Gentes: Term

Sunday, 31 July 2016

Neuropathy A Factor In Long Term HIV

Today's post from aidsmap.com (see link below) looks at the various health problems that may affect long-term and older HIV-patients and these include neuropathy. HIV medication is now so effective, that most people can expect to live a virtually normal life span but that doesn't mean that they are free from HIV-related co-morbidities (either caused by the virus or long-term medication, or normal old age) that can seriously affect their quality of life. The question will always be: are these complications the result of normal ageing, or are they HIV-related? Most experts seem to agree that HIV can definitely be a factor in contracting neuropathy but other diseases may come from other sources. Worth a read.

Geriatric conditions common in middle-aged and older HIV-positive men
Michael Carter Published: 17 June 2015

Geriatric conditions were common in middle-aged and older HIV-positive adults in a San Francisco clinic, investigators report in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes. Common conditions included pre-frailty, difficulties with activities of daily living and cognitive impairment. A quarter of patients reported falls or urinary incontinence. The authors were concerned that these conditions of older age were occurring earlier in their HIV-positive patients – who had a median age of just 57 years - compared to individuals in the general population.

“Our findings suggest that even in middle-aged HIV-infected adults with controlled HIV, the burden of geriatric syndromes is important and will need to be addressed clinically to minimize age-related complications in this population,” comment the investigators.

Improvements in treatment and care mean that many HIV-positive patients now have an excellent life expectancy and are living well into old age. But there’s now a considerable corpus of research showing that HIV-infection is associated with a number of co-morbidities - such as cardiovascular disease and reduced bone mineral density – normally associated with older age.

Geriatric syndromes such as frailty, falls and functional impairment are multifactorial conditions used to identify vulnerable older adults. Little is known about the prevalence and risk factors for these syndromes in patients with HIV. Investigators from the University of California San Francisco therefore designed a cross-sectional study to determine how common these factors are in older (aged 50 plus) HIV-positive individuals and to see if any HIV- and non-HIV-related factors increased the risk of these syndromes.

Their study population comprised 155 patients enrolled in the SCOPE study (an ongoing study of HIV infection in adults). All were taking antiretroviral therapy with viral suppression for a median of three years; median CD4 count was over 500 cells/mm3.

Using questionnaires and physical examinations, the patients were assessed for geriatric syndromes including falls, urinary incontinence, functional and mobility impairment, impaired hearing and vision, depression, cognitive impairment and frailty. Data were also gathered on co-morbid conditions and use of medication to treat these ailments.

Participants had been living with HIV for a median of 21 years. Almost all (94%) were men. Co-morbid conditions were highly prevalent, with a median of four per patient, and individuals were taking a median of nine non-antiretroviral medications to control these conditions. The most common co-morbidities were elevated lipids (63%), hypertension (50%) and peripheral neuropathy (40%).

The majority of patients (54%) had two or more geriatric syndromes. The most common conditions were pre-frailty (56%), difficulty with one or more functional tasks (47%) and cognitive impairment (47%). At least one fall was reported by a quarter of patients and a similar proportion reported urinary incontinence. Mild depression was reported by a fifth of patients with 18% meeting the criteria for the diagnosis of moderate-to-severe depression.

A lower nadir CD4 count (IRR = 1.16; 95% CI, 1.06-1.26) and increasing number of co-morbidities (IRR = 1.09; 95% CI, 1.03-1.15) were associated with an increased risk of geriatric syndromes.

The authors were concerned that the prevalence of problems such as frailty, falls and incontinence observed in their patients was similar to or higher than that recorded in HIV-negative men living in a community for individuals aged 65 years or older. Geriatric conditions therefore seemed to be occurring earlier in patients with HIV.

‘The association with lower CD4 nadir suggests that earlier antiretroviral treatment initiation may help to prevent aging-related complications, and the association with increasing number of co-morbidities suggests that treatment and prevention of other co-morbid conditions are equally important to the management of HIV in the aging HIV population,” conclude the authors. “Consideration of how to incorporate assessment of geriatric syndromes into HIV care and development of targeted interventions for risk factors of geriatric syndromes is needed as the HIV-infected population continues to age.”

Reference

Greene M et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr 69: 161-67, 2015.

http://www.aidsmap.com/Geriatric-conditions-common-in-middle-aged-and-older-HIV-positive-men/page/2977201/

Saturday, 25 June 2016

Neuropathy Over The Long Term

Today's post from livestrong.com (see link below) looks at the effects of neuropathy over the long term and although short and to the point, may help you understand what and why certain things are happening to you. It makes the point that ,"some types of peripheral neuropathy do not have a cure" when the truth is that, in fact very few types of neuropathy do have the potential for a cure but other than that, the information is accurate. Not happy reading for those living with nerve damage over several years but if you know what to look out for, you may be able to take steps to reduce the impact on your lives. Remember also, autonomic neuropathy is not a given by any means (you'll understand after reading the article).

Long-Term Effects of Peripheral Neuropathy
Last Updated: Sep 22, 2015 | By Lia Stannard

Overview

Peripheral neuropathy is a condition that affects the nerves outside of the brain or spinal cord. It can cause changes to sensation, movement and involuntary functions. Pressure on the nerves can cause peripheral neuropathy, as can certain conditions such as Charcot-Marie-Tooth disease, an inherited disorder. MedlinePlus, a website of the National Institutes of Health, points out that some types of peripheral neuropathy do not have a cure. The nerve damage from this condition can have lasting effects.

Reduced Feeling

Peripheral neuropathy affects three types of nerves: sensory, motor and autonomic. The sensory nerves relay information to the brain such as a change in temperature. When peripheral neuropathy damages the sensory nerves, patients can experience nerve pain, burning sensations or tingling. Some patients may have numbness that starts in the feet and moves up in the body. MayoClinic.com explains that with the numbness, patients can have reduced feeling in their limbs, which can affect their ability to sense changes. Problems can arise, such as in the case of a peripheral neuropathy patient who cannot feel pain in his feet and therefore does not notice a foot injury. If the injury goes untreated, an infection can develop.

Problems Moving

Since peripheral neuropathy can affect the motor nerves, patients may have a partial or total loss of movement and muscle control. For example, patients may experience paralysis of certain parts of the body such as the arms or legs. MedlinePlus points out that patients may fall from tripping over themselves. Peripheral neuropathy can cause muscle atrophy, in which patients lose some muscle tissue. Patients may have a lack of muscle control and dexterity, which can affect their ability to do tasks that require fine movements, such as writing with a pen. Damage to the autonomic nerves, which control the involuntary functions, can also impair movement. For example, patients can have dizziness when they stand up.

Weight Loss

Peripheral neuropathy patients may lose weight as a result of the autonomic nerve damage symptoms. MedlinePlus points out that peripheral neuropathy patients can lose more than 5 percent of their body weight. They may have nausea and vomiting after meals. The autonomic symptoms of peripheral neuropathy cause patients to feel full after eating a small amount of food, which can also affect weight. Motor nerve damage in the throat can affect patients' ability to swallow, which may cause them to eat less.

Low Self-esteem

MedlinePlus explains that the symptoms of peripheral neuropathy can cause patients to have low self-esteem. For example, male peripheral neuropathy patients may feel self-conscious about impotency problems. Urinary incontinence, or urine leakage, is another embarrassing problem related to peripheral neuropathy that can affect self-esteem.

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