Over the next fifteen years, the clinical needs of the Dutch living with HIV will have changed substantially due to three quarters of them at the age of 50. Overall, 84% will have at least one medical condition, such as cardiovascular disease or cancer at the top of their HIV, 28% will have three or more medical conditions, and 53% will have problems with drug interactions or contraindications.
The forecasts are derived from a more detailed analysis of the likely future trends in HIV care for an aging population of people living with HIV not yet realized, prepared by Mikaela Smit and her colleagues at Imperial College London and published online last week at Lancet infectious diseases. The results are likely to be relevant to other Western countries with co-epidemics concentrated in homosexual men, the authors say.
Due to the effectiveness of antiretroviral treatments, the expectation of life HIV-positive patients are increasingly dilated. Previous researchers have estimated the growing number of patients in their fifties or sixties. They have shown that older adults tend to have better grip and are more likely to have viral load undetectable than younger people.
However, the researchers did not calculate how increasing the patient's age will impact the prevalence of medical conditions that are commonly experienced in the higher age brackets. Managing these comorbidities is likely to make it much more difficult to deliver appropriate clinical care to people with advanced age living with HIV and its implicit complications.
Mathematical model based on the Netherlands
Detailed data on all adults living with HIV in the Netherlands are collected from the ATHENA cohort. The researchers examined information on the age range of people living with HIV, new infections, new diagnoses, deaths, use of HIV treatment, experience of comorbidities (other medical conditions), and medication to manage comorbidities.
Based on real life, the data was collected until the year 2010, and they, the researchers, developed a mathematical model based on future projections that "predicts" events until 2030.
For example, the model took into account the causal pathways between diabetes, kidney disease, high blood pressure, high cholesterol, heart attacks and strokes. The model also analyzed trends in osteoporosis and cancer (excluding cancer defining AIDS; Kaposi's sarcoma, for example).
Other problems were not included because of the lack of reliable data. In the note, what is included is depression, cognitive impairment, fractures and incontinence.
Data from 10.278 people living with the HIV virus in the Netherlands were included. Of note, 1.005 women who had become pregnant and were excluded from the analysis, due to the way the drugs used during pregnancy deviate the predictions regarding interactions in the sense of "drug by drug".
In the cohort, 59% are men who have sex with men, 16% are women and 66% are born in Europe.
Changes from 2010 to 2030
The proportion of HIV-positive people with more than 50 years will jump from 28% to 2010% to 73% in 2030, with people over 60 years old will have increased from 8% to 39%. In 2030, the average age of a person with HIV will be 56 years.
Most of you need medical care for a condition on the top of your HIV infection. The share with at least one comorbidity will increase from 29% to 84%. The ratio of three or more comorbidities that is close to zero in 2010 will jump to 28% in 2030.
Much of the course of these comorbidities will be driven by various forms of cardiovascular disease (high blood pressure, high cholesterol, heart attacks and strokes), with 78% of them having at least one of these problems until 2030. In addition, 17% will have diabetes and 17% will have a cancer.
The prevalence of comorbidities will be slightly higher than in HIV-negative patients in people of the same age, reflecting the contributions of HIV itself and some antiretroviral drugs to the development of these medical conditions.
Due to comorbidities, 54% will have to have at least one other “long-term” treatment along with the monthly prescription of their antiretroviral drugs and 20% will have three or more drugs established. Based on comorbidities, only for peripheral HIV neuropathy I take 3 different drugs: Risperidone, gabapentin and methadone, with risperidone being taken only before bed and the other two being taken in alternate doses every 90 minutes. I needed to install an APP on my MEDSAFE, app of which I am one of the “beta-testers”. Note that I am “just 51 years old and I already had two pulmonary embolisms, a heart attack, I suffered from peripheral insulin resistance and it all stopped only because I had a gastroplasty and it cut triglycerides from more than 6 to 3000, 220…)
The model predicts that this may cause an increase in complications in HIV treatment - increasing the risk of drug interactions with antiretrovirals currently recommended in first-line regimens by 53% or it will be advised to choose an alternative drug due to comorbidities. For example, tenofovir is not recommended for people with chronic kidney disease, while abacavir is contraindicated for people with severe cardiovascular disease.
Researchers assume that a number of demographic and clinical factors will continue to be a constant in the future.
However, if people's lifestyles (diet, smoking, etc.) improve considerably, if physicians efficately and humbly evaluate and treat the aforementioned comorbidities, or if better antiretrovirals with fewer contraindications were developed then , the results would be slightly different.
The success of HIV-related medicine - longer life and quality of life - can be offset by an increased burden of age-related illnesses, the prescription of various medications and an increasing number of patients who have complications with HIV. your HIV treatment, the authors say. This will place new demands on health services.
“Care management for HIV-infected individuals will increasingly have the need to appeal to a wide range of disciplines, including geriatric doctors, medical clinic, cardiology and oncology. And based on evidence, changes to screening and monitoring protocols for noncommunicable diseases in HIV-infected patients will be important to ensure the maintenance of high-quality care, ”they write.
Considering that trials have often excluded people with comorbidities from studies, studies on drug interactions, side effects and adherence to HIV treatment are needed along with other medications.
New drugs may be needed. "Antiretroviral drugs with no drug-drug interactions with medications for non-communicable diseases that will increase the prevalence over the next 20 years, including drugs for osteoporosis, cardiovascular disease and diabetes, will be particularly important," the researchers say.
While the model is based on the Dutch epidemic, they believe that global standards will be replicated in other countries in Europe, North America and Australia.
Translated from the original in English Geriatric HIV: living with multiple medical conditions will become the norm as population ages by Cláudio Santos de Souza on the afternoon of 16's June day of 2015