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.5 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.6
The general commitment among the scientific community is to design treatment that will have a minimal intrusion on the lives of PLHIV, including a good safety and tolerability profile, 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 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.7
What about stigma?
While ART and HIV management has continued to improve, social and health consequences of stigma have persisted and, in many countries, increased. As Michael Dorosh notes, “HIV is now a treatable chronic disease with few complications, but the disease we have no treatment for is stigma.”
"HIV is now a treatable chronic disease with few complications, but the disease we have no treatment for is stigma."
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 need to understand the unique contribution that HIV is making to the ageing process for PLHIV. To better understand this phenomenon, long-term follow-up from large patient groups who are both HIV positive and HIV negative will provide insights on management and prevention.”
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, including educational programmes and data generation.
In a recent trial for one of our investigational medicines, at least 25% of PLHIV enrolled were aged 50 years and over. We also actively support and are involved in large observational studies in older PLHIV, such as the POPPY (Pharmacokinetic and clinical Observations in People over fifty) cohort and ADHOC (Aging with Dignity, Health, Optimism, & Community) cohort. These are studies that not only look at the clinical challenges faced by PLHIV, but also societal factors that may impact their wellbeing.
By collaborating with the community that is directly impacted by these issues, we are supporting efforts that improve the care and control of the HIV epidemic helping us to map a new future in HIV, leaving no person living with HIV behind.
- AIDS info. Available at: http://aidsinfo.unaids.org/. Accessed August 2020
- 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
Yang H-Y, et al. Scientific Reports 2019;9:18514
- 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
- Toh HS, et al. AIDS 2020. PED0830
- Hirono J. AIDS 2020. PED0785.