Current opinion in HIV and AIDS最新文献

Purpose of review: Menopause, defined as 12 months without menstruation, is a complex biopsychosocial transition. This review synthesizes current knowledge on menopause in individuals living with HIV, highlighting its clinical significance, research gaps, and approaches for optimizing care.

Recent findings: Women and people with ovaries with HIV may experience menopause earlier, and with more severe vasomotor, mood, and musculoskeletal symptoms compared to people without HIV. Increasing severity of symptoms is associated with reduced quality of life and poorer engagement in HIV care. Additionally, estrogen depletion combined with HIV increases the risk of cardiometabolic disease and osteoporosis. Biomarkers like AMH have shown promise for assessing ovarian reserve in this population, but current evidence remains inconclusive. Menopause remains under-recognized in HIV care, with low rates of menopausal hormone therapy use and limited provider confidence in menopause management.

Summary: Addressing menopause in people with HIV is vital for improving quality of life, supporting engagement in HIV care, and reducing comorbidity risk. Integrated and holistic care models, peer support, and focused research are essential to meet the needs of this growing population and close existing gaps in care.

Purpose of review: As the population of people living with HIV ages, the integration of geriatric principles into HIV care is increasingly important. This review synthesizes innovative care models, evidence-informed strategies, and emerging practices designed to address the unique needs of people aging with HIV.

Recent findings: People aging with HIV face an accelerated onset of age-related conditions, frailty, and multimorbidity due to a combination of factors, including chronic systemic inflammation, medication toxicities, and disparities in care. Emerging models of care integrate HIV and geriatric services, demonstrating promising outcomes in patient satisfaction, health improvements, and care team collaboration. Additionally, recently funded demonstration projects expand screening, case management, and holistic care delivery for older adults with HIV in new ways.

Summary: Although randomized controlled trials are limited, evidence-informed and emerging strategies show potential to improve outcomes for people aging with HIV. By combining geriatric and HIV care, addressing multimorbidity, incorporating additional specialties and care providers, and prioritizing patient-centered approaches, these innovative strategies lay the foundation for advancing health and enhancing the quality of life for this growing population.

Purpose of review: Older persons with HIV (OPWH) are at risk of earlier onset of age-related comorbidities and common geriatric syndromes, notably frailty. The purpose of this review is to provide an update on recent developments related to frailty in OPWH, particularly as they relate to common co-occurrence of frailty with other geriatric syndromes which have an adverse impact on health outcomes.

Recent findings: Recent studies reliably demonstrate that frailty co-occurs with other geriatric syndromes due to common biologic risk factors. They often have an equal or greater impact on mortality and quality of life (QoL) compared to age-related comorbidities. Frailty is potentially reversible and risk factors for progression to or regression from a state of frailty have been identified. Importantly, HIV and Aging care centers have been initiated based on proven geriatric-based principles and frail OPWH should be referred. The role of agism and stigmatization are identified as contributors to states of frailty.

Summary: Recent findings focus on the important role geriatric syndromes especially frailty play in determining QoL in OPWH and this has led to efforts to operationalize frailty screening methods and to develop appropriate management protocols to limit or delay the impact of frailty on health.

Purpose of review: With the advent of antiretroviral therapy, people with HIV (PWH) are living longer and are at risk of developing age-related comorbid illnesses, such as chronic kidney disease (CKD). The purpose of this review article is to summarize recent advances in the diagnosis and management of kidney disease in PWH, and ultimately inform clinical practice.

Recent findings: Individuals of West African descent are often genetically predisposed to develop CKD. Among carriers of the APOL-1 risk variant, Na + /K + transport has been identified as the proximal driver in APOL-1-mediated pathogenesis. The use of urine biomarkers in CKD diagnosis among PWH has been supported and is comparable to the general population. Additionally, novel CKD therapies, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists can potentially offer significant clinical benefit to PWH with CKD.

Summary: Despite being an underrepresented group in clinical trials, recent research findings have broadened our understanding of kidney disease in PWH. Given that PWH experience an increased risk of developing CKD, early detection and management is vital in improving quality of life and overall healthcare outcomes.

Purpose of review: Cognitive disorders have been described in persons with HIV since the advent of virologically suppressive antiretroviral therapy. As persons with HIV age, their demographics and risk factors for cognitive health have changed. Here, we review these changing demographics and the recent literature regarding risk factors for cognitive decline and best management strategies.

Recent findings: Rates on noninfectious comorbidities are higher in persons with HIV compared to those without HIV and specifically include high rates of mental health conditions and cardiovascular complications. The optimal management of these noninfectious comorbidities is crucial for maintaining brain health. The early initiation of antiretroviral therapy may prevent irreversible damage to brain health and modern integrase-strand-transfer-inhibitor based antiretroviral regimens appear to have a positive effect on cognitive health.

Summary: Risk factors for cognitive decline in persons with HIV have dramatically changed in recent years along with clinical management strategies. As persons with HIV globally continue to age, ongoing considerations of these risk factors and management strategies will continue to be key in maintaining brain health for the 40 million people living with HIV globally.

Purpose of review: Human immunodeficiency virus (HIV) was historically considered a terminal illness. However, medical advancements, including antiretroviral therapy (ART), have extended the lifespan of people with HIV (PWH), emphasizing the importance of maximizing quality of life (QoL) in this aging population. These populations face unique health challenges due to various structural and environmental barriers, and comorbidities. This review aims to consolidate recent data on pain management and other palliative needs in older people with HIV (OPWH).

