Download Aging with HIV

Homero E. del Pino, PhD
Assistant Professor
Charles R. Drew University
Psychiatry and Human Behavior
Alison Moore, MD, MPH, FACP
Professor of Medicine and Psychiatry
David Geffen School of Medicine at UCLA
Division of Geriatric Medicine
Adjunct Assistant Professor
David Geffen School of Medicine
Division of Geriatric Medicine &
Psychiatry and Biobehavioral Sciences
African American HIV University
Science and Treatment College
Black AIDS Institute
September 9, 2014
By the end of this session, you will be able to
1. Explain the medical and psychosocial
challenges of aging with HIV
2. List two challenges for African-Americans
aging with HIV
3. List two consequences of at-risk drinking for
older people with HIV
4. Think about qualitative research analysis
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Video (http://bit.ly/ZfkEA5)
1.
Aging and HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
1.
Aging and HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
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CDC estimates that 15% of new HIV cases
occur in people 50 years old and older
By 2015, half of people living with HIV will be
50 years old and older
Rates of HIV/AIDS among 50+
 Whites 4.2/100K
 Hispanics 21.4/100K (5 x Whites)
 Blacks 51.7/100K (12 x Whites)
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50 years of age is considered “older” because:
 HIV infection may “accelerate” the aging process
 Evidence of earlier onset of age-related disease
states.
 HIV associated with non-AIDS comorbidities such
as diabetes mellitus and coronary heart disease,
depression, non-AIDS cancers, etc.
 Complex cases of cognitive impairment
1.
Aging with HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
Bridelee Gittens, 48
Living with HIV: 22 years
“AIDS is different than before.
It’s not Kaposi’s sarcoma and
PCP. Now it’s more diabetes
and heart disease, high blood
pressure and cancers. That’s
what’s going on now. The
disease has evolved.”
http://www.nytimes.com/interactive/2013/06/02/nyregion/faces-of-hiv.html?_r=0
Neurodegeneration,
Osteoporosis
memory loss
Macular degeneration,
hearing loss
Heart disease
Vascular disease
Sarcopenia,
frailty
Diabetes,
metabolic syndrome
Decreased
lung, kidney, etc function
Slide adapted from Judith Campisi, PhD
Vance, et. al. Successful Aging and the Epidemiology of HIV. Clinical Interventions in Aging. 2011:6 181-192
1.
Aging with HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
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Many older adults do not practice safe sex
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Impact of ageism, discrimination, & stigma
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Healthcare professionals may
underestimate risk
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Better medication adherence
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With increased number of comorbidities,
higher risk for polypharmacy and drugdrug interactions.
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Higher risk for social isolation
 Little data on issues specific to aging
in African-Americans but given higher
rates of HIV infection in younger age
groups, this emerging population will
pose challenges and successes.
1.
Aging with HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
1 drink= 12 oz. of beer, 5 oz. of wine, 1.5 oz. spirits
Low risk drinking
Men aged < 65 years: No more than 14 drinks per week and no
more than 4 drinks on any single day.
Women aged < 65 years: No more than 12 drinks per week and
no more than 3 drinks on any single day.
Women and Men aged >65 years: No more than 7 drinks per
week and no more than 3 drinks on any single day.
17
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Increased brain sensitivity to alcohol and
increased blood alcohol levels for a given
dose compared to younger persons
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Alcohol, even at “low risk” levels, may
adversely affect a variety of medical and
psychiatric conditions and impact negatively
with a variety of medications

Alcohol use associated with nonadherence
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Alcohol use decreases survival
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Lifetime prevalence of alcohol use disorder
two to three times higher than the general
population
1.
Aging with HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research
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Emphasis on “meaning” that
participants place on behaviors

Tries to answer “why” people do what
they do

Cannot be generalized
In the social world, some gay men experience:

