Annals of Tropical Medicine and Public Health
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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 1  |  Issue : 2  |  Page : 72
An elderly lady with non specific symptoms


1 Med India Hospitals, Coimbatore, India
2 Department of Gastroenterology, Stanley Medical College, Chennai, India

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How to cite this article:
Chandrasekar T S, Prabhu RP, Jayanthi V. An elderly lady with non specific symptoms. Ann Trop Med Public Health 2008;1:72

How to cite this URL:
Chandrasekar T S, Prabhu RP, Jayanthi V. An elderly lady with non specific symptoms. Ann Trop Med Public Health [serial online] 2008 [cited 2020 Oct 31];1:72. Available from: https://www.atmph.org/text.asp?2008/1/2/72/50691
Sir,

In November 2007, a 70-year-old female presented with a 1 year history of anorexia, early satiety, and nausea. There was no abdominal pain, vomiting, gastrointestinal bleeding, fever, or cough. She had been receiving anti-tuberculosis therapy for 2 months elsewhere which was discontinued as there was no clinical improvement. She had a hysterectomy in the past. On physical examination, she was lean, her BMI was 18.5 kg/m 2 , her pallor was evident, and there were no superficial palpable lymph nodes. A systemic examination was normal.

Investigations : Hb: 11 g/dL, PCV: 38%, total leucocyte count: 9,000 cells/cumm, ESR: 100 mm/hr. Urine Bence Jones protein was negative. Blood sugar, renal function tests, and liver function tests were normal. Stool occult blood was negative; chest skiagram was normal; mantoux was negative. An abdominal ultrasound revealed hepatic steatosis. An upper gastrointestinal endoscopy was normal. A further evaluation showed an HIV enzyme-linked immunosorbent assay (ELISA) to be positive and was confirmed by a Western Blot assay.

Retrospectively, she remembered a blood transfusion she had received during the hysterectomy. She was started on anti-retroviral therapy and is on follow-up.

HIV infection in the elderly is distinct from those acquired in younger age. Studies have shown that the time of progression of HIV infection to acquired immunodeficiency syndrome (AIDS) is short in older persons and they are likely to die within the same month of diagnosis compared with those acquiring the infection early in life. [1]

In the West, 11% of patients are below 60 years old and 3% are above 60 years old. [1],[2] Though the exact data in India is lacking, research has shown that among the elderly HIV is predominantly contracted by heterosexual transmission. The diagnosis of HIV infection among the elderly is challenging. Similarities in clinical presentation and the aging process often delays diagnosis of AIDS infection. Fatigue, memory loss, and GI complaints are common to both. A prevailing myth that the elderly are less likely to be sexually active further delays the diagnosis. The elderly population is often neglected by health educators; details on sexual behavior are often not discussed and HIV screening is seldom recommended. Further, the presence of primary immunological failure in the elderly is often overlooked. Among the elderly women, there is an increased susceptibility to HIV infection because of the atrophic vaginal wall and infrequent use of condoms as a preventive measure against infection.

Aggressive therapy for non HIV-related conditions in elderly HIV-infected patients is strongly recommended and is not to be delayed or withheld solely because of the HIV seropositive status. [3]

 
   References Top

1.Ship JA, Wolff A, Selik RM. Epidemiology of acquired immunodeficiency syndrome in persons aged 50 years or older. J Acquir Immune Defic Syndr 1991;4:84-82.  Back to cited text no. 1  [PUBMED]  
2.Ferro S, Salit IE. HIV infection in patients over 55 years of age. J Acquir Immune Defic Syndr 1992;5:348-55.  Back to cited text no. 2  [PUBMED]  
3.Butt AA, Dascomb KK, DeSalvo KB, Bazzano L, Kissinger PJ, Szerlip HM. Human immunodeficiency Virus Infection in Elderly Patients. South Med J 2001;94:397-400.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

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Correspondence Address:
T S Chandrasekar
Med India Hospitals, Coimbatore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.50691

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