Managing the Older Adult Patient with HIV

ISBN-13: 9783319201306 / Angielski / Miękka / 2016 / 227 str.

Giovanni Guaraldi; Chiara Mussi; Julian Falutz

Opis

This concise, clinically focused pocket guide offers a complete overview of HIV in the older patient and reviews the latest guidelines, treatment options, clinical trials, and management of HIV within this subgroup. The easily accessible text offers infectious disease specialists and other health care professionals with an excellent quick reference tool, with full color tables and figures enhancing the text further. HIV is a chronic disease that affects the immune system, leading to AIDS. As treatments have progressed and patients with HIV are living longer a new aspect has to be taken in to consideration when treating HIV and other conditions. Comorbidities are rife within older adults with HIV, as many of the treatments for HIV cause long-term side effects, such as heart conditions and cancer. Special consideration must be taken to ensure no toxic drug-drug interactions between treatments.

Recenzje

"Guaraldi and colleagues have produced a concise review of ageing and HIV infection. ... The focus of HIV care is shifting from immunodeficiency and opportunistic infections to age-related comorbidities. This informative resource allows practitioners in the field of HIV infection to familiarize themselves with current thinking in this area." (Frank Post, British Journal of Hospital Medicine, Vol. 77 (9), September, 2016)

Spis treści

1. Introduction

References

 

2. Pathophysiology of HIV/AIDS

Key points

2.1 Immunodeficiency, immune activation, and chronic inflammation

2.2 HIV and immunosenescence

2.3 Evolving clinical profile

References

 

3. HIV associated non-AIDS conditions in patients aging with HIV

Key points

3.1 HIV-associated non-AIDS conditions versus comorbidities

References

 

4. Comorbid conditions and older adults with HIV

Key points

4.1 Multimorbidity

4.2 Accentuated versus accelerated aging

4.3 Aging versus aged

References

 

5. Frailty in HIV

Key points

5.1 Defining frailty

5.2 Measuring frailty

5.3 The utility of measuring frailty

5.4 Frailty in the context of HIV

References

 

6. Disability

Key points

6.1 Overview

6.2 Functional impairment and disability in patients with HIV

6.3 Tools to measure disability

6.4 Conclusion

References

 

7. Geriatric syndromes

Key points

7.1 Definition

7.2 Falls

7.3. Delirium

7.4 Conclusion

References

 

8. HIV prevention and screening in older adults

Key points

8.1 Age-related risk factors

8.2. Barriers to prevention

8.3. Screening and counselling opportunities

References

 

9. Multidimensional geriatric assessment in older patients with HIV

Key points

References

 

10. Antiretroviral treatment in older patients

Key points

10.1 When to start antiretroviral therapy

10.2 What to start

10.3 What to change

10.4 Future perspectives

References

 

11. HIV, aging, and polypharmacy

Key points

References

 

12. Nutrition and physical exercise in older patients with HIV

Key points

12.1 Overview

12.2 Assessment of risk of malnutrition

12.3 Intervention

12.4 Sarcopenic obesity

12.5 Physical exercise

12.6 Conclusion

References

 

13. Smoking cessation in patients with HIV

Key points

13.1 Pharmacological strategies to treat nicotine dependence

References

 

14. Self-management

Key points

References 

O autorze

Giovanni Guaraldi, MD, is Assistant Professor of Infectious disease at University of Modena and Reggio Emilia, Italy, where he also completed his medical training. Dr Guaraldi undertook his residency at Liverpool School of Tropical Medicine, UK, and Jackson Memorial Hospital, USA.

Dr Guaraldi was awarded the Dean's Delegate Cooperation for development projects of Modena University. He has extensive experience in HIV in resource limited countries and has coordinated the European Africa, Caribbean, Pacific project CoBaSys (Community Based System in HIV Treatment) focused on antiretroviral access programs in sub-Saharan African countries.

In 2002 Dr Guaraldi started a liver and kidney transplant program for people with HIV at the multivisceral transplant centre at Policlinico of Modena, Italy. Since the centre opened he has personally cared for approximately 80 patients with HIV who have received solid organ transplantation. Dr Guaraldi has lead the Modena HIV Metabolic Clinic since 2000. This referral centre cares for more than 4000 patients and offers a multidisciplinary team consisting of infectious disease physicians, nutritionists, occupational therapists, psychologists, cardiologists, nephrologists, endocrinologists, and plastic surgeons for the diagnosis and treatment of non-infectious comorbidities.

