 yrs on ART, current CD4 527, VL<25 in 39 subjects – MBCT group reported significant  in quality of life vs. controls (energy, pain, emotional reactions, sleep, social isolation, mobility) Visualization/Mental Imagery – 70 HIV+ pts assigned prospective memory (PM) medication task; randomized to visualization exercise vs. repeating instructions 83% male, mean 56 yo, 70% Caucasian, 91% cART, 93% CD4 >200, 85% VL undetectable – visualization significantly improved ability to complete PM task (55% vs. 30%, p<0.05) Fumaz et al. [#O_09]. Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA. Woods et al. Ibid, #O_10.

8 Saturday, November 19 th, 2011

9 Falls: A Geriatric Syndrome Falls common in people ≥ 65 yrs of age – 30% rate per year, associated with significant morbidity (ER visits, nursing home placements, loss of independence) Risk factors: – comorbidities (depression, HTN, arthritis, DM, pain, urinary incontinence) – physical impairment (balance, strength, gait, cognition) – polypharmacy (esp. psychoactive meds) Erlandson KM, et al. [#O_05] Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

10 Falls in HIV-Infected Persons: Prevalence and Risk Factors Cross-sectional study of 359 HIV+ pts yo on cART for > 6 months with VL<48 copies/mL Verbally questioned about falls in past year – 70% no falls – 30% ≥ 1 fall – 18% frequent falls (≥ 2 falls) Current CD4, nadir CD4, duration of ART similar b/w frequent & non-fallers Risk factors for frequent falls: – female, smokers, comorbidities and polypharmacy (p<0.01) Frequent fallers: – weaker grip strength, greater difficulty arising from a chair, greater difficulty with balance, slower gait speed over 400 m (all statistically significant) – Frailty by Fried’s definition 1 (OR 9.3, CI , p<0.001) Conclusions: – fall risk for middle-aged HIV+ persons is consistent with rates in general population ≥ 65 yo –  risk with comorbidities and meds Erlandson KM, et al. [#O_05] Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

11 OR (CI) 3.0 ( ) 5.6 ( ) 3.2 ( ) 8.2 ( ) 3.2 ( ) 4.6 ( ) 3.7 ( ) Erlandson KM, et al. [#O_05] Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA. Multiple Comorbidities are Associated with Greater Fall Risk in HIV-1 Infected Persons

12 OR (CI) 3.6 ( ) 4.5 ( ) 3.9 ( ) 4.6 ( ) 2.8 ( ) 5.5 ( ) Polypharmacy is Associated with Greater Odds of Falling in HIV-Infected Persons Erlandson KM, et al. [#O_05] Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

13 Frailty and Hospitalizations in IDUs Prospective cohort of subjects with current/past IDU – n=1206, median 48 yo, 4652 person visits – 28% HIV+ (n=345): median CD4 290, VL 3.1 log, CD4 nadir 138, 21.7% AIDS diagnosis, 51% on cART Overall prevalence of frailty 8.3%, pre-frailty 59% – associated with age, female, socioeconomic class, depressive Sx, HIV status – higher risk in advanced HIV with poor virologic control – frailty was an independent predictor of hospitalization (adjusted HR 1.5, CI ) Piggott DA, et al. Frailty and Incident Hospitalization among HIV+ and At Risk Injection Drug Users (IDUs). [#O_06]. Presented at the 2 nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

14 Frailty and Hospitalizations in IDUs Frailty and HIV Clinical Status: Prefrail Adj OR* (95% CI) Frail Adj OR* (95% CI) HIV negativeRef HIV+, CD4  350, VL UD 1.14 (0.81, 1.62)1.13 (0.65, 1.97) HIV+, CD4<350, VL UD1.37 (0.97, 1.95)1.75 (1.02, 2.98) HIV+, CD4  350, VL (0.79, 1.63)1.80 (1.00, 3.21) HIV+, CD4<350, VL+1.49 (1.17, 1.89)2.26 (1.51, 3.39) Piggott DA, et al. Frailty and Incident Hospitalization among HIV+ and At Risk Injection Drug Users (IDUs). [#O_06]. Presented at the 2 nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

15 Hospitalization by Frailty Status in ALIVE Piggott DA, et al. Frailty and Incident Hospitalization among HIV+ and At Risk Injection Drug Users (IDUs). [#O_06]. Presented at the 2 nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.

16 Current Realities/Challenges of Aging Well with HIV Cure DNA repair oxidative stress telomere protection? HIV cure Chronic Management medication adherence exercise risk modification management of comorbidities cognitive-based tx search for treatable factors vs. Adapted from Valcour V. Presented at the 2nd International Workshop on HIV & Aging, October 27-28, 2011, Baltimore, USA.


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