Treatment Issues

So treatment!  I'm not going to go into a lot of detail here about specific drug regimens since they would be the same as we would see among other age groups and vary greatly from practitioner to practitioner.  If you are interested in specific therapies and new innovations though, here is a great link to check out all the latest: http://www.hivatis.org/

What I would like to address here is some of the issues that are pertinent to older adults when it comes to treatment; what are the things that we need to be think about when we are treating our patients who are HIV positive and older?

The first thing that we need to take into consideration is drug interactions.  Antiretroviral therapies tend to have a lot of bad drug interactions.  In particular the protease inhibitors, which are a key part of most modern therapies, are metabolized in the liver and inhibits the metabolization of other drugs.  This increase the likelihood of  bad drug interactions.  Though this is, of course, as issue for all ages it becomes even more so for older adults because they tend to already be taking a great deal more medicines than younger folks because of any mixture of age related medical reasons.

And, speaking of these age-related illnesses; another problem we find with ART is that they tend to exacerbate these common ailments that we find in older adults.  Examples of this might include heart disease, high blood pressure, high cholesterol, diabetes, high triglyceride levels, kidney stones, inflammation of pancreas, liver damage, and bone loss which can lead to fracture.  In addition, it is common for older adults to already have a weakened immune system, which could make it difficult for them to respond to ART as a younger person might.

Another aspect that might also be considered is memory issues.  While some might suggest that we need to consider the fact that it may be more difficult for older adults to remember to take their ART, there are those who suggest that this population is already accustomed to taking several pills a day and adding a few more won't make that big a deal.  Thsi still needs to be on the table though simply because of the importance of adherance in ART.

There is still a LOT that needs to be understood about how these drug therapies work in older populations.  Most studies that have examined ART in the past have failed to include older adults as a population of concern.  These interactions and exacerbations will only continue to pose numerous challenges for both practitioners and patients alike until more attention given to this population.

http://www.bidmc.org/YourHealth/TherapeuticCenters/AIDS.aspx?ChunkID=14570

http://www.gmhc.org/files/editor/file/fall09.pdf

http://www.thebody.com/content/art14281.html