“It's a burden, it's a nuisance. I wish I didn't have these other ailments”: a qualitative exploration of comorbidities management among older people living with HIV who use drugs in Vancouver, British Columbia

Abstract

Introduction People living with HIV (PLHIV) who use illicit drugs (other than or in addition to cannabis) are living longer due to antiretroviral therapy (ART). Older PLHIV who use drugs have an increased risk for comorbidities, and managing multiple health conditions is a growing concern among this population. However, in‐depth understandings of the lived realities and complexities of living with HIV alongside comorbidities among older PLHIV who use drugs remain limited. We sought to explore how older PLHIV who use drugs manage their comorbid conditions in a setting with universal ART access. Methods Between January 2019 and March 2020, semi‐structured, in‐depth interviews were conducted in Vancouver, Canada with 42 older PLHIV who use drugs and were living with at least one comorbidity. All participants were currently on ART, and had initiated treatment at least 2 years prior to the interviews. Data were analysed using inductive and deductive approaches. Results Several themes were identified through this analysis. First, comorbidities were perceived as more urgent health concerns and prioritized over HIV. Second, stigma and discrimination hindered access to care for comorbidities. Third, the concurrent management of HIV and comorbidities was often challenging due to unmanaged or poorly managed comorbidities. Fourth, the potential impact of ART on the development of comorbidities was a source of concern and frustration. Finally, integrated treatment approaches facilitated engagement with HIV and comorbidities care. Conclusions Our findings underscore the need for HIV care to shift from a primary focus on managing HIV to an integrated, patient‐centred approach that addresses both HIV and non‐HIV‐related health needs, as well as an equitable and non‐judgemental delivery of such care for an ageing population of PLHIV who use drugs.

The experienced positive and negative influence of HIV on quality of life of people with HIV and vulnerable to HIV in the Netherlands

“…Being diagnosed with HIV or being vulnerable to HIV in the pre-ART era may have caused a significant burden in the past 5 , 16 , 35 – 39 . The predominant and negative influence of HIV shared by participants in our study was described to have improved due to ART, PrEP, and U = U, but it did not disappear 5 , 33 , 40 – 42 . Improvements in clinical management in the ART era meant new discomforts for participants, such as the side effects of ART.…”

Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review

“…Polypharmacy was significantly associated with meeting deprescribing criteria ( p = 0.008) Limitations to this study include the use of dispensing records as some information may be missing and the reliability of the information depends on the inputting physician. Furthermore, the small sample size limits the generalisability of the data Rozanova et al, 2020 (Ukraine) [ 97 ] n = 123 Age = 55–81 years Community Data were collected via telephone surveys Older PLWH with substance misuse disorders maintained their HIV and substance use disorder therapies over the Covid-19 lockdown, however, social support was highlighted to be critical to avoid treatment interruptions A limitation to this study is that telephone surveys may have led to social desirability bias in participant answers Chayama et al, 2021 (Canada) [ 55 ] n = 42 Age = 50+ years Community Semi-structured in-depth interviews were used to collect data Participants viewed co-morbidities as more urgent and prioritised them over HIV. Access to care for co-morbidities were hindered by stigma and discrimination.…”

“…Older PLWH are more likely to be affected by anxiety, depression, cancer, chronic kidney disease (CKD), chronic pain, diabetes, hypertension, osteoporosis, hepatitis B/C infections than HIV-negative individuals [ 31 , 32 , 34 , 36 , 39 , 42 – 45 , 47 , 51 , 55 , 58 , 61 ]. A study comparing HIV-positive older males to their HIV-negative counterparts found that older participants were six times more likely to be diagnosed with osteoporosis [ 31 ].…”

“…Another participant reported not knowing if they were tired due to getting older, their co-morbidities or side effects of their medicines [ 71 ]. Many PLWH who were diagnosed in the 1990s or just after the 2000s do not view HIV as their most pressing concern, but rather prioritise co-morbidities—their HIV is perceived to be under control due to adherence to ART [ 55 ].…”

“…Nonetheless, barriers to achieving optimal adherence may affect older PLWH [ 66 ], including co-morbidities, regimen complexity and fatigue, mental health conditions and cognitive impairment, lack of social support and social isolation, and stigma [ 30 , 36 , 37 , 54 , 55 , 61 , 64 , 66 , 80 , 82 , 86 , 87 ]. Practical difficulties (e.g., those associated with obtaining refills) can lead to medicine non-adherence among older PLWH [ 61 , 81 ].…”