With effective treatment, people with HIV live longer. But as they age, they face higher rates of age-related comorbidities and hospitalizations, according to a recent study of hospitalized patients.
Policymakers will need to allocate resources, train providers and plan ways to manage chronic diseases, such as diabetes and cancer, in geriatric HIV patients, according to the authors.
“There will be more [HIV] patients with age-related chronic conditions at an earlier age who will use or have a unique need for [healthcare for] these geriatric conditions,” said first author Khairul A. Siddiqi, PhD, University of Florida College of Medicine in Gainesville, in an interview with Medscape Medical News. “Ultimately, this can increase resource utilization and inpatient costs.”
The study was published online June 8 to HIV medicine.
Aging with HIV
Analyzing the National Inpatient Sample (NIS) from the Health Care Cost and Utilization Project, the authors compared the characteristics and comorbidities associated with hospital stays among people living with HIV ( HSWH) to those related to hospital stays in people without HIV (HSWOH).
The NIS is a database of hospital records that captures 20% of discharges in the United States and covers all payers. The data for this analysis covered the years 2003 to 2015.
Among HSWH, patients aged 50 or older accounted for an increasing proportion over time, rising from less than 25% in 2003 to more than 50% in 2015, according to the authors. The 65-80 year old subgroup increased from 2.39% to 8.63% in 2015.
The authors also studied the rates of eight comorbidities, called non-AIDS-associated conditions (HANA): cardiovascular, pulmonary, hepatic, neurological and renal diseases; Diabetes; cancer; and bone loss.
The average number of these conditions among HSWHs and HSWOHs has increased over time. But this change was disproportionately high among HSWHs aged 50 to 64 and those aged 65 and older.
Over the study period, among patients aged 65 or older, six of the eight age-related conditions studied by the researchers increased disproportionately in HSWH compared to HSWOH; among those aged 50 to 64, five conditions made it.
The researchers are now building on the current HSWH study by looking at utilization rates for resources, such as MRIs and procedures, Siddiqi said.
Limitations of the study included a lack of data from long-term facilities, potential bias by patients hospitalized multiple times, and inherent limitations of administrative data.
A unique group of seniors
Among people living with HIV (PWH) in the United States, nearly half are age 50 or older. By 2030, this group is expected to represent approximately 70% of PWH.
“We have to be careful about what we know about aging in general. It’s also important to study aging in this particular population, because we don’t necessarily know that much about it,” said Amy Justice, MD. , PhD, Professor of Medicine. and public health at Yale University, in an interview with Medscape Medical News. Justice did not participate in the study.
The HIV epidemic has disproportionately affected people of color, men who have sex with men, and people with a history of injection drug usesaid the judge.
“We don’t know how to grow old with [a] history of injection drug use. We don’t even know much about aging with Hepatitis Cnecessarily,” she said. “There are therefore many reasons to pay attention to this population to try to optimize its care.
Moreover, compared to their HIV-uninfected counterparts, these individuals are more susceptible to HANA comorbidities. They may experience these conditions at a younger age or more severely. Chronic inflammation and polypharmacy may be to blame, Justice said.
Given the burden of comorbidities and polypharmacy in this patient population, Siddiqi said, policymakers will need to focus on developing chronic disease management interventions for them.
However, Justice added that the risk of multimorbidity is higher in people living with HIV throughout the age cycle: “It’s not like I’m 50 with HIV and all of suddenly all the wheels came off. There are ways to successfully grow old with HIV.
Need for expertise in geriatric HIV
Justice called the study’s analysis a useful addition to the literature and noted its implications for training.
“One of the biggest challenges with this big bowl of people aging with HIV,” she said, “is how much care should they be taken by the people who cared for them – largely infectious disease doctors — and to what extent should we really shift their care to people with more experience with aging.”
Another key issue, Justice said, relates to nursing homes and assisted living facilities, whose staff may lack experience caring for HIV patients. Training them and hospital providers is crucial, in part to avoid key mistakes, such as missed antiretroviral doses, she said: “We really need to think about how to bring non-HIV-positive providers up to speed.
It can start simply by making it clear that this population is here.
“Ten years ago, HIV-positive patients had shorter life expectancies, so all HIV studies used 50 years as the cut-off point for [the] older population,” Siddiqi said. “Now we know they live longer.
Justice added: “Previously, people thought that aging and HIV were not coincidental discoveries.”
The study was funded by the Office of the Vice President for Research at the University of South Carolina. The authors and Justice have disclosed no relevant financial relationship.
HIV drug. Published online June 8, 2022. Summary
Jenny Blair, MD, is a journalist, writer and editor in Vermont.