Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-24T02:33:28.615Z Has data issue: false hasContentIssue false
  • English
  • Français

HIV and ageing: what the geriatrician needs to know

Published online by Cambridge University Press:  27 November 2013

T Levett ,
J Wright  and
M Fisher
T Levett*
Affiliation:
Department of Elderly Medicine, Royal Sussex County Hospital, Brighton, UK
J Wright
Affiliation:
Department of Elderly Medicine, Royal Sussex County Hospital, Brighton, UK
M Fisher
Affiliation:
Department of HIV/GUM, Royal Sussex County Hospital, Brighton, UK
*
Address for correspondence: Dr Tom Levett, Department of Elderly Medicine, Nigel Porter Unit, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE. Email: [email protected] or [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

The transformation of human immunodeficiency virus (HIV) from a rapidly fatal disease to a chronic manageable illness has resulted in annual increases in the numbers of people living with HIV. The HIV cohort is therefore ageing, with numbers of older adults with HIV climbing, through both prolonged survival and late acquisition of the disease. Associated with ageing is an accumulation of HIV-associated non-AIDS related co-morbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and complex social issues. With this in mind, this review seeks to explore areas where HIV (diagnosed or undetected) may impact on the work of clinical geriatricians.

Keywords

HIVageinggeriatricsreview
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 1 , February 2014 , pp. 10 - 24
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1The Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008; 372: 293–99.Google Scholar
2May, M, Gompels, M, Delpech, Vet al.Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ 2011; 343: d6016 (accessed March 2013).Google Scholar
3Health Protection Agency. HIV in the United Kingdom: 2012 Report. London: Health Protection Services, Colindale. November 2012. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317137200016 (accessed March 2013).Google Scholar
4Effros, RB, Fletcher, CV, Gebo, Ket al.Aging and infectious disease: workshop on HIV and aging: what is known and future research directions. Clin Infectious Disease 2008; 47: 542–53.CrossRefGoogle ScholarPubMed
5O'Keefe, KJ, Scheer, S, Chen, MJet al.People fifty years or older now account for the majority of AIDS cases in San Francisco, California, 2010. AIDS Care, online edition, 2013; doi: 10.1080/095401212.2012.752565.CrossRefGoogle ScholarPubMed
6Negin, J, Cumming, RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Org 2010; 88: 847–53.Google Scholar
7Mills, EJ, Bärnighausen, T, Negin, J. HIV and aging – preparing for the challenges ahead. New Engl J Med 2012; 366: 1270–73.Google Scholar
8Onen, NF, Shacham, E, Stamm, KE, Overton, ET. Comparisons of sexual behaviors and STD prevalence among older and younger individuals with HIV infection. AIDS Care 2010; 22: 711–17.Google Scholar
9Dolcini, MM, Catania, JA, Stall, RD, Pollack, L. The HIV epidemic among older men who have sex with men. J Acquired Immune Deficiency Syndromes 2003; 33: S115–21.Google Scholar
10Lindau, ST, Schumm, LP, Laumann, EO, Levinson, W, O'Muircheartaigh, CA, Waite, LJ. A study of sexuality and health among older adults in the United States. New Engl J Med 2007; 357, 762–74.Google Scholar
11Pratt, G, Gascoyne, K, Cunningham, K, Tunbridge, A. Human immunodeficiency virus (HIV) in older people. Age Ageing 2010; 39: 289–94.Google Scholar
