EACS 2019 – Ageing with HIV: a complex issue to deal with


  • Cristina Ferrario — Agenzia Zoe
  • Conference Reports
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Takeaway

  • Models of care designed to tackle specific needs of ageing HIV population are needed
  • Collaboration between specialists and patient empowerment should be always taken into account, together with a deep knowledge of patients’ needs and a personalised approach.

Why this matters?

  • An increasing number of patients diagnosed with HIV are aged, mainly as a result of effective treatments.
  • Ageing with HIV gives rise to many health, social and psychological issues.

 

Nowadays, HIV-infected patients live longer than in the past and the older HIV-positive population is growing faster, giving rise to challenges HIV specialists are not always able to deal with. These include multiple comorbidities (as chronic pain, diabetes, depression, cardiovascular issues), polypharmacy and social issues. The question arises on how to treat these patients in the current models of care, which are not really equipped to deal with this complexity. The topic was discussed in a special session during the 17th European AIDS Conference.

Different patients, different models

From Norway to Italy, passing through the UK, several models of care were presented during the session. All of them highlighting the pivotal importance of a multidisciplinary approach. As a matter of fact, a single doctor cannot have the expertise to treat this complex patient properly. Moreover, within the older HIV population, a subset of people became HIV-positive at an older age and this should be taken into account as every single year lived with the infection impacts the ageing process. Personalisation of the process of care is the key for a successful model, tailored to the clinic demographics, and to the time and resources available.

Open questions

Even if several different health care models are now in place for older HIV-patients, no evidence is available that these approaches really work. Moreover, uncertainty remains on referral criteria to dedicated clinics, type and timing of screening, the role of preventing and assessing frailty and the impact of antiretroviral therapies on frail and non-frail ageing people. Many barriers could be identified in the real-life setting making it difficult to reach the goal of a good model of care for ageing HIV patients. These include; lack of resources and/or expertise, unclear targeting, inadequate social resources and stigma, the latter also leading to reduced compliance. The collaboration of different stakeholders (doctors, nurses, patients) and new technology (mobile app) could help answer some of these questions.