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Individuals with HIV may be at a greater risk of developing age-related health conditions such as cardiovascular (heart) disease, chronic pulmonary (lung) disease, osteoporosis (bone density loss), and cognitive impairment (changes in memory and thinking) than similarly aged peers without HIV.HIV disease or its treatment may actually contribute to these conditions,explains Dr.Meredith Greene Fellow in the Division of Geriatrics at University of California, San Francisco.She points to recent findings from the Veterans Aging Cohort Study, which demonstrated that individuals living with HIV were 50% more likely to experience heart attacks than similarly aged veterans who did not have HIV, even after adjusting for traditional risk factors such as smoking, substance use, and diabetes.
This link between HIV and other co-occurring disorders makes HIV more difficult to manage and treat. According to Greene, the difficulty in caring for adults over age 50 living with HIV oftentimes stems from a syndrome created by multiple, interacting chronic health conditions on top of HIV, called “multimorbidity.”
Treatment regimens in the presence of multimorbidity may quickly become daunting, as each chronic condition likely requires its own set of prescriptions and instructions. Having to manage and use a complex set of many medications, termed “polypharmacy,” becomes worrisome as drug-drug interactions and adverse drug reactions are more likely. And with each additional health condition, drug-disease interactions must also be considered. “Kidney or liver disease might make certain drugs less of an option for someone,” Greene explains. “For example, if someone has kidney problems, they might not be able to take tenofovir [a widely prescribed HIV drug that can impair kidney function] or have to take a lower dose.” 
For the first part of the project, the PCMH team of Dr.Green outlined the types of questions and assessments most relevant for older adults living with HIV. For instance, because older adults living with HIV are at an increased risk for bone thinning and bone loss, the PCMH model of care includes an assessment of falls (which oftentimes cause bone fractures in patients with bone density loss). Other assessments include screenings for depression, anxiety, and post-traumatic stress disorder; questions about social support and loneliness; and memory exams.
Greene did stress the importance of considering “function” first and foremost. How well a person is able to complete activities of daily living—like managing medications, getting dressed, or going shopping—is key as providers assess how well a patient is doing overall.
“Someone might have HIV, heart disease, and kidney disease but still be able to go out and play tennis every day. And then someone who’s the same age and who has the exact same conditions might be having a lot of trouble with activities of daily living and might be in a nursing home. One of the fundamental geriatric principles is that everything comes back to functional status,” explains Greene.



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