UNDERSTANDING THE CHANGES IN AGEING WITH HIV
Advances in treatment have dramatically improved the life expectancy of people living with HIV (PLHIV), which is welcome progress. However, challenges remain for those ageing with HIV.
Paul was first diagnosed in 1988 after feeling unwell and visiting his GP. At the appointment, the GP carried out a series of tests to uncover why this was the case, one of which was a HIV test. This came back positive. This diagnosis came at a time when there was a high level of fear and stigma about the condition, a lot of misinformation and no effective treatments. This high level of stigma impacted people’s ability to access care and treatments, or indeed disclose their HIV status to friends and family.
Now a long-term survivor, Paul highlights that as his generation continue to age with HIV, they are “forever in unchartered territory”. Ageing isn’t a straightforward downward trajectory, he adds, and more needs to be done to recognise age-related health concerns, such as long-term effects of ARVs, and drug interactions with medicines taken for other conditions.
As someone who is taking a multitude of different medications for COPD, high blood pressure, elevated cholesterol, as well as his antiretroviral drugs, Paul has felt compelled to keep in close contact with his healthcare providers, urging them to ensure the optimal management of his general health as well as making sure his HIV medications are fully represented on his record. However, he recognises that this level of advocacy isn't possible for everyone. To close these gaps, we must look at the patient in their totality, which includes not only the conditions of ageing, but also their HIV medication.
Despite notable progress in HIV treatment, challenges remain for those ageing with HIV. Andrew Clark, Global Medical Lead at ViiV Healthcare said, “There are medical challenges for those who become resistant to HIV medicines; adherence challenges for those who have difficulty sticking to daily medication, and the additional pressure of having to manage other medical conditions, known as ‘co-morbidities.’ Additionally, these individuals may also face significant social challenges such as a lack of access to care and experiencing stigma.”
Andrew Clark, Global Medical Lead, explains that we must change the way we approach treatment for people ageing with HIV.
An increasing, ageing population
Evidence from the Netherlands shows that there has been a dramatic change in the demographics of the population of PLHIV, with HIV clinics now caring for an increasing number of people aged 50 years or older in many countries.1 According to the medical journal Lancet HIV, it’s estimated that in the Netherlands, the median age of people on treatment will increase from 44 years in 2010 to 57 in 2030, with the proportion of PLHIV aged 50 years or older increasing from 28% in 2010 to 73% in 2030.2
In addition, PLHIV may have an elevated risk of a variety of chronic illnesses so may require additional care, particularly as the population of PLHIV who are ageing grows.4 These statistics point to a growing need for specialised research and care focused on those PLHIV who are ageing, and the chronic conditions associated with HIV.5
The changing treatment needs of older PLHIV
Current novel ARTs allow many PLHIV to achieve a near-normal life span; however, as people age, the risk of other health challenges increases.6 These health challenges include cardiovascular disease, cancer, osteoporosis and other diseases in which the organs, such as the liver or kidney, are ultimately affected by chronic or progressive diseases.7
The general commitment among the scientific community is to design and then develop treatments that will have a minimal impact on the lives of PLHIV, including better safety and tolerability profiles compared to current standards of care, with limited organ-related side-effects, or ‘toxicities’ (such as those affecting the liver or kidney) and interactions that occur between different medicines. However, a better understanding of how age affects PLHIV, and how ART may influence this will help address the clinical issues faced by the ageing PLHIV community.
Taking multiple medications on a long-term basis creates concerns for PLHIV, one of which, is the impact they might have on the immune system. As we age, so does our immune system, making it more difficult for the body to fight off infection and cancers. The ageing immune system is further impaired by HIV-associated complications, causing ongoing inflammation.
Sponsored by ViiV Healthcare and developed in collaboration with an international, multi-disciplinary Advisory Committee, findings from the Positive Perspectives Study suggests that PLHIV are concerned about taking multiple medications.8
Scientists are looking into multiple sources and studies to better understand ageing in PLHIV and are investigating the potential therapeutic treatments or interventions that could be combined with ART to improve outcomes for PLHIV.
What about stigma?
While ART and HIV management has continued to improve, social and health consequences of stigma have persisted and, in some countries, increased.
Mapping a new future in HIV
ViiV Healthcare is committed to helping PLHIV live long, healthy lives. We run and support multiple studies to build our understanding of how treatments affect older PLHIV.
We are working to help understand the clinical, scientific and societal effects of HIV on ageing. Our research programmes focus on generating meaningful data for new medicines and treatment strategies, with the aim of reducing the short and long-term burden of ART on the lives of PLHIV. This involves close engagement with patient organisations, and includes educational programmes and data generation.
References
- McGettigan, P., Morales, D.R., Moreno‐Martos, D. and Matin, N. (2022). Changing co‐morbidity and increasing deprivation among people living with HIV: UK population‐based cross‐sectional study. HIV Medicine. doi:https://doi.org/10.1111/hiv.13389.
- Smit et al., Lancet Infect Dis 2015 Jul;15(7):810-8). Global AIDS Update. Available at: https://aids2020.unaids.org/report/. Accessed August 2020
- AIDS info. Available at: http://aidsinfo.unaids.org/. Accessed August 2020
- UNAIDS. The Gap Report. Available at: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf. Last accessed: Nov 2016
- Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Inf Dis 2015;15:810-18.
- Gebo KA. Epidemiology of HIV and response to antiretroviral therapy in the middle aged and elderly. Aging Health 2008; 4: 615–27
- Okoli C, de los Rios P, Eremin A, Brough G, Young B, Short D. Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV. Prev Chronic Dis 2020;17:190359. DOI: http://dx.doi.org/10.5888/pcd17.190359
- Nobili A. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbidity 2011; 1:28–44
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