Julie A Womack1,2, Amy C Justice1,3. 1. VA Connecticut Healthcare System, West Haven. 2. Yale School of Nursing, Orange. 3. Yale School of Medicine, New Haven, Connecticut, USA.
Abstract
PURPOSE OF REVIEW: Persons living with HIV (PLWH) are aging, continue to use alcohol and other substances, and experience age-associated adverse effects. We explore a new syndemic: OATH (opioids and other substances, aging, alcohol, tobacco, and HIV). RECENT FINDINGS: Frailty and falls are important problems that affect the health status of PLWH who continue to use alcohol and other substances. HIV, alcohol and other substance use, and aging each contributes to inflammaging. Multimorbidity and polypharmacy are also important pathways as alcohol and other substances interact with prescribed medications resulting in adverse-drug interactions leading to potentially serious consequences. Social conditions including racism, poverty, sex bias, stress, and stigma contribute to the existence and persistence of this syndemic. SUMMARY: Substance use, HIV, and aging are linked in a new syndemic (OATH) that drives age-related outcomes such as frailty and falls. We need to expand our understanding of the 'healthcare team' so that we include social and political advocates who can support necessary structural change. Treatment of substance use should be better incorporated into the management of HIV, including a focus on potential medication/substance interactions. Finally, we need to explore treatment of frailty rather than individual manifestations of frailty (e.g., atherosclerosis, neurodegeneration).
PURPOSE OF REVIEW: Persons living with HIV (PLWH) are aging, continue to use alcohol and other substances, and experience age-associated adverse effects. We explore a new syndemic: OATH (opioids and other substances, aging, alcohol, tobacco, and HIV). RECENT FINDINGS: Frailty and falls are important problems that affect the health status of PLWH who continue to use alcohol and other substances. HIV, alcohol and other substance use, and aging each contributes to inflammaging. Multimorbidity and polypharmacy are also important pathways as alcohol and other substances interact with prescribed medications resulting in adverse-drug interactions leading to potentially serious consequences. Social conditions including racism, poverty, sex bias, stress, and stigma contribute to the existence and persistence of this syndemic. SUMMARY: Substance use, HIV, and aging are linked in a new syndemic (OATH) that drives age-related outcomes such as frailty and falls. We need to expand our understanding of the 'healthcare team' so that we include social and political advocates who can support necessary structural change. Treatment of substance use should be better incorporated into the management of HIV, including a focus on potential medication/substance interactions. Finally, we need to explore treatment of frailty rather than individual manifestations of frailty (e.g., atherosclerosis, neurodegeneration).
Authors: Savita Pahwa; Steven Deeks; Shimian Zou; Natalie Tomitch; Leia Miller-Novak; Elisabet Caler; Amy Justice; Ned Sacktor; Dana Gabuzda; Peter W Hunt; Todd Brown; Ann Kurth; Stefan Baral; Michael Mugavero; Kenneth H Mayer; Emily Mendenhall; Roger Detels; Vincent Mutabazi Journal: J Acquir Immune Defic Syndr Date: 2021-01-01 Impact factor: 3.771
Authors: Viviane D Lima; Lu Wang; Paul Sereda; Taylor McLinden; Rolando Barrios; Julio S G Montaner Journal: PLoS One Date: 2021-02-12 Impact factor: 3.240
Authors: David R Lorenz; Shibani S Mukerji; Vikas Misra; Hajime Uno; Benjamin B Gelman; David J Moore; Elyse J Singer; Susan Morgello; Dana Gabuzda Journal: AIDS Date: 2021-12-01 Impact factor: 4.177
Authors: Jeffrey V Lazarus; Kelly Safreed-Harmon; Adeeba Kamarulzaman; Jane Anderson; Ricardo Baptista Leite; Georg Behrens; Linda-Gail Bekker; Sanjay Bhagani; Darren Brown; Graham Brown; Susan Buchbinder; Carlos Caceres; Pedro E Cahn; Patrizia Carrieri; Georgina Caswell; Graham S Cooke; Antonella d'Arminio Monforte; Nikos Dedes; Julia Del Amo; Richard Elliott; Wafaa M El-Sadr; María José Fuster-Ruiz de Apodaca; Giovanni Guaraldi; Tim Hallett; Richard Harding; Margaret Hellard; Shabbar Jaffar; Meaghan Kall; Marina Klein; Sharon R Lewin; Ken Mayer; Jose A Pérez-Molina; Doreen Moraa; Denise Naniche; Denis Nash; Teymur Noori; Anton Pozniak; Reena Rajasuriar; Peter Reiss; Nesrine Rizk; Jürgen Rockstroh; Diana Romero; Caroline Sabin; David Serwadda; Laura Waters Journal: Nat Commun Date: 2021-07-16 Impact factor: 14.919