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CATIE - www.catie.ca

U.S. researchers look at chronic conditions in HIV-positive people over the age of 65

25 August 2016 - The widespread availability of potent anti-HIV therapy (commonly called ART) in Canada and other high-income countries has had a tremendous impact on the health of HIV-positive people. Many ART users have had an increase in their life expectancy. The power of ART is so profound that researchers increasingly expect that a young adult who becomes HIV positive today and who initiates ART shortly thereafter and who takes ART every day and receives regular monitoring and checkups and who does not have other pre-existing serious health complications should have a near-normal lifespan.

Independently of HIV, aging is associated with the development of an increased risk for other health conditions as key organs and systems gradually degrade. According to a team of U.S. researchers who have reviewed scientific publications about aging and HIV, there are reports that some HIV-positive people experience an earlier onset of age-related health issues or may experience them in a more severe form than HIV-negative people do. The same researchers note that although there are more and more studies that assess the health of HIV-positive people over the age of 50, relatively few seek to address the health of the subset of HIV-positive people aged 65 and older.

To begin to address this issue, the researchers reviewed and compared diagnoses of selected co-existing health conditions (called comorbidities) in a massive population of older people. Their study involved reviewing health information of people aged 65 and older that was collected in a database. They found that HIV-positive people were significantly more likely to have certain chronic health conditions compared to HIV-negative people.

At a minimum, these findings suggest that clinics and health systems will have to prepare for the complexities of caring for more HIV-positive people who have chronic conditions as they age. This may mean that health policy planners will have to ensure that more funds are available for caring for elderly HIV-positive people.

Study details

Researchers analysed a database containing health-related information from people who had made use of the American health insurance program called Medicare. This program is primarily used by people who are 65 and older. The data were collected between 2006 and 2009. Researchers compared data collected from Medicare recipients who were distributed as follows:

  • HIV negative – 29,060,418 people
  • HIV positive – 24,735 people

On average, HIV-positive participants were more likely to be people of colour and male and somewhat younger (71 years) than HIV-negative people (75 years).

HIV-positive people were significantly more likely to have been diagnosed with the following chronic health conditions:

  • higher-than-normal blood pressure
  • abnormal levels of fatty substances in the blood (cholesterol and triglycerides)
  • coronary artery disease
  • diabetes
  • rheumatoid arthritis and/or osteoarthritis

Furthermore, researchers found that, in general, more HIV-positive people were likely to have been diagnosed with all five of these comorbid conditions than HIV-negative people.

Bear in mind

  1. This was not a comprehensive study about HIV and aging that was trying to find all the problems that could develop in older people. Rather, researchers looked back in time at the distribution by HIV status of selected comorbidities that are relatively common in the Medicare system. Due to the study's size and the fact that participants were living in many states, the study has yielded broad trends about comorbidities, particularly among people with HIV. The researchers mentioned that some smaller studies have reported similar comorbidities in older HIV-positive people.
  2. The study sends an important signal: HIV-positive people aged 65 and older are at elevated risk for certain health complications. This means that clinics and health systems need to screen for at least these comorbidities when assessing older HIV-positive people.
  3. The study only examined data from a three-year period. As a result, we do not know how long participants had been living with these conditions or the severity of the comorbidities. Also, the nature of the study and its limited ability to collect data cannot tell us when participants developed these comorbidities. Other studies (including re-assessment of previous studies) may be useful in helping chart the trajectory for the development of common comorbidities over time in HIV-positive people. Such research will be helpful because it can guide doctors and nurses when screening younger HIV-positive patients for these conditions or early forms of these comorbidities. This would also allow healthcare professionals to help their patients intervene to reverse the course of these comorbidities or lessen their impact on quality of life, overall health and survival.
  4. Care for older people (with or without HIV) who have multiple chronic conditions is likely to be complex. For instance, the more drugs a person takes, the greater the risk that one or more drugs may interact, causing new side effects or enhancing old ones. The U.S. researchers point to the need for cooperation among different specialists: “Greater collaboration between infectious disease and chronic disease practitioners will be needed to ensure the appropriate medical management of these patients including complex medication regimens.”

The findings from this study are a good first step in identifying some of the health issues faced by people aged 65 and older. Hopefully this study will spur additional research into the health care needs of older HIV-positive people.

Resources

“ America's other drug problem: Giving the elderly too many prescriptions ” – Washington Post

Emerging issues in older HIV-positive people – TreatmentUpdate 214

Older people with HIV face different long-term health challenges – CATIE News

Denmark—unexpected trends in use of psychotropic medicines – TreatmentUpdate 204

Impressive gains in survival for older people with HIV but still less than general population – CATIE News

Danish study raises questions about accelerated aging in HIV – CATIE News

Quantification of biological aging in young adults – Proceedings of the National Academy of Science USA

Management of Human Immunodeficiency Virus Infection in Advanced Age – Journal of the American Medical Association

Long-term HIV infection and health-related quality of life – CATIE News

Dutch doctors explore intersection of aging and HIV – CATIE News

Geriatric syndromes found to be common among some people with HIV – CATIE News

HIV and Aging: State of Knowledge and Areas of Critical Need for Research. A Report to the NIH Office of AIDS Research by the HIV and Aging Working Group

The CIHR Comorbidity Agenda – Canadian Institutes of Health Research (CIHR)

CIHR's HIV Comorbidity Research Agenda: Relevant Research Areas

HIV and aging – Healthy living tips for people 50 and over living with HIV

Mental Health – HIV in Canada: A primer for service providers

HIV and brain-related issues – TreatmentUpdate 204

Longer life expectancy for HIV-positive people in North America – TreatmentUpdate 200

Factsheets on HIV and aging in Canada – Canadian AIDS Society

HIV & Aging: A 2013 Environmental Scan of Programs and Services in Canada – Community Report – Canadian Working Group on HIV and Rehabilitation (CWGHR)

Directory of Promising Programs and Services for Older People Living with HIV in Canada – CWGHR

Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis – CWGHR

—Sean R. Hosein

REFERENCES:

  1. Friedman EE, Duffus WA. Chronic health conditions in Medicare beneficiaries 65 years and older with HIV infection. AIDS . 2016; in press .
  2. Marcus JL, Chao CR, Leyden WA, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. Journal of Acquired Immune Deficiency Syndromes. 2016 Sep 1;73(1):39-46.
  3. Patterson S, Cescon A, Samji H, et al. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infectious Diseases . 2015 Jul 17;15:274.
  4. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One . 2013 Dec 18;8(12):e81355.

From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca

Source: CATIE: CANADIAN AIDS TREATMENT INFORMATION EXCHANGE


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