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Italian and U.S. Researchers Look to the Future and Explore Aging-Related Issues

November 7, 2017

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The Need to Prevent NCDs

According to the researchers, "The aging of the HIV-positive populations in Italy and the U.S. will have major implications for HIV care. Our forecasts suggest that three-quarters of HIV-positive patients on ART will be over 50 years in both countries by 2035, resulting in an increased NCD burden in this population." Recall that the main drivers of this burden of NCDs will be as follows:

  • higher-than-normal levels of blood pressure
  • abnormal lipid levels in the blood
  • type 2 diabetes
  • cancers unrelated to HIV

Furthermore, the researchers said:

"These shifts [toward NCDs] will have considerable implications for direct HIV care costs, with average care costs attributable to NCD treatment expected to double in Italy and increase by 40% in the U.S. Evidence-based approaches on effective prevention interventions and treatment protocols will be vital to mitigate this growing burden."


A Change in Health Management

In high-income countries, as patients initiate ART earlier in the course of HIV disease, care provided by doctors, for the most part, continues to shift from preventing the life-threatening infections that are the hallmark of AIDS to what the research team called "the long-term prevention, screening and treatment of NCDs." The researchers underscored that as this shift continues the following aspects of care and treatment will need particular attention:

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  • choice of the best ART regimen
  • management of interactions between ART and medicines used to prevent and treat NCDs
  • adherence not just to ART but also to NCD medicines

As patients age, the researchers call for "multidisciplinary patient management" focusing on the following elements of optimal health:

  • principles of geriatric medicine
  • personalized treatment protocols
  • interventions with patients to help prevent or minimize the effects of NCDs, such as guidance on risk factors that can be modified (quitting smoking, dietary changes, exercise and so on)

To help effect these changes, the researchers call for training in geriatric medicine to become available for healthcare providers, particularly family medicine specialists.

The publication of the model's results should stimulate other countries and regions to conduct their own assessments of the trajectories of people with HIV as they age and which NCDs need to be prevented and treated.


Bear in Mind

There are several issues that may affect the present model's accuracy:

  • Researchers focused on a handful of NCDs. Future computer models could add other NCDs such as asthma, chronic obstructive pulmonary disease, obesity and so on.
  • Researchers did not take into account cognitive impairment, which can occur because of HIV and also because of aging.
  • The U.S. data came from patients who had private health insurance coverage that provided what the researchers called "the best access to health care." Such patients might be healthier than patients who rely on public health programs or those without health insurance.

These and other reasons suggest that the computer model is likely to have underestimated future NCDs and associated healthcare costs.


Resources

CATIE Resources

Frailty, nerve injury and falls in middle-aged and older HIV-positive people -- CATIE News

Factors linked to falling in HIV-positive women -- CATIE News

Nerve pain and numbness from A Practical Guide to HIV Drug Side Effects

Unravelling the complexity of HIV and fatigue -- CATIE News

Alberta researchers warn about increasing costs of HIV care -- CATIE News

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

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

Strengthening the aging brain -- TreatmentUpdate 203

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

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

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


Non-CATIE Resources

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

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

"America's other drug problem: Giving the elderly too many prescriptions" -- Washington Post

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

CIHR's HIV Comorbidity Research Agenda: Relevant Research Areas

Factsheets on HIV and aging in Canada -- Canadian AIDS Society

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

Directory of Promising Programs and Services for Older People Living with HIV in Canada -- realize

Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis -- BMJ Open


References

  1. Smit M, Cassidy R, Cozzi-Lepri A, et al. Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A.: A modelling study. PLoS One. 2017 Oct 23;12(10):e0186638.
  2. Smit M, van Zoest RA, Nichols BE, et al. Cardiovascular disease prevention policy in HIV: recommendations from a modelling study. Clinical Infectious Diseases. 2017; in press.
  3. Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infectious Diseases. 2015 Jul;15(7):810-8.

[Note from TheBodyPRO.com: This article was originally published by CATIE on Nov. 7, 2017. We have cross-posted it with their permission.]

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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