12Cahill, A, Valadez, R. Growing older with HIV/AIDS: new public health challenges. Am J Public Health 2013; 103: e7–15.CrossRefGoogle ScholarPubMed
13Kearney, F, Moore, A, Donegan, CF, Lambert, J. The ageing of HIV: implications for geriatric medicine. Age Ageing 2010; 39: 536–41.CrossRefGoogle ScholarPubMed
14Smith, RD, Delpech, VC, Brown, AE, Rice, BD. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS 2010; 24: 2109–15.Google Scholar
15Iwuji, CC, Churchill, D, Gilleece, Yet al.Older HIV-infected individuals present late and have a higher mortality: Brighton, UK cohort study. BMC Public Health 2013; 13: 397.Google Scholar
16Vance, DE, Mugavero, M, Willig, J, Raper, JL, Saag, MS. Aging with HIV: a cross-sectional study of comorbidity prevalence and clinical characteristics across decades of life. J Assoc Nurses AIDS Care 2011; 22: 17–25.Google Scholar
17CASCADE Collaboration. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet 2003; 362: 1267–74.CrossRefGoogle Scholar
18Perez, JL, Moore, RD. Greater effect of highly active antiretroviral therapy on survival in people aged > or = 50 years compared with younger people in an urban observational cohort. Clin Infect Dis 2003; 36: 212–18.Google Scholar
19Deeks, SG, Phillips, AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2008; 338: 288–92.Google Scholar
20Reiss, P. The art of managing Human Immunodeficiency Virusi: a balancing act. Clin Infectious Dis 2009; 49: 1602–4.Google Scholar
21Fisher, M, Cooper, V. HIV and ageing: premature ageing or premature conclusions? Current Opin Infectious Dis 2012; 25: 1–3.Google Scholar
22Obel, N, Omland, LH, Kronborg, Get al.Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study. PLoS One 2011; 6: e22698. doi: 10.1371/journal.pone.0022698.Google Scholar
23Guaraldi, G, Orlando, G, Zona, Set al.Premature age-related co-morbidities among HIV-infected persons compared to the general population. Clin Infect Dis 2011; 53: 1120–26.CrossRefGoogle Scholar
24Hasse, B, Ledergerber, B, Furrer, Het al.Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infectious Dis 2011; 53: 1130–39.Google Scholar
25Lewden, C, May, T, Rosenthal, Eet al.Changes in causes of death among adults infected by HIV between 2000 and 2005: the ‘Mortalite 2000 and 2005’ surveys. J Acquir Immune Defic Syndr 2008; 48: 590–98.Google Scholar
26Rhee, MS, Greenblatt, DJ. Pharmacologic considerations for the use of antiretroviral agents in the elderly. J Clin Pharmacol 2008; 48: 1212–25.Google Scholar
27Nogueras, M, Navarro, G, Anton, Eet al.Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more. BMC Infectious Dis 2006; 4: 46.Google Scholar
28Gebo, KA. Epidemiology of HIV and the response to antiretroviral therapy in the middle aged and elderly. Aging Health 2008; 4: 615–27.Google Scholar
29Sabin, CA, Smith, CJ, d'Arminio Monforte, Aet al. Response to combination antiretroviral therapy: variation by age. AIDS 2008; 22: 1463–73.Google Scholar
30Branas, F, Berenguer, J, Sanchez-Conde, Met al.The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy. Am J Med 2008; 121: 820–24.Google Scholar
31European Clinical AIDS Society. Guidelines. 2009. Available at: http://www.europeanaidsclinicalsociety.org/images/stories/EACS-Pdf/version-5-november2009-eacs-guidelines-cologne.pdf (accessed July 2013).Google Scholar
32Orlando, G, Meraviglia, P, Cordier, Let al.Antiretroviral treatment and age related co-morbidities in a cohort of older HIV-infected patients. HIV Med 2006; 7: 549–57.Google Scholar