Dr Guaraldi has been the principal investigator in several studies generated by the MHMC, mainly focused on frailty and HIV associated comorbidities. He has extensive experience in scientific publication, with more than 260 peer reviewed papers, he is co-editor of Journal of Antimicrobial Chemotherapy, serves as reviewer for the major HIV journals, and as a consultant for EMA. He supervises PhD student in the Experimental Medicine PhD course at Modena University.

Dr Guaraldi is a panel member of the European AIDS Clinical Society guidelines on prevention and management of HIV associated comorbidities and has published widely on clinical aspects of HIV treatment and care.

Julian Falutz MD, FRCP(C), is Assistant Professor of Medicine at McGill University and Associate Physician at the Montreal General Hospital Site of the McGill University Hospital Centre (MUHC), Canada. He is the Director of the Comprehensive HIV and Aging Initiative in the Chronic Viral Illness Service and a Senior Physician in the Division of Geriatrics at the MUHC.

Dr Falutz attended McGill University School of Medicine, where he completed his residency in General Internal Medicine and received subspecialty training in both Internal Medicine and Geriatrics. He has been actively involved in the clinical care of both HIV and geriatric patients at the MUHC for over 25 years. He is active as a clinical teacher at the undergraduate and graduate levels and was the Director of the HIV elective program at the MUHC for 20 years.

His research in HIV has focused on the interaction of immunodeficiency, nutrition, and metabolic complications. He has initiated and participated in numerous studies on the management of HIV-related complications. He was the Co-Principal Investigator for the pivotal multinational studies investigating a novel Growth Hormone Releasing Factor for the treatment of abdominal obesity in patients with HIV. The investigated drug has since been approved for use in both the US and Canada. He is the Canadian Coordinator for the REPRIEVE Study, a multinational study of statins to prevent cardiovascular disease in low-risk treated HIV patients. He has initiated a Program for the evaluation of patients aging with HIV and plays an active role in emerging studies evaluating frailty and comorbidities in patients aging with HIV.

Chiara Mussi, MD, PhD, is a Doctor in Medicine within the Modena HIV Metabolic Clinic at the University of Modena and Reggio Emilia, Italy. Dr Mussi earned her medical degree from the University of Modena and Reggio Emilia in 1995, and her graduation thesis centred on orthostatic hypotension in the elderly. In 1999 Dr Mussi specialized in Geriatrics, and in 2004 she gained her PhD in Biology and Pathophysiology of Aging, where her main research topic was cardiovascular autonomic changes in older patients. In 2008 she obtained a research grant from the University of Modena and Reggio Emilia to research syncope in the elderly. Dr Mussi has been a researcher and Chair of Geriatrics at the University of Modena and Reggio Emilia since 2009. She also works as an MD at The New S Agostino-Estense Civil Hospital in Baggiovara, Modena.

Dr Mussi has authored more than 100 peer-reviewed papers published in international and national journals, is an expert in multidimensional geriatric evaluation and geriatric syndromes, and has been a consultant in the Multidisciplinary Expert Working Group dedicated to HIV aging population issues since 2013 (sponsored by ViiV Healthcare).

Ana Rita Silva, MD, is an Infectious Diseases Specialist in the Department of Infectious Diseases at the Hospital Beatriz Ângelo, Portugal. She works within the Infectious Diseases ward and is a consultant at the outpatient clinic. Dr Silva is currently undertaking her PhD in Clinical and Experimental Medicine at the University of Modena and Reggio Emilia, Italy, where Dr Giovanni Guaraldi and Dr Emília Valadas are her tutors.

Dr Silva attended the Coimbra School of Medicine (Faculdade de Medicina da Universidade de Coimbra) in Portugal, and started her residency in Infectious Diseases in 2008. In 2009, after attending a 3 month internship at the Clinica Metabolica, Dr Silva helped to create the Metabolic Consult at the Hospital de Joaquim Urbano, Portugal. Since 2009 she has been involved in several projects in the area of HIV and Aging, both in Portugal and with Dr Guaraldi in Italy, and has published several in this field. Dr Silva has also collaborated in the formation of residents and has participated as a lecturer in several courses, community actions, and congresses.

In 2013 she was awarded the certification in Travel Medicine by the International Society of Travel Medicine (ISTM) after taking the Certificate of Knowledge Examination. Throughout her career, Dr Silva has participated both as Principal and Co-investigator in several studies on HIV and HIV/Hepatitis C co-infection.