The Issue of Comorbidities

HIV, Aging and Cognitive Impairment

I’ve been spending some time lately on the relationship between cognitive impairment and older age in people living with HIV.  The research is inconclusive.  Recent findings suggest that there could be an increased risk for HIV-associated dementia and minor cognitive motor disorders in this population.  However, as I pointed out in last week’s post, research in this area is new and the findings are complex.  While older age may be a contributing factor in cognitive impairment, other issues to consider are: HIV itself, treatments for HIV, other age-related diseases and their treatments, as well as heredity and lifestyle.

A first step in optimizing your health is to identify the factors that you can control.  In order to do that, older people living with HIV must consider the issue of  co-morbid conditions.

Comorbidities and Cognition

Aging with HIV can create a complicated health-related picture.  In addition to the effects of HIV itself, people taking medications to treat HIV and its symptoms may experience co-morbid conditions from those drugs, such as heart disease and diabetes.

This population also faces non-HIV- related illnesses common to older persons in the general population including: diabetes, hypertension, arthritis, and coronary artery disease. These comorbidities may affect HIV disease progression and may play a role in cognitive impairment.

Depression and other untreated mood disorders can also impact cognition and affect quality of life.  In addition, alcohol and substance use can negatively affect one’s cognitive functioning.

Finally, illness can set in motion a negative feedback loop when physical limitations cause reductions in social involvement, depression and further complications of illness.

Treating Comorbidities

Developing an accurate picture of your health involves appreciating the complex and changing impact of HIV-disease progression, medications, mood, lifestyle and heredity.  That means routine general health maintenance and appropriate diagnosis, treatment, and prevention of non-HIV-related medical and neuro-psychiatric conditions*

There is a great deal you can do to optimize your health outside of your doctor’s office.  Your daily health care regimen can include activities that prevent, treat or modify the presence of comorbid conditions.  Factor’s such as diet, exercise, participating in alternative therapies (such as meditation, acupuncture, yoga and massage), and maintaining an active social life have all been demonstrated to improve quality of life.  Optimal aging with HIV involves working within your limitations to maximize your day-to-day life.

What one step can you take today to enhance your well-being?

*Goodkin, K. & Stoff, D., “Older Age and HIV Infection.” In Cohen M, Gorman J, eds. Comprehensive Textbook of AIDS Psychiatry. New York, NY: Oxford University Press, 2008, pp. 357-376.

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