感染愛滋病毒的老年人有不同的特徵和不同的需求

資料來源：Alain Volny-Anne / 2022 年 10 月 4 日 /aidsmap / 財團法人台灣紅絲帶基金會編譯

 

 

圖片來源：Shutterstock Studios HIV 視圖庫

 

儘管同樣被視為「老年愛滋病毒感染者」，但長期愛滋病毒倖存者和 65 歲以上的愛滋病毒感染者俱有明顯不同的特徵和相關需求。這是在 PLOS ONE 上發表的一項西班牙研究發現的結果，證實了愛滋病毒感染者是一個異質群體。

今天，一半的愛滋病毒感染者年齡在 50 歲以上，而且這一人口還在不斷增長。這是由於抗反轉錄病毒療法的成功和該年齡組新的愛滋病毒診斷的增加。感染 HIV 的老年人可能有額外的健康狀況（合併症），然而，個體之間的表現往往不同。

這些差異在多大程度上重要？來自馬德里的 Universitario Infanta Leonor 醫院的 Fátima Brañas 博士及其同事評估了感染愛滋病毒的老年人之間的差異，同時考慮了年齡和人們被診斷出的時間。

研究人員分析了 2018-2019 年在 FUNCFRAIL 中招募的 801 名參與者的數據，這是一項針對 50 歲及以上愛滋病毒感染者的西班牙世代研究。

參與者在加入研究時根據實際年齡（一個人已存活了多久）分為三組：年輕（50-54 歲）、中級（55-64 歲）和年長（65 歲以上）。根據他們被診斷出感染 HIV 的時間，他們還被分為兩組：長期 HIV 倖存者（1996 年之前）和 HAART 時代的參與者（從 1996 年起，高效抗反轉錄病毒療法在西班牙廣泛使用）。

數據記錄了參與者的社會人口學特徵、HIV 感染、多種藥物（除抗反轉錄病毒藥物外的五種或更多藥物）和合併症：高血壓、糖尿病、血脂異常、冠心病、中風、慢性阻塞性肺病 (COPD)、慢性腎病、癌症（診斷後不到五年），癌症病史（診斷後五年以上），抑鬱症，精神疾病和骨關節疾病（例如關節炎）。

每個參與者都進行了老年評估，包括對虛弱、跌倒、力量、步態速度和平衡的評估。 （虛弱是一種包括身體萎縮、虛弱、耐力差、精力不足、行動遲緩和身體活動受限的綜合症候群，在老年人中很普遍。）特定問卷測試了認知障礙、抑鬱、生活品質和疼痛。

在 801 名參與者中，195 名（25%）是女性。中位年齡為 57 歲，其中 36% 年齡在 50-54 歲之間，49% 年齡在 55-64 歲之間，15% 年齡在 65 歲或以上。幾乎一半 (47%) 是長期 HIV 倖存者。

實際年齡

按實際年齡進行的分析顯示，65 歲或以上的參與者在 HIV 診斷時平均比相對應的年輕的同儕大 20 歲（53 歲對 31 歲；p <0.001）。他們已知感染HIV 的時間最短（分別為 17 年和 21 年和 23年，分別相較於年輕組和中級組；p <0.001），其中同性戀和雙性戀男性明顯多於其他組（48% 對 31%年輕組和中級組分別為 25%；p = 0.001）。更多 65 歲或以上的參與者獨居（49% vs 33% 和 38%，p = 0.007）。

關於抗反轉錄病毒治療的病毒學和免疫學反應，年齡組之間沒有差異。

與最年輕的組相比，更多 65 歲或以上的參與者患有三種或四種合併症（34% 對 22%；p = 0.001），其中 65 歲以上的人首當其衝（42% 對最年輕的 24%），糖尿病（25% 對 9%）和血脂異常（51% 對 35%）。然而，抑鬱症在年輕組和中間組（分別為 15% 和 18%）中比在年長組（8%）中更為普遍。

在年輕和中年組中，目前吸煙率是 65 歲或以上人群中發現的 16% 的三倍（分別為 52% 和 48%；p <0.001）。年齡最大的參與者 (35%) 的多藥治療明顯高於其他年齡組 (約 25%)。最年長年齡組的虛弱患病率是其他組兩倍多（50-54 歲和 55-64 歲分別為 11% 和 4% 和 5%）。 65 歲或以上患有功能障礙的參與者的比例是其他年齡組的兩倍（32% 對 12% 和 15%）。

在 65 歲或以上的人群中，認知障礙的患病率 (22%) 是 50-54 歲 (9%) 和 55-64 歲 (11%) 的兩倍。在生活質量方面，年齡組之間沒有差異。

比較 1996 年前後確診的人數

轉向 HIV 診斷時期的分析，研究人員發現女性佔長期 HIV 倖存者的 31%，但在 HAART 時代組中僅佔 19% (p <0.001)。

在長期 HIV 倖存者中，56% 為 55-64 歲，9% 在進入研究時為 65 歲或以上。 20% 的 HAART 時代參與者在參加研究時年齡在 65 歲或以上——是長期 HIV 倖存者比例的兩倍。

