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Effectively treating other medical conditions in patients with HIV may reduce HIV's overall impact on functioning

With increased survival due to use of potent antiretroviral therapy and a growing incidence of HIV infection among older adults, the total number of AIDS cases in Americans over 50 years of age has increased more than fivefold since 1990. The adverse impact of HIV disease progression on physical functioning is well documented. Yet, given the strong association of comorbidity and function, effectively treating other medical conditions may improve physical functioning in HIV-infected adults, concludes a new study.

The researchers examined the demographic and clinical factors associated with physical functioning in 889 HIV-infected veterans and 647 HIV-negative veterans enrolled in the Veterans Aging Cohort Study (VACS-5 site) in 2001 and 2002. Increased age was associated with reduced physical functioning in both HIV-infected and HIV-negative patients. The proportion of patients with reported difficulty performing basic activities of daily living (ADLs), mobility, and vigorous activities was similar in HIV-infected and HIV-negative patients, although the latter group was older.

Impairment in basic ADLS was uncommon in both groups (less than 9 percent), but more than half of all patients had difficulty with vigorous activities such as heavy work and running. Among HIV-infected patients, results remained unchanged after controlling for the impact of antiretroviral therapy and HIV disease stage.

While aging was associated with physical disability in both groups, this effect was not independent of coexisting disease and lifestyle factors such as smoking and obesity. For example, when coexisting conditions (such as chronic lung disease, hypertension, arthritis, and hepatitis C) were entered into the models for both groups, association with age was no longer significant. This suggests these coexisting conditions have an important role on functioning and treating them in persons with HIV may reduce the overall impact of disease on physical functioning. The use of veterans limits the generalizability of the study findings beyond patients in the VA medical centers.

This study was supported in part by the Agency for Healthcare Research and Quality (HS16097).

See "Association of comorbidity with physical disability in older HIV-infected adults," by Krisann K. Oursler, M.D., Sc.M., Joseph L. Goulet, Ph.D., David A. Leaf, M.D., and others, in AIDS Patient Care and STDs 20(11), pp. 782-791, 2006.

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