33Sabin, CA, Smith, CJ, Delpech, Vet al.The associations between age and the development of laboratory abnormalities and treatment discontinuation for reasons other than virological failure in the first year of highly active antiretroviral therapy. HIV Med 2009; 10: 35–43.Google Scholar
34Marzolini, C, Back, D, Weber, Ret al.Ageing with HIV: medication use and risk for potential drug-drug interactions. J Antimicrobial Chemotherapy 2011; 66: 2107–11.Google Scholar
35Sherr, L, Harding, R, Lampe, Fet al.Clinical and behavioural aspects of aging with HIV infection. Psychol Health Med. 2009; 14: 273–79.Google Scholar
36McLennon, SM, Smith, R and Orrick, JJ. Recognizing and preventing drug interactions in older adults with HIV. J Gerontol Nursing 2003; 29: 5–12.Google Scholar
37Marzolini, C, Elzi, L, Gibbons, Set al.Prevalence of comedications and the effect of potential drug-drug interactions in the Swiss HIV Cohort Study. Antiviral Therapy 2010; 15: 413–23.Google Scholar
38Waters, L, Patterson, B, Scourfield, Aet al.A dedicated clinic for HIV-positive individuals over 50 years of age: a multidisciplinary experience. Int J STI AIDS 2012; 23: 546–52.CrossRefGoogle ScholarPubMed
39Rastegar, DA, Knight, AM, Monolakis, JS. Antiretroviral medication errors among hospitalized patients with HIV infection. Clin Infect Dis 2006; 43: 933–38.Google Scholar
40Mok, S, Minson, Q. Drug-related problems in hospitalized patients with HIV. Am J Health Syst Pharm 2008; 65: 55–59.Google Scholar
41Evans-Jones, J, Cottle, LE, Back, DJet al.Recognition of risk for clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis 2010; 50: 1419–21.Google Scholar
42Hinkin, CH, Hardy, DJ, Mason, KIet al.Medication adherence in HIV-infected adults: effect of patient age, cognitive status and sub-stance abuse. AIDS 2004; 18 (suppl 1): S19–25.Google Scholar
43Lee, S, Shafe, ACE, Cowie, MR. UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the General Practice Research Database. BMJ Open 2011; 1:e000269. Available at: http://bmjopen.bmj.com/content/1/2/e000269.long (accessed 29 March 2013)Google Scholar
44Ovbiagele, B, Nath, A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology 2011; 76: 444–50.CrossRefGoogle ScholarPubMed
45Benjamin, LA, Bryer, A, Emsley, HCA, Khoo, S, Solomon, T, Connor, MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurology 2012; 11: 878–90.CrossRefGoogle ScholarPubMed
46Corral, I, Quereda, C, Moreno, Aet al.Cerebrovascular ischemic events in HIV-1-infected patients receiving highly active antiretroviral therapy: incidence and risk factors. Cerebrovasc Dis 2009; 27: 559–63.Google Scholar
47Pinto, AN. AIDS and cerebrovascular disease. Stroke 1996; 27: 538–43.Google Scholar
48Cole, JW, Pinto, AN, Hebel, JRet al.Acquired immunodeficiency syndrome and the risk of stroke. Stroke 2004; 35: 51–56.Google Scholar
49Modi, G, Modi, M, Mochan, A. Is stroke a HIV-related neurological manifestation? Expert Rev Neurotherapeutics 2008; 8: 1247–53.Google Scholar
50Rasmussen, LD, Engsig, FN, Christensen, Het al.Risk of cerebrovascular events in persons with and without HIV: a Danish nationwide population-based cohort study. AIDS 2011; 25: 1637–46.Google Scholar
51Chow, FC, Regan, S, Feske, S, Meigs, J, Grinspoon, SK, Triant, VA. Comparison of ischaemic stroke incidence in HIV-Infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndrome 2012; 60: 351–58.CrossRefGoogle Scholar
52Tipping, B, de Villiers, L, Wainwright, H, Candy, S, Bryer, A. Stroke in patients with human immunodeficiency virus. J Neurol Neurosurg Psychiatry 2007; 78: 1320–24.Google Scholar
53Roquer, J, Palomeras, E, Knobel, H, Pou, A. Intracerebral haemorrhage and AIDS. Cerebrovasc Dis 1998; 8: 222–27.Google Scholar