人們感染 HIV 的方式存在顯著差異：61% 的長期倖存者使用或曾經使用過注射藥物，而在 HAART 時代的參與者中這一比例為 14%。長期倖存者（34%）的性傳播比 HAART 時代的參與者（76%）少。儘管這些差異是驚人的，但研究人員告訴aidsmap.com，獲取途徑與虛弱、合併症或多重疾病無關。

「長期愛滋病毒倖存者的合併症發生率最高，包括影響生活品質的合併症」。

值得注意的是，與長期獨自生活的 HIV 倖存者相比，HAART 時代的參與者更多（44% 對 31%，p <0.001）。

在病毒學和免疫學結果方面沒有觀察到差異。

長期 HIV 倖存者的平均合併症數量顯著較高（相較於HAART 時代組為 2.6 對 1.8），具有五種或更多合併症的參與者比例（16% 對 8%）也是如此。但是，儘管某些合併症（例如抑鬱症、慢性阻塞性肺病）在長期 HIV 倖存者中更為普遍，但其他一些合併症（例如高血壓、糖尿病、心臟病發作）並非如此。

與 HAART 時代組相比，長期 HIV 倖存者吸煙的更多（54% 對 37%；p <0.001）。同樣，多種藥物在長期 HIV 倖存者中更為普遍（31% 對 22%，p <0.001），使用精神安定藥（17% 對 7%；p <0.001）、苯二氮卓類藥物（27% 對 15%； p <0.001) 和催眠藥 (32% vs 3%; p <0.001)。

長期 HIV 倖存者和 HAART 時代個體在虛弱（5% 對 6%）或跌倒（18% 對 14%）方面沒有顯著差異。然而，長期倖存者的認知障礙較低（9% vs 14%）。

與 HAART 時代的參與者相比，長期 HIV 倖存者的生活品質明顯更差（生活品質一般或差，分別為 63% 和 52%；p <0.01）。重要的是，疼痛在長期倖存者中更為普遍（41% 對 31%）。

結論

顯然，該研究顯示，長期 HIV 倖存者的合併症發生率最高，包括那些已知對生活品質有更大負面影響的合併症，例如慢性阻塞性肺病、癌症、抑鬱症和疼痛。然而，長期 HIV 倖存者和 HAART 時代個體在虛弱方面沒有出現差異，這顯示儘管長期 HIV 倖存者的虛弱和合併症很常見，但它們並不一定相關。

Brañas 及其同事表示，他們的結果很有趣，「因為 HIV照護提供者在提及感染 HIV 的老年人時，通常認為這一群體主要由 1996 年之前被診斷出的人組成」。事實上，照顧感染愛滋病毒的老年人不能依賴這種誤解。相反，它應該基於對本研究揭示的這一人群的許多差異的全面理解。

 

參考文獻：

Brañas F et al.  根據實際年齡和 HIV 診斷年份，感染 HIV 的老年人的不同特徵：FUNCFRAIL 世代研究 (GeSIDA 9817)。 PLoS ONE 17：e0266191, 2022（開放獲取）。

https://doi.org/10.1371/journal.pone.0266191

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Older adults with HIV have different profiles and different needs

Alain Volny-Anne / 4 October 2022 / aidsmap

 

Shutterstock Studios HIV in View gallery

Although equally considered “older people with HIV”, long-term HIV survivors and people with HIV who are aged over 65 have markedly different characteristics and related needs. This is what a Spanish study published in PLOS ONE has found, confirming that people who are ageing with HIV are a heterogeneous group.

Today, half of people with HIV are aged over 50 and this population keeps growing. This is due to the success of antiretroviral therapy and the increase of new HIV diagnoses in this age group. Older adults with HIV may have additional health conditions (co-morbidities) which, however, often present differently between individuals.

To what extent do these differences matter? Dr Fátima Brañas from the Hospital Universitario Infanta Leonor in Madrid and colleagues evaluated differences between older people with HIV, taking into account both age and how long people had been diagnosed for.

The investigators analysed data from 801 participants recruited in 2018-2019 in FUNCFRAIL, a Spanish cohort study of people with HIV aged fifty years and over.

Participants were stratified into three groups according to their chronological age (how long a person has lived) when joining the study: younger (50-54), intermediate (55-64) and older (over 65 years). They were also stratified into two groups, based on when they were diagnosed with HIV: long-term HIV survivors (before 1996) and HAART-era participants (from 1996 onwards, when highly active antiretroviral therapy became widely available in Spain).

Data were recorded on participants’ sociodemographic profiles, HIV infection, polypharmacy (five or more medicines other than antiretrovirals) and comorbidities: hypertension, diabetes, dyslipidaemia, coronary heart disease, stroke, chronic obstructive pulmonary disease (COPD), chronic kidney disease, cancer (less than five years after diagnosis), a history of cancer (over five years after diagnosis), depression, psychiatric disorders and osteoarticular disease (for example, arthritis).

Each participant went through a geriatric assessment, including an evaluation of frailty, falls, strength, gait speed and balance. (Frailty is a syndrome comprising body shrinking, weakness, poor endurance, low energy, slowness and limited physical activity that is prevalent in older adults.) Specific questionnaires tested cognitive impairment, depression, quality of life and pain.

