HIV and aging: a clinical journey from Koch's postulate to the chronic disease model and the contribution of geriatric syndromes.

ABSTRACT

PURPOSE OF REVIEW With the discovery and widespread use of antiretroviral therapies, growing numbers of individuals with HIV are now able to live into advanced age. Nevertheless, growing evidence indicates that these dramatic gains in longevity have also resulted in increased prevalence among the survivors of non-AIDS morbidity and disability, together with acceleration of many underlying aging processes. As a result, individuals involved in HIV care, policy, and research have increasingly had to refocus their efforts from a traditional infectious disease emphasis toward conceptual models grounded in the management of common chronic diseases and geriatric syndromes. RECENT FINDINGS: It has been estimated that by 2015, one-half of all Americans with HIV will be 50  years or older. Such individuals are likely to develop chronic diseases typically seen in their older HIV-negative counterparts. Moreover, the presence of multiple coexisting chronic conditions together with polypharmacy and acceleration of varied age-related physiological changes renders many older HIV-positive individuals more vulnerable to becoming disabled or dying from conditions that are not immediately linked to HIV. SUMMARY: As growing numbers of individuals confront the prospect of a life with HIV, both they and their providers will need to shift their focus toward a broader and more encompassing perspective that considers the impact of multiple coexisting conditions and age-related changes on outcome measures associated with function, independence, and quality of life. To that end, there is an urgent need for increased dialog between different disciplines, ensuring that the care of older HIV-positive individuals is guided by research that incorporates relevant functional outcome measures.