54Ortiz, G, Koch, S, Romano, JG, Forteza, AM, Rabinstein, AA. Mechanisms of ischemic stroke in HIV-infected patients. Neurology 2007; 68: 1257–61.Google Scholar
55Kumwenda, JJ, Mateyu, G, Kampondeni, S, van Dam, AP, van Lieshout, L, Zijlstra, EE. Differential diagnosis of stroke in a setting of high HIV prevalence in Blantyre, Malawi. Stroke 2005; 36: 960–64.Google Scholar
56Lindsberg, PJ, Grau, AJ. Inflammation and infections as risk factors for ischemic stroke. Stroke 2003; 34: 2518–32.Google Scholar
57Sen, S, Rabinstein, AA, Elkind, MS, Powers, WJ. Recent developments regarding human immunodeficiency virus infection and stroke. Cerebrovasc Dis 2012; 33: 209–18.CrossRefGoogle ScholarPubMed
58Boccara, F, Cohen, A. Coronary artery disease and stroke in HIV-infected patients: prevention and pharmacological therapy. Adv Cardiol 2003; 40: 163–84.Google Scholar
59Dobbs, MR, Berger, JR. Stroke in HIV infection and AIDS. Expert Rev Cardiovasc Therapy 2009; 7: 1263–71.Google Scholar
60Heaton, RK, Franklin, DR, Ellis, RJet al.HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 2011; 17: 3–16.Google Scholar
61Garvey, L, Surendrakumar, V, Winston, A. Low rates of neurocognitive impairment are observed in neuroasymptomatic HIV-infected subjects on effective antiretroviral therapy. HIV Clin Trials 2011; 12: 333–38.Google Scholar
62Antinori, A, Arendt, G, Becker, JTet al.Updated research nosology for HIV associated neurocognitive disorders. Neurology 2007; 69: 1789–99.Google Scholar
63González-Scarano, F, Martín-García, J. The neuropathogenesis of AIDS. Nat Rev Immunol 2005; 5: 69–81.Google Scholar
64Robertson, KR, Smurzynski, M, Parsons, TDet al.The prevalence and incidence of neurocognitive impairment in the HAART era. AIDS 2007; 21: 1915–21.Google Scholar
65Mateen, FJ, Mills, EJ. Aging and HIV-related cognitive loss. JAMA 2012; 308: 349–50.Google Scholar
66Department of Health. Living well with dementia: A National Dementia Strategy. 3 February 2009. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_094051.pdf (accessed 14 April 2013).Google Scholar
67Asboe, D, Aitken, C, Boffito, Met al.on behalf of the BHIVA Guidelines Subcommittee. British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Med 2012; 13: 1–44.Google Scholar
68British Psychological Society (BPS), British HIV Association (BHIVA) and Medical Foundation for AIDS & Sexual Health (MedFASH) Standards for psychological support for adults living with HIV. 17 November 2011. Available at: http://www.bhiva.org/StandardsForPsychologicalSupport.aspx (accessed 14 April 2013).Google Scholar
69British HIV Association. Standards of Care for People Living with HIV, 2013. Available at: http://www.bhiva.org/documents/Standards-of-care/BHIVAStandardsA4.pdf (accessed 14 April 2013).Google Scholar
70Smurzynski, M, Wu, K, Letendre, Set al.Effects of central nervous system antiretroviral penetration on cognitive functioning in the ALLRT cohort. AIDS 2011; 25: 357–65.Google Scholar
71Erlandson, KM, Allshouse, AA, Jankowski, CMet al.Risk factors for falls in HIV-infected persons. J Acquired Immune Deficiency Syndrome 2012; 61: 484–89.CrossRefGoogle ScholarPubMed
72Tinetti ME. Preventing falls in elderly persons. New Engl J Med 2003; 348: 42–49.Google Scholar
73Brown, TT, Qaqish, RB. Antiretroviral therapy and the prevalence of osteoporosis and osteopenia: A meta-analytical review. AIDS 2006; 20: 2164–74.CrossRefGoogle Scholar
74Arnsten, JH, Freeman, R, Howard, AA, Floris-Moore, M, Lo, Y, Klein, RS. Decreased bone mineral density and increased fracture risk in aging men with or at risk of HIV infection. AIDS 2007; 21: 617–23.Google Scholar