Recent findings: Recent research developments focus on providing relief by incorporation of geriatric and palliative care (PC) principles, use of long-acting injectable-antiretroviral therapies (LAI-ARTs), cannabinoids, exercise and self-management interventions, and tailored cognitive-behavioral therapy (CBT) for older people with HIV (OPWH; ≥50 years). The potential of these novel interventions can fulfil the needs of this underserved demographic suffering from a niche subset of physical and psychosocial issues. Yet, there remains variability in access to these services, with disparities often linked to healthcare infrastructure and socioeconomic factors.

Summary: Interventions for an aging population of PWH should take a person-centered approach, balancing different priorities and exploring multiple avenues for symptom relief.

Purpose of review: This review explores the unique challenges faced by older people with HIV (PWH) in resource-limited settings, particularly in managing age-related health issues alongside HIV. It highlights gaps in healthcare systems, structural barriers, and the need for better integration of services to improve outcomes.

Recent findings: There is currently a lack of integrated healthcare services for aging PWH, resulting in delayed treatment for noncommunicable diseases. There is also limited geriatric expertise in HIV care which exacerbates challenges in diagnosing and managing age-related conditions. Women with HIV face additional barriers due to gender disparities but have limited representation in research. Furthermore, older adults acquiring HIV are often diagnosed late, leading to poorer outcomes.

Summary: This review calls for integrating aging care into HIV programs, improving healthcare training, and garnering greater consensus on assessment tools for geriatric conditions. Additionally there is a need for more targeted HIV prevention programs for older adults who remain at risk of acquiring HIV and presenting late to care.

Purpose of review: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among people with HIV (PWH) and increasingly recognized as a major contributor to morbidity and mortality. The field of MASLD is rapidly evolving with adoption of a new nomenclature and approval of the first FDA-approved therapy within the past year. These developments underscore the need to consider the current state of the science specifically in the context of HIV.

Recent findings: MASLD in PWH (MASLD-HIV) follows a more aggressive clinical course compared to HIV-negative individuals. While MASLD-HIV shares common pathogenic mechanisms with MASLD in the general population, HIV-specific factors - including altered body composition, chronic immune activation, enhanced gut permeability, and antiretroviral therapy - exacerbate disease progression. Despite an expanding pipeline of MASLD therapies, a critical gap remains in evaluating these interventions specifically among PWH. Nonetheless, dedicated studies of glucagon-like peptide-1 receptor agonists and the growth hormone-releasing hormone analog tesamorelin have shown promise in MASLD-HIV.

Summary: MASLD is a key contributor to liver-related and cardiovascular-morbidity in PWH. While there have been exciting advances to improve diagnosis and management of MASLD in the general population, differences in MASLD pathophysiology demonstrate the need to tailor our approach specifically for PWH.

Purpose of review: We describe the emerging clinical outcomes for adults born with perinatally acquired HIV (PHIV), who have been living with HIV throughout their life. Whilst many comorbidities appear similar to adults with horizontally acquired HIV, they manifest at a younger chronological age. The additional impact of HIV throughout postnatal, childhood and adolescent growth and development requires further consideration.

Recent findings: There is growing evidence of an increased incidence of metabolic, cardiovascular, respiratory, bone and renal impairment as well as structural brain changes associated with impaired cognitive function, and mental health disorders; early case series data suggests a six-fold increased prevalence of psychosis for those with lifelong HIV compared with age-matched peers. Older age, prior CDC-C diagnoses and lower nadir CD4 count confer the greatest risk of PHIV complications in adulthood, but biological factors are compounded by socioeconomic deprivation, bereavement, HIV-associated stigma, discrimination and immigration. The aetiology of these increased comorbidities is yet to be fully elucidated but includes lifelong systemic inflammation and immune dysfunction despite suppressive antiretroviral therapy (ART).

Summary: Adults living with lifelong HIV experience increased risk of comorbidities at a younger chronological age despite viral suppression on ART. Exploring the aetiology and characterizing the clinical manifestations of lifelong HIV can best inform screening tools and interventions that can enhance quality of life and longevity.

Purpose of review: Osteoporosis and fragility fractures continue to be a concern for aging people living with HIV (PLWH), despite newer antiretroviral (ART) formulations that are associated with reduced bone toxicity. The aim of this review is to evaluate recent literature focusing on estimates of osteoporosis and fractures in various study populations, efficacy of current fracture risk assessment tools, and interventions to improve bone health outcomes.

Recent findings: Prevalence of low bone mineral density (BMD) remains higher among PLWH globally, with new estimates ranging from 24 to 59%. The FRAX tool underestimates rate of major osteoporotic fractures in PLWH; some studies suggest that modifications can improve accuracy. Bone quality assessments with trabecular bone score may also improve prediction of vertebral fractures in PLWH. Preexposure prophylaxis (PrEP) with TDF/FTC is generally safe for maternal and infant bone health. Denosumab treatment effectively improves bone mass in PLWH.

Summary: Despite advancements in ART, osteoporosis and fragility fractures remain common among PLWH. There is a need for continued research on development of fracture risk assessment tools including use of clinical data, imaging studies and biomarkers, and implementation of preventive and treatment strategies for at-risk subgroups.