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Medical Management of Older HIV-Infected Adults
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Medical Management of Older HIV-Infected Adults
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Overview of Talk
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Epidemiology
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HIV in Older Individuals
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Epidemiology
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Those over 50 Make Up Less Than 10 Percent of New HIV Cases
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Percent of Older HIV-Infected Individuals Will Continue to Increase
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Positive Health Program, Ward 86
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Case
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Case
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Case
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Case
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Diagnosis
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Presentation of Older Individuals
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Risk Behaviors in Older Individuals
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Summary of Epidemiology
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Age and HIV Disease Progression
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Natural History of HIV in Older People
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Natural History of HIV in Older People
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Natural History of HIV in Older People
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Older Age at Seroconversion Predicts Faster Progression to AIDS and Death
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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Post-HAART, Survival Is Equal among Older and Younger Individuals
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HAART Equalizes 3-Year Survival in Those over 50 and Those under 50
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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Effect of HAART on Natural History
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In Older Adults, Slower and Reduced Progression to CD4 of up to 200
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Despite Good Virologic Suppression, Those under 50 Had Clinical Progression
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Summary of HIV Disease Progression
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Common Immunologic Deficits among Elderly and HIV-Infected Individuals
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Immunosenescence
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Immune Risk Profile
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Biomarker #1: Inverted CD4/CD8 Ratio in Elderly Predicts Survival
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Life Expectancy Decreases If Low CD4/CD8 Ratio or Cognitive Impairment
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Inverted CD4/CD8 Ratio Persists despite HIV Therapy
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Biomarker #2: Naive T Cells
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Decrease in Naive T Cells and Increase in Memory T Cells with Aging
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Decrease in Naive T Cells with HIV
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Decrease in Naive T Cells with HIV
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Decrease in Naive T Cells with HIV
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Biomarker #3: Expansion of CD28- Cells: Those With IRP Have Expansion of CD28- Cells
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HIV Expands CD28- Cell Population
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HIV Expands CD28- Cell Population
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HIV also Expands CD28- Cell Population
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Summary of Similarities between HIV and Aging
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Hypotheses
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HIV and Non-AIDS-Related Medical Conditions
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Non-AIDS-Related Deaths Have Not Decreased with HAART
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Non-AIDS-Related Deaths Overlap with Age-Associated Conditions
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Cardiovascular Risk and HIV
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Increasing Years of HAART Increases Risk of Cardiac Events
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HIV-Infected Individuals with Myocardial Infarction Are Younger
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Increased Rates of Diastolic Dysfunction in HIV-Infected Individuals
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Distribution of PASP in Patients
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Summary of Cardiovascular Disease
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Summary of Cardiovascular Disease
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Metabolic Syndrome
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Older Age Is Associated with More Visceral Adipose Tissue (VAT) and Less Leg Fat in HIV-Infected Men and Women
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Older Age and Menopause Are Associated with DM and Insulin Resistance
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Summary of Metabolic Effects
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Osteoporosis
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Increased Risk of Cancers in HIV-Infected Compared with HIV-Uninfected Populations
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Increased Rate of Neoplastic Lesions at Screening Flexible Sigmoidoscopy
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Risk Factors for Colorectal Neoplasms
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Summary of Malignancy Risk
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Summary of Conditions for Which HIV Infected Are at Increased Risk
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Medical Care of Older HIV-Infected Individuals
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Concomitant Medical Conditions in HIV Patients
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Prescription Drug Use Is Disproportionate among Older Persons
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Case
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Medication List
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Pharmacologic Issues with Aging
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HAART in Older Individuals
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Preventative Medicine in Older Adults Living with HIV
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Vaccination Rates High in Older HIV-Infected Individuals
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Cancer Screening Varies Based on Ease of Availability of Test
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Summary of Conclusions
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Recommendations for Care
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Recommendations for Care
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Research Needs
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Research Needs
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Thank You
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