HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Abstract

Introduction: Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the ''graying'' of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods: HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results: Of 238 participants, 112 (47%) completed ACP. Persons ‡ 55 years of age (OR 2.8; CI 1.6,5.0; p < 0.001), males (OR 4.1; CI 1.8,9.3; p = 0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p = 0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p = 0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p = 0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p = 0.4). Current CD4+ cell counts were similar between those completing and not completing documentation (588 cells/lL and 604 cells/lL, respectively; p = 0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion: Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.

Advance directives among people living with HIV: room for improvement

“…These comorbidities (cardiovascular disease, neurologic disease, chronic kidney disease, and malignancy) are often considered independently associated with increased morbidity and mortality. This differs from a similar study by Erlandson et al (2012). In addition, we found increased odds of AD completion in patients with a history of AIDS-defining illness, which is consistent with older studies where more than 50% of patients with advanced AIDS had discussed end-of-life issues with their clinician (Curtis, Patrick, Caldwell, Greenlee, & Collier, 1999).…”

“…Our finding that 23% had completed ADs falls in between the two most recently reported completion percentages for PLWH (8-47%), but is lower than those of other chronic diseases (Barakat et al, 2013;de Caprariis et al, 2012;Erlandson et al, 2012;Rao et al, 2014;Salmond & David, 2005;Schellinger et al, 2011). Several previously identified barriers to ACP for PLWH may contribute to low AD completion.…”

“…A recent retrospective study of hospitalized PLWH by de Caprariis and colleagues reported only 8% of patients had an AD prior to hospital admission (de Caprariis, Carballo-Diéguez, Thompson, & Lyon, 2012). Erlandson et al found that 47% of older PLWH on effective ART had completed some component of ACP (Erlandson et al, 2012). However, none of the reported studies assessed AD completion rates in the outpatient setting regardless of age or HIV-disease control.…”

Age-dependent molecular alterations in the autophagy pathway in HIVE patients and in a gp120 tg mouse model: reversal with beclin-1 gene transfer

“…In either case, understanding how HIV affects neuronal autophagy may lead to therapies that slow down neurodegeneration. Importantly, neither of these scenarios considers those individuals who contract HIV infection after turning 50, for which alternative patterns of disease have been reported (Erlandson et al 2012). Additional studies using samples from large cohorts of HIV patients combined with animal models and cellular-based studies will prove valuable in dissecting the complications of aging with neuroAIDS.…”

Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions

“…Advance care planning for PLWH was encouraged when mortality was high, even though 50% or fewer PLWH were reported to have engaged in such planning with their health care providers (Haas et al, 1993; Wenger et al, 2001). In the current era of improved medical outcomes due to better antiretroviral therapy, the reported completion rate of advance care planning by PLWH continues in the range of 14-47% (Barocas, Erlandson, Belzer, Hess, & Sosman, 2015; de Caprariis, Carballo-Dieguez, Thompson, & Lyon, 2013; Erlandson et al, 2012). These results compare to advance directive completion rates of 26.3% in the general U.S. population (Rao, Anderson, Lin, & Laux, 2014) and 63% in a U.S. population of adults 65 years of age or older (Alano et al, 2010).…”