75Pepe, J, Isidori, AM, Falciano, Met al.The combination of FRAX and Ageing Male Symptoms scale better identifies treated HIV in males at risk for major fracture. Clin Endocrinol 2012; 77: 672–78.Google Scholar
76Mary-Krause, M, Viard, JP, Ename-Mkoumazok, Bet al.Prevalence of low bone mineral density in men and women infected with human immunodeficiency virus 1 and a proposal for screening strategy. J Clin Densitometry 2012; 15: 422–33.Google Scholar
77Prior, J, Burdge, D, Maan, Eet al.Fragility fractures and bone mineral density in HIV positive women: a case-control population-based study. Osteoporosis Int 2007; 18: 1345–53.Google Scholar
78Arnsten, JH, Freeman, R, Howard, AA, Floris-Moore, M, Santoro, N, Schoenbaum, EE. HIV infection and bone mineral density in middle-aged women. Clin Infect Dis 2006; 42: 1014–20.Google Scholar
79Yin, MT, McMahon, DJ, Ferris, DCet al.Low bone mass and high bone turnover in postmenopausal human immunodeficiency virus-infected women. J Clin Endocrinol Metab 2010; 95: 620–29.Google Scholar
80Bonjoch, A, Figueras, M, Estany, Cet al.High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. AIDS 2010; 24: 2827–33.Google Scholar
81Jones, S, Restrepo, D, Kasowitz, Aet al.Risk factors for decreased bone density and effects of HIV on bone in the elderly. Osteoporosis Int 2008; 19: 913–18.Google Scholar
82Ofotukun, I, Weitzmann, MN. HIV-1 infection and antiretroviral therapies: risk factors for osteoporosis and bone fracture. Curr Opin Endocrinol Diabetes Obesity 2010; 17: 523–29.Google Scholar
83Cummings, SR, Melton, LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002; 359:1761–67.Google Scholar
84Klotzbeucher, CM, Ross, PD, Landsman, PB, Abbott, TA, Berger, M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Mineral Res 2000; 15: 721–39.Google Scholar
85Van Staa, TP, Leufkens, HGM, Cooper, C. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporosis Int 2002; 13: 624–29.CrossRefGoogle Scholar
86Triant, VA, Brown, TT, Lee, H, Grinspoon, SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clinical Endocrinol Metab 2008; 93: 3499–504.Google Scholar
87Womack, JA, Goulet, JL, Gibert, Cet al.for the Veterans Aging Cohort Study Team. Increased risk of fragility fracture among HIV infected compared to uninfected make veterans. PLoS ONE 2011; 6: e17217.Google Scholar
88Young, B, Dao, CN, Buchacz, Ket al.Increased rates of bone fracture among HIV-infected Persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000–2006. Clin Infect Dis 2010; 52: 1061–68.Google Scholar
89McComsey, GA, Huang, JS, Woolley, IJet al.Fragility fractures in HIV-infected patients: Need to better understanding of diagnosis and management. J Int Assoc Physicians AIDS Care 2004; 3: 86–91.Google Scholar
90Kanis, JA, Johnell, O, Oden, A, Johansson, H, McCloskey, E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporosis Int 2008; 19: 385–97.Google Scholar
91Gazzola, L, Comi, L, Savoldi, Aet al.Use of the FRAX equation as first-line screening of bone metabolism alteration in the HIV-infected population. J Infect Dis 2010; 202: 330–31Google Scholar
92McComsey, GA, Kendall, MA, Tebas, Pet al.Alendronate with calcium and vitamin D supplementation is safe and effective for the treatment of decreased bone mineral density. AIDS 2007; 21: 2473–82.CrossRefGoogle ScholarPubMed
93Guaraldi, G, Orlando, G, Madeddu, Get al.Alendronate reduces bone resorption in HIV associated osteopenia/osteoporosis. HIV Clin Trials 2004; 5: 269–77.Google Scholar