Of the 801 participants, 195 (25%) were women. Median age was 57, with 36% aged 50-54, 49% aged 55-64 and 15% aged 65 or over. Almost half (47%) were long-term HIV survivors.

Chronological age

The analysis by chronological age revealed that participants 65 or over had been on average twenty years older than their younger counterparts at HIV diagnosis (53 years vs 31; p <0.001). They had lived with known HIV for the fewest years (17 vs 21 and 23 in the younger and intermediate groups, respectively; p <0.001) and significantly more of them were gay and bisexual men than in the other groups (48% vs 31% and 25% in the younger and intermediate groups, respectively; p 0.001). More participants aged 65 or over lived alone (49% vs 33% and 38%, p = 0.007).

Regarding virological and immunological response to antiretroviral therapy, there were no differences between age groups.

Compared to the youngest group, more participants 65 or over had three or four co-morbidities (34% vs 22%; p = 0.001), with the over 65s bearing the brunt of hypertension (42% vs 24% in the youngest), diabetes (25% vs 9%) and dyslipidaemia (51% vs 35%). However, depression was more prevalent in the younger and intermediate groups (15% and 18%, respectively) than in the older group (8%).

In the younger and intermediate groups, current smoking was triple the 16% rate found among the 65 or over (52% and 48%, respectively; p <0.001). Polypharmacy was significantly higher among the oldest participants (35%) than in the other age groups (around 25%). Frailty was more than twice as prevalent in the oldest age group (11% vs 4% and 5% in the 50-54 and 55-64, respectively). The proportion of participants 65 or over with functional impairment was double that of the other age groups (32% vs 12% and 15%).

Among those 65 or over, cognitive impairment was twice as prevalent (22%) as in the 50-54 (9%) and the 55-64 (11%). There were no differences between age groups regarding quality of life.

Comparing people diagnosed before and after 1996

Turning to the analysis by period of HIV diagnosis, the investigators found that women accounted for 31% of long-term HIV survivors but only 19% of the HAART-era group (p <0.001).

Of long-term HIV survivors, 56% were 55-64 years old and 9% were 65 or over when entering the study. Twenty per cent of the HAART-era participants were aged 65 or over when they joined the study – twice the proportion of long-term HIV survivors.

There were significant differences by how people acquired HIV: 61% of the long-term survivors used or had used injectable drugs, compared to 14% of the HAART-era participants. Sexual transmission was less common in the long-term survivors (34%) than among the HAART-era participants (76%). Although these differences are striking, the researchers told aidsmap.com that acquisition route was not associated with frailty, comorbidities or multimorbidity.

” Long-term HIV survivors have the highest rates of comorbidities, including those affecting quality of life.”

Significantly, more HAART-era participants than long-term HIV survivors lived alone (44% vs 31%, p <0.001).

No differences were observed regarding virological and immunological outcomes.

The mean number of comorbidities was significantly higher among long-term HIV survivors (2.6 vs 1.8 in the HAART-era group), as was the proportion of participants having five or more comorbidities (16% vs 8%). But although some comorbidities (e.g. depression, COPD) were more prevalent in long-term HIV survivors, this was not the case for some others (e.g. hypertension, diabetes, heart attack).

More long-term HIV survivors smoked than in the HAART-era group (54% vs 37%; p <0.001). Likewise, polypharmacy was more prevalent in long-term HIV survivors (31% vs 22%, p <0.001), as was the use of neuroleptics (17% vs 7%; p <0.001), benzodiazepines (27% vs 15%; p <0.001) and hypnotics (32% vs 3%; p <0.001).

No significant differences were seen between long-term HIV survivors and HAART-era individuals in terms of frailty (5% vs 6%) or falls (18% vs 14%). However, cognitive impairment was lower among long-term survivors (9% vs 14%).

Quality of life was significantly worse in long-term HIV survivors, compared to HAART-era participants (fair or poor quality of life reported by 63% vs 52%; p <0.01). Importantly, pain was more prevalent in long-term survivors (41% vs 31%). 

Conclusion

Clearly, the study shows that long-term HIV survivors present the highest rates of comorbidities, including those known to have a stronger negative impact on quality of life, such as COPD, cancer, depression and pain. However, no differences emerged between long-term HIV survivors and HAART-era individuals in terms of frailty, demonstrating that although frailty and comorbidities are frequent in long-term HIV survivors, they are not necessarily connected. 

Brañas and colleagues say their results are interesting “because HIV care providers, when referring to the older adults with HIV, commonly assume this group is mostly formed by those diagnosed before 1996.” In fact, care for older adults with HIV cannot rely on such misconceptions. Rather, it should be based on a comprehensive understanding of the many differences in this population revealed by this study.

References

Brañas F et al. Different profiles among older adults with HIV according to their chronological age and the year of HIV diagnosis: The FUNCFRAIL cohort study (GeSIDA 9817). PLoS ONE 17: e0266191, 2022 (open access).

https://doi.org/10.1371/journal.pone.0266191