Aging with HIV CoChairs Sharon Walmsley Adrian Betts Disclosure - PowerPoint PPT Presentation

Aging with HIV Co‐Chairs Sharon Walmsley Adrian Betts

Disclosure • Served as an advisor, and spoken at CME events for Viiv, Merck, Bristol Meyers, Abbvie, Gilead, and Jannsen

Plenary Speakers Julian Falutz‐ McGill University Alice Tseng‐ University Health Network Richard Harding‐ King’s College, London, UK

Objectives • Using a case to discuss – The impact of aging with HIV on frailty and function – Considerations of polypharmacy in the elderly – Helping the aging person with HIV retain function, support and dignity

The HIV population is aging

Narrowing the Gap in Life Expectancy for HIV+ vs HIV‐ Individuals: Kaiser Permanente HIV Cohort 80 8000 13‐Year Gap 7077 65 63 60 6000 53 Expected years of life remaining 40 4000 at age 20 (dots) Deaths per 100,000 person‐ years 19 (lines) 20 2000 P <0.001 1054 P =0.062 439 381 0 0 1996‐1997 1998‐1999 2000‐2001 2002‐2003 2004‐2005 2006 2007 2008 2009 2010 2011 Year of Study Follow‐Up 8 year gap with ART initiation at CD4 ≥ 500. Life expectancy  Blacks & IVDU.  Hispanics Gap narrowed if no hepatitis, drug/alcohol, or smoking Marcus J, et al. 23rd CROI; Boston, MA; February 22‐25, 2016. Abst. 54.

The aging HIV Population Active HIV patients, University Health Network, 2015

Non-AIDS cancers Osteoporosis CVD Depression Diabetes mellitus Cognitive disorders Frailty Chronic liver Chronic renal COPD disease di

Case Presentation- Mr LF  71 year old MSM  Diagnosed with HIV in 1990  Worked in advertising, moved to T oronto with his partner in 1994  At that time; CD4 163/mm3  Participated in many of the early ARV studies  Viral load undetectable since 2000  CD4 count 400-500/mm3 for years

Mr LF  No HIV related complications  Comorbidities ◦ mixed lipodystrophy ◦ dyslipidemia ◦ COPD ◦ cataracts ◦ benign prostatic hypertrophy ◦ cognitive decline

Functional status  Complains of fatigue for years  Increasing memory loss  Lightheaded and balance issues with frequent falls  Decreased participation in activities of daily living and social encounters  Pill bottles “everywhere”  MOCA 16/30

Dr. Falutz Is LF typical of a person aging with HIV? What may be the reasons for his functional and cognitive decline? What would you recommend?

Mr LF Medications  ARV- SQV/r + Truvada  Atorvastatin  Spiriva and onbrez inhalers  GP wants to start Flomax  Neurology wants to try Sinemet  Psychiatry wants to try Citalopram

Dr. Tseng  What are some of the drug interaction issues to consider?  How does polypharmacy impact the person aging with HIV?

Social status  Number of long term relationships, outlived several partners  Current partner 20 years  Mom in Palm Springs  Lives in apartment with partner and dog  Gave up his fitness membership  Relies on partner for cooking, cleaning  Needs help to use the subway

Dr. Harding  How do we help LF improve his quality of life while aging with HIV?  What further supports should we consider for him?