November 7, 2017
Researchers in Canada and other high-income countries increasingly expect that many people who take combination anti-HIV treatment (ART) every day and achieve and maintain an undetectable viral load and keep up with regular clinic and laboratory visits will achieve a near-normal life span. In light of this tremendous effect of ART on people's life spans, ministries and departments of health should begin planning for the care that will be required by a growing proportion of aging HIV-positive people. A first step in this process is estimating which diseases and health conditions are occurring in older HIV-positive people now, and then projecting these estimates into the future and calculating their costs.
A team of researchers in Italy and the United States has collected health-related information from about 11,000 HIV-positive people and used this to produce a computer model that could explore some effects of aging. The computer model focused on non-communicable diseases (NCD) and projected health outcomes for aging HIV-positive people in both countries, comparing the years 2015 and 2035.
The computer model predicted that in 2035 the average age of HIV-positive people in Italy will be nearly 60 years and in the U.S. it will be 58 years. Furthermore, it predicted that nearly 90% of HIV-positive older people will have at least one of the following NCDs in 2035:
To a lesser extent, there will also be increases in heart attacks and strokes.
The researchers therefore predicted that the cost of caring for HIV-positive people will likely rise due to the increased presence of NCDs. The model likely underestimates some of the costs of care, as it takes into account only a handful of NCDs. The research team also made recommendations for interventions to reduce NCDs among older patients and for enhancing the training of doctors and nurses so they can better help look after an aging population.
The research team adapted a well-validated model previously used in the Netherlands to explore aging among HIV-positive people in that country. The researchers used data from an ongoing study in Italy called ICONA, which is focusing on 7,499 HIV-positive people. Data from the U.S. were obtained from 3,748 HIV-positive people with private insurance coverage from a nationally representative sample.
The researchers' model focused on the following NCDs:
By the year 2035, the model predicted the following:
The average age of HIV-positive patients will be nearly 60 years.
The average age of HIV-positive patients will be 58 years.
The proportion of patients who are aged 50 years or older will be as follows:
The proportion of patients who are aged 65 years or older will be as follows:
According to the researchers, in 2035 "the increasing burden of NCDs will be driven by" the following:
The proportions of HIV-positive people who had these conditions in 2015 are as follows:
Higher than normal blood pressure and elevated lipid levels
Type 2 diabetes
Cancers unrelated to HIV
The computer model predicted that the following proportions of HIV-positive people will have NCDs in 2035:
Higher-than-normal blood pressure and elevated lipid levels
Type 2 diabetes
Cancers unrelated to HIV
When researchers assessed trends in heart attacks and strokes, they expected the following proportions of people to have one or more of these conditions in 2035, as follows:
This difference in rates of serious cardiovascular disease between the two countries is, according to the researchers, "driven by the higher age-specific prevalence and incidence of serious cardiovascular disease observed in the U.S. compared to Italy."
The researchers estimated the annual costs of care directly related to NCDs and found that the computer model suggested it would increase between 2015 and 2035 in both countries, as follows:
The researchers estimated that currently 11% of the cost of caring for HIV-positive people arises from treatment of NCDs. By 2035 this figure is expected to rise to almost 23%. The greatest proportion of this increase will be due to the cost of care associated with abnormal lipid levels and chronic kidney disease.
The researchers estimated that currently 40% of the total costs of care for HIV-positive people arises from treatment of NCDs. By 2035 this figure is expected to rise to almost 56%.
These findings are supported by studies in the Netherlands, which also suggest that NCDs and in particular cardiovascular disease (and its cost) will increase as HIV-positive people age.
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