94Mondy, K, Powderly, WG, Claxton, SAet al. Alendronate, vitamin D and calcium for the treatment of osteopenia/osteoporosis associated with HIV infection. J Acquired Immune Deficiency Syndrome 2005; 38: 426–31.Google Scholar
95Negredo, E, Martınez-Lopez, E, Paredes, Ret al.Reversal of HIV-1-associated osteoporosis with once-weekly alendronate. AIDS 2005; 19: 343–45.Google Scholar
96Markle-Reid, M, Browne, G. Conceptualizations of frailty in relation to older adults. J Advanced Nursing 2003; 44: 48–58.Google Scholar
97Fried, LP, Tangen, CM, Walston, Jet al.Frailty in older adults: evidence for a phenotype. J Gerontol A Bio Sci Med Sci 2001; 56: 146–56.Google Scholar
98Rockwood, R, Mitnitski, A. Frailty defined by deficit accumulation and geriatric medicine defined by Frailty. Clinical Geriatric Med 2001; 27: 17–26.Google Scholar
99Desquilbet, L, Jacobson, LP, Fried, LPet al.HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol 2007; 62A: 12791286.Google Scholar
100Desquilbet, L, Margolick, JB, Fried, LPet al.Relationship between a frailty-related phenotype and progressive deterioration of the immune system in HIV-infected men. J Acquir Immune Defic Syndr 2009; 50: 299–306.Google Scholar
101Onen, NF, Agbebi, A, Shacham, E, Stamm, KE, Onen, AR, Overton, ET. Frailty among HIV-infected persons in an urban outpatient care setting. J Infection 2009; 59: 346–52.Google Scholar
102Terzian, AS, Holman, S, Nathwani, Net al.Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health (Larchmt) 2009; 18: 1965–74.Google Scholar
103Ianas, V, Berg, E, Mohler, MJ, Wendel, C, Klotz, SA. Antiretroviral therapy protects against frailty in HIV-1 infection. J Int Assoc Providers AIDS Care (JIAPAC) 2013; 12: 62–66.Google Scholar
104Pathi, S, Gilbert, C, Weiss, HAet al.Frailty in HIV-infected adults in South Africa. J Acquir Immune Defic Syndr 2013; 62: 43–51.CrossRefGoogle Scholar
105Desquilbet, L, Jacobson, LP, Fried, LPet al.A frailty-related phenotype before HAART initiation as an independent risk factor for AIDS or death after HAART among HIV-infected men. J Gerontol A Biol Sci Med Sci 2011; 66A: 1030–38.Google Scholar
106Ruiz, M, Cefalu, C. Palliative care program for human immunodeficiency virus-infected patients: rebuilding of an academic urban program. Am J Hospice Palliative Med 2011; 28: 16–21.Google Scholar
107Karus, D, Raveis, VH, Alexander, Cet al.Patient reports of symptoms and their treatment at three palliative care projects servicing individuals with HIV/AIDS. J Pain Symptom Management 2005; 30: 408–17.Google Scholar
108Simms, V, Higginson, IJ and Harding, R. What palliative care-related problems do patients experience at HIV diagnosis? A systematic review of the evidence. J Pain Symptom Management 2011; 42: 734–53.Google Scholar
109Lorenz, KA, Cunningham, WE, Spritzer, KL, Hays, RD. Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV. Qual Life Res 2006; 15: 951–58.Google Scholar
110Corless, IB, Nicholas, PK, Davis, SM, Dolan, SA, McGibbon, CA. Symptom status, medication adherence, and quality of life in HIV disease. J Hospice Palliative Care Nursing 2005; 7: 129–38.Google Scholar
111Harding, R, Easterbrook, P, Higginson, IJ, Karus, D, Raveis, VH, Marconi, K. Access and equity in HIV/AIDS palliative care: a review of the evidence and responses. Palliative Med 2005; 19: 251–58.Google Scholar
112Green, K, Tuan, T, Vu Hoang, T, Thi Trang, NN, Thanh Ha, NT, Hung, ND. Integrating palliative care into HIV outpatient clinical settings: preliminary findings from an intervention study in Vietnam. J Pain Symptom Management 2010; 40: 31–34.Google Scholar
