Future challenges for clinical care of an ageing population infected with HIV: a modelling study

Abstract

SummaryBackgroundThe population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future.MethodsWe constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs—including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies—and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030.FindingsOur model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug–drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens.InterpretationThe profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge.FundingMedical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.

A Longitudinal Analysis of the Impact of Physical Activity on Neurocognitive Functioning Among HIV-Infected Adults

“…Mixed-effects models were used for these data to accommodate for within subject correlations that naturally occur in longitudinal studies. The mixed effect linear models on global and domain neurocognitive scores in the overall sample included terms for [1] HIV status; [2] PA group (i.e., ''No PA'', ''consistent PA'', and ''inconsistent PA''); [3] time; [4] the twoway interactions between PA group and time, HIV status and time, and HIV status and PA group; [5] the three-way interaction among HIV status, PA and time; and [6] adjustments for demographic characteristics (age at baseline, education, gender, ethnicity) and significant covariates. To create a more parsimonious model, non-significant interaction terms were subsequently removed.…”

“…Es importante recalcar que la AF es un factor de vida modificable que podría proteger contra los daños neurocognitivos independientemente de si las personas tienen o no VIH. Dada la proporción de personas con VIH que demuestran problemas neurocognitivos relacionados con esta enfermedad, será importante enfocar los esfuerzos Introduction Antiretroviral therapy (ART) has improved a number of health outcomes and extended the lifespan of individuals infected with human immunodeficiency virus [1,2]. Yet, HIV-associated neurocognitive impairment (NCI) continues to be prevalent, with approximately half of communitydwelling HIV-infected adults experiencing NCI [3].…”

Immunosenescence and hurdles in the clinical management of older HIV-patients

“…69 Few large randomized studies enrolled patients >50 y old, so data regarding efficacy and tolerability of HAART in this special population is somewhat scarce, especially considering that by 2030 more than 70% of HIV-infected patients will be more than 50 y old. 70 …”

“…70,[120][121][122][123] The clinician must face the challenge of selecting an appropriate HAART regimen in a na€ ıve HIV-infected elderly patient and to adapt an ongoing HAART according to concurrent medications in an aging patients already receiving antiretrovirals. Table 2 illustrate a brief summary of the most relevant interactions between first-line antiretrovirals and commonly prescribed drugs in the aging population.…”

Evolución de las características epidemiológicas y clínicas de pacientes adultos del programa nacional al inicio de la terapia anti-retroviral en la Cohorte Chilena de SIDA, 2001-2015

“…Este tipo de estudios permite abordar objetivos amplios, por períodos prolongados de seguimiento y evaluar resultados de la aplicación de programas de intervención en "el mundo real" 1 . Los principales estudios de cohorte provienen de Europa y Estados Unidos de América, con reportes de 10.000 o más pacientes en seguimiento desde antes del año 2000, tales como la cohorte Suiza, la "ATHENA Cohort" de Países Bajos, la cohorte Aquitaine en Francia y la ICONA en Italia y, especialmente a través de agrupaciones de cohortes como EuroSIDA, NA-Accord o ART-CC, con un gran número de pacientes [2][3][4] . Estos estudios han entregado información relevante sobre eficacia y mortalidad a largo plazo, factores bio-demográficos asociados a efectividad y toxicidad, incidencia de enfermedades marcadoras y no definitorias de SIDA, recuperación inmunológica y toxicidades específicas, entre otras.…”