Family rejection, stigma, and discrimination

Greater psychological distress and
psychiatric morbidity
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Alcohol used to cope
22
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Stigma, stress, discrimination threaten recovery
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Negative health outcomes
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AIM: To describe how HIV+, middle-aged gay
men in recovery cope with ongoing stigma and
stress
23
“I just had this guilt… and shame because of the
way I was brought up, and the prejudices of being,
you know, my being Latino and being gay in
Pasadena, California at that time.”
Amino, Latino, 59 years old
“I didn’t know that I was queer, gay, homosexual or
any of those words. I just knew that I was
attracted to guys from …a very young age. And…
religion and people crippled me by things that
they said and things that I’ve heard.”
Junior, Latino, 51 years old
Based on these men’s experiences,
1.
What does it mean to feel stigmatized?
2.
How do the men’s coping abilities
change?
3.
What programmatic changes should
we consider to support middle-aged
gay men in their recovery efforts?
25
1.
Aging and HIV
2.
Aging comorbidities
3.
Prevention and Care Challenges
4.
Aging, Alcohol Use, and HIV
5.
Current Research

National Institute on Aging: P30-AG021684. UCLA
Resource Centers for Minority Aging Research Center for
Health Improvement of Minority Elderly
(RCMAR/CHIME)

National Institute on Aging: P30-AG028748. UCLA Older
Americans Independence Center

National Center for Research Resources/National Center
for Advancing Translational Science: UL1TR000124.
UCLA CTSI

National Institute for Minority Health and Health
Disparities: U54MD007598. CDU-AXIS
27
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Alison A. Moore, MD, MPH, FACP
[email protected]

Homero E. del Pino, PhD
[email protected]
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Administration on Aging website
http://www.aoa.gov/AoARoot/AoA_Program
s/HPW/HIV_AIDS/
Thebody.com
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CDC. HIV/AIDS among Persons Aged 50 and Older. 2008
Greene et. al. Management of Human Immunodeficiency Virus in Advanced Age. JAMA.
2013; 309(13):1397-1405
Effros RB, Fletcher CV, Gebo K, et al. Aging and infectious diseases: workshop on HIV
infection and aging: what is known and future research directions. Clin Infect Dis.
2008;47(4):542-553.
Youle M and Murphy G. Coming of Age: a guide to ageing well with HIV. HIV Research and
Training Institute. http://www.natap.org/2011/PDF/ComingAgeBook.pdf Accessed July 12,
2013.
Sankar A, Nevedal A, Neufeld S, et al. What do we know about older adults and HIV? A
review of social and behavioral literature. AIDS Care. 2011;23(10):1187-1207.
Cahill S, Valadez R. Growing older with HIV/AIDS: new public health challenges. Am J Public
Health. 2013;103(3):e7-e15.
Rowe, et. al. Successful Aging. The Gerontologist. Vol. 37, #4, 433-440
Moore AA, Blow FC, Hoffing M, et al. Primary care-based intervention to reduce at-risk
drinking in older adults: a randomized controlled trial. Addiction. 2011;106(1):111-120.
Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol research & health
: the journal of the National Institute on Alcohol Abuse and Alcoholism. 1999;23(1):40-54.
Moore AA, Giuli L, Gould R, et al. Alcohol use, comorbidity, and mortality. J Am Geriatr Soc.
2006;54(5):757-762.
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Vance, et. al. Successful Aging and the Epidemiology of HIV. Clinical Interventions in Aging.
2011:6 181-192
Moore AA, Beck JC, Babor TF, et al. Beyond alcoholism: identifying older, at-risk drinkers in
primary care. J Stud Alcohol. 2002;63(3):316-324.
Fink A, Morton SC, Beck JC, et al. The alcohol-related problems survey: identifying
hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc.
2002;50(10):1717-1722.
Barnes AJ, Moore AA, Xu H, et al. Prevalence and correlates of at-risk drinking among older
adults: the project SHARE study. J Gen Intern Med. 2010;25(8):840-846. Effros RB, Fletcher
CV, Gebo K, et al. Aging and infectious diseases: workshop on HIV infection and aging:
what is known and future research directions. Clin Infect Dis. 2008;47(4):542-553.
Youle M and Murphy G. Coming of Age: a guide to ageing well with HIV. HIV Research and
Training Institute. http://www.natap.org/2011/PDF/ComingAgeBook.pdf Accessed July 12,
2013.
Saag MS. HIV now firmly established in the Middle Ages. Clin Infect Dis. 2011;53(11):11401142.
Cahill S, Valadez R. Growing older with HIV/AIDS: new public health challenges. Am J Public
Health. 2013;103(3):e7-e15.