113Cochrane, J. The experience of uncertainty for individuals with HIV/AIDS and the palliative care paradigm. Int J Palliative Nursing 2003; 9: 382–88.Google Scholar
114Karasz, A, Dyche, L, Selwyn, P. Physicians’ experiences of caring for late-stage HIV patients in the post-HAART era: challenges and adaptations. Social Sci Med 2003; 57: 1609–20.Google Scholar
115Corless, IB, Nicholas, PK. Long-term continuum of care for people living with HIV/AIDS. J Urban Health 2000; 77: 176–86.Google Scholar
116Harding, R, Karus, D, Easterbrook, P, Raveis, VH, Higginson, IJ, Marconi, K. Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence. Sex Transm Infect 2005; 81: 5–14.Google Scholar
117Kell, ME, Walley, JD. Palliative care for HIV in the era of antiretroviral therapy availability: perspectives of nurses in Lesotho. BMC Palliative Care 2009; 8: 11.Google Scholar
118Simms, V, Higginson, IJ, Harding, R. Integration of palliative care throughout HIV disease. Lancet Infect Dis 2012; 12: 571–75.Google Scholar
119Harding, R, Simms, V, Krakauer, Eet al.Quality HIV care to the end of life. Clin Infect Dis 2011; 52: 553–54.CrossRefGoogle ScholarPubMed
120Erlandson, KM, Allshouse, AA, Jankowski, CMet al.Comparison of functional status instruments in HIV infected adults on effective antiviral therapy. HIV Clin Trials 2012; 13: 324–34.Google Scholar
121Oursler, KK, Goulet, JL, Leaf, DAet al. Association of comorbidity with physical disability in older HIV-infected adults. AIDS Patient Care STDs 2006; 20: 782–91.Google Scholar
122Emlet, CA.An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Social Work 2006; 31: 299–308.Google Scholar
123Shippy, RA, Karpiak, SE. The aging HIV/AIDS population: fragile social networks. Aging Mental Health 2005; 9: 246–54.Google Scholar
124Nokes, KN, Holzember, WL, Corless, IBet al.Health-related quality of life in persons younger and older than 50 living with HIV/AIDS. Res Aging 2000; 22: 290–310.Google Scholar
125Poindexter, C, Shippy, RA. Networks of older New Yorkers with HIV: fragility, resilience, and transformation. AIDS Patient Care STDs 2008; 22: 723–33.Google Scholar
126Fritsch T. HIV/AIDS and the older adult: an exploratory study of the age-related differences in access to medical and social services. J Appl Gerontol 2005; 24: 35–54.Google Scholar
127Pitts, M, Grierson, J, Misson, S. Growing older with HIV: a study of health, social and economic circumstances for people living with HIV in Australia over the age of 50 years. AIDS Patient Care STDs 2005; 19: 460–65.Google Scholar
128Owen, G, Catalan, J ‘We never expected this to happen’: narratives of ageing with HIV among gay men living in London, UK. Culture, Health & Sexuality. 2011. doi: 10.1080/13691058.2011.621449Google Scholar
129McMahon, J, Wanke, C, Terrin, N, Skinner, S, Knox, T. Poverty, hunger, education, and residential status impact survival in HIV. AIDS Behaviour 2011; 15: 1503–11.Google Scholar
130Power, L, Bell, M, Freemantle, I. Joseph Rowntree Foundation. A National Study of Ageing and HIV (50 Plus). 2010. Available at: http://www.jrf.org.uk. ISBN: 978-1-85935-754-5Google Scholar
131High, KP, Brennan-Ing, M, Clifford, DBet al.HIV and aging: state of the knowledge and areas of critical need for research. A report of the NIH offices of AIDS research by the HIV and aging working group. J Acquir Immune Defic Syndrome 2012; 60 (suppl 1): S1–18.Google Scholar
132Hughes, AK. HIV knowledge and attitudes among providers in aging: results from a national survey. AIDS Patient Care STDs 2011; 25: 539–45.Google Scholar