Challenges ahead for future care of aging patients infected with HIV

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - The profile of patients infected with HIV may be changing as more of them age and develop multiple health problems, according to new research from the Netherlands.

"In the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care," the study authors reported online June 10 in the Lancet Infectious Diseases.

Lead author Dr. Mikaela Smit, of Imperial College London, wrote in an email to Reuters Health, "This is the first time anyone has quantified the consequences of aging with HIV in terms of the emerging epidemic of age-related conditions."

"Hopefully, detailing the size of this burden in the years to come will help make this issue one of the focal points on the future HIV care agenda," she added. "These patients will not only become more unwell as they age but also more complicated to manage clinically. The message is that we need to prepare for this in terms of guidelines for treatment, monitoring, and screening."

Dr. Smit and colleagues created a model of the aging HIV-infected population in the Netherlands that followed patients being treated for HIV as they grew older, developed non-communicable diseases (including chronic kidney and cardiovascular disease, diabetes, osteoporosis and non-AIDS malignancies), and started taking medications for these conditions.

Using the data of 10,278 patients from the national Dutch ATHENA cohort, the authors included patients age 18 and above who were infected with HIV-1, had been diagnosed with HIV on or after Jan 1, 1996 and who were antiretroviral-drug naive. They analyzed the data and made projections up to 2030.

Overall, 8586 (84%) patients were male, 1692 (16%) were female, their average age was 44.5 in 2010; 58% had been born in the Netherlands; and the others came from sub-Saharan Africa, Europe and elsewhere. Most were Dutch men who had sex with men. The 1005 (9.7%) women known to have been pregnant during follow-up were excluded.

According to the authors' model, the median age of HIV-infected patients on combination antiretroviral therapy will increase from 43.9 years in 2010 to 56.6 in 2030, and the proportion of HIV-infected patients age 50 and above will increase from 28% in 2010 to 73% in 2030.

In 2030, 84% of HIV-infected patients will have at least one non-communicable disease, up from 29% in 2010, with 28% of them having three or more. In 2030, 54% of HIV-infected patients will be prescribed co-medications, compared with 13% in 2010, and 20% of them will be taking three or more.

The authors predict that most of this change will result from the increasing prevalence of cardiovascular disease and associated drugs. In 2030, due to drug-drug interactions and contraindications, 40% of patients may have complications with the currently recommended first-line HIV medications.

Drs. David E. Vance and Shameka L. Cody, of the University of Alabama at Birmingham, wrote in an accompanying editorial, "Adults infected with HIV are expected to have close to normal life spans and Smit and colleagues' study provides a glimpse into the many challenges (e.g., drug adherence, lifestyle modification, engagement in care) that will need to be addressed, especially in the resource-rich countries in which these findings are most applicable."

They added that the study "contributes to the growing body of research on ageing with HIV and provides solid insights about what to expect for patients as they age. By extrapolation from these findings to other relevant areas, as we have done for neurocognitive functioning (e.g., medical management, case management, retirement issues), researchers, clinicians, and policy makers can plan to allocate resources accordingly to provide care to this growing geriatric population."

The Medical Research Council, the Bill & Melinda Gates Foundation, the Rush Foundation, and the Netherlands Ministry of Health, Welfare and Sport supported this research. The authors reported no disclosures.

SOURCE: https://bit.ly/1GRoWwF and https://bit.ly/1H3XKwW

Lancet Infect Dis 2015.