Page 146 - HIV/AIDS Guidelines

Few data exist on the use of ART in severely debilitated patients with chronic, severe, or non-AIDS terminal
conditions. 33-34 Withdrawal of ART usually results in rebound viremia and a decline in CD4 cell count. Acute
retroviral syndrome after abrupt discontinuation of ART has been reported. In very debilitated patients, if
there are no significant adverse reactions to ART, most clinicians would continue therapy. In cases where
ART negatively affects quality of life, the decision to continue therapy should be made together with the
patient and/or family members after a discussion on the risks and benefits of continuing or withdrawing ART.

Conclusion

HIV infection may increase the risk of many major health conditions experienced by aging adults and
35
possibly accelerate the aging process. As HIV-infected adults age, their health problems become
increasingly complex, placing additional demands on the health care system. This adds to the concern that
outpatient clinics providing HIV care in the United States share the same financial problems as other chronic
disease and primary care clinics and that reimbursement for care is not sufficient to maintain care at a
36
sustainable level. Continued involvement of HIV experts in the care of older HIV-infected patients is
warranted. However, given that the current shortage of primary care providers and geriatricians is projected
to continue, current HIV providers will need to adapt to the shifting need for expertise in geriatrics through
continuing education and ongoing assessment of the evolving health needs of aging HIV-infected patients. 37
The aging of the HIV-infected population also signals a need for more information on long-term safety and
efficacy of ARV drugs in older patients.

References
1. Centers for Disease Control and Prevention. HIV Surveillance Report
http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2011. Accessed December 7, 2011.
2. Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ.
2009;338:a3172.
3. Levy JA, Ory MG, Crystal S. HIV/AIDS interventions for midlife and older adults: current status and challenges. J
Acquir Immune Defic Syndr. Jun 1 2003;33(Suppl 2):S59-67.

4. Levy BR, Ding L, Lakra D, Kosteas J, Niccolai L. Older persons' exclusion from sexually transmitted disease risk-
reduction clinical trials. Sex Transm Dis. Aug 2007;34(8):541-544.

5. Stone VE, Bounds BC, Muse VV, Ferry JA. Case records of the Massachusetts General Hospital. Case 29-2009. An 81-
year-old man with weight loss, odynophagia, and failure to thrive. N Engl J Med. Sep 17 2009;361(12):1189-1198.

6. Zablotsky D, Kennedy M. Risk factors and HIV transmission to midlife and older women: knowledge, options, and the
initiation of safer sexual practices. J Acquir Immune Defic Syndr. Jun 1 2003;33(Suppl 2):S122-130.

7. Schick V, Herbenick D, Reece M, et al. Sexual behaviors, condom use, and sexual health of Americans over 50:
implications for sexual health promotion for older adults. J Sex Med. Oct 2010;7(Suppl 5):315-329.
8. Vital signs: HIV testing and diagnosis among adults—United States, 2001-2009. MMWR Morb Mortal Wkly Rep. Dec 3
2010;59(47):1550-1555.
9. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and
pregnant women in health-care settings. MMWR Recomm Rep. Sep 22 2006;55(RR-14):1-17.
10. Althoff KN, Gebo KA, Gange SJ, et al. CD4 count at presentation for HIV care in the United States and Canada: are
those over 50 years more likely to have a delayed presentation? AIDS Res Ther. 2010;7:45.
11. Sabin CA, Smith CJ, d'Arminio Monforte A, et al. Response to combination antiretroviral therapy: variation by age.
AIDS. Jul 31 2008;22(12):1463-1473.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents I-30

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