People Living With HIV in U.S. Nursing Homes in the Fourth Decade of the Epidemic

Abstract

As the number of persons living with HIV (PLWH) will continue to increase in the coming years, it is critical to understand factors influencing appropriate nursing home (NH) care planning. This study described the socio-demographic characteristics as well as the antiretroviral therapy (ART) treatment and physical and mental health among Medicare-eligible PLWH in NHs. PLWH were identified and summarized using a 2011–2013 nationwide dataset of Medicare claims linked to NH resident health assessments and a prescription dispensing database, comparing new admissions in 2011–2013 to those from 1998–2000. We identified 7,188 PLWH from 2011–2013 in NHs of whom 4,031 were newly admitted. Of the total, 79% were prescribed ART. Most were male (73%), Black/African American (51.1%), and a plurality resided in southern NHs (47%). Comparing the datasets, new admissions were older (60 vs. 44), had higher prevalence of viral hepatitis (16.2% vs. 7.5%), and anemia (31.1% vs. 25.1%), but less pneumonia (11.0% vs. 13.6%), and dementia (8.7% vs. 21.0%). NH nurses can better anticipate health care needs of PLWH using these health profiles, understanding that there have been changes in the health of PLWH at admission over time.

Economic Barriers to Antiretroviral Therapy in Nursing Homes

“…4 In the NH setting, the percentage of dually eligible persons living with HIV/AIDS was found to be as high as 93%. 6 Since 2006, Part D has served as Medicare's drug coverage. It is administered via third-party insurance companies and requires annual reenrollment.…”

What Does Aging with HIV Mean for Nursing Homes?

“…A recent complementary analysis to that of Miller et al used data on Medicare-eligible PLWH and focused on new nursing home admissions among PLWH, comparing admissions from 1998 to 2000 with those from 2011 to 2013. 10 Comparing the two time intervals, recent admissions of PLWH were 16 years older (60 vs 44 y), had twice the prevalence of viral hepatitis (16% vs 8%) and more anemia (31% vs 25%) but had less pneumonia (11% vs 14%) and less than half as much dementia (9% vs 21%). Taken together, these studies suggest that the proportion of PLWH admitted to and experiencing extended nursing home admissions is growing, that the difference in age at admission among PLWH and those without is narrowing, and that the profile of disease may differ in important ways by HIV status.…”

“…A recent complementary analysis to that of Miller et al used data on Medicare‐eligible PLWH and focused on new nursing home admissions among PLWH, comparing admissions from 1998 to 2000 with those from 2011 to 2013 . Comparing the two time intervals, recent admissions of PLWH were 16 years older (60 vs 44 y), had twice the prevalence of viral hepatitis (16% vs 8%) and more anemia (31% vs 25%) but had less pneumonia (11% vs 14%) and less than half as much dementia (9% vs 21%).…”

“…Aging with HIV is not just like aging without HIV. Liver and kidney disease are more common in PLWH in nursing homes than in uninfected individuals . Many common forms of cancer including lung, anal, lymphoma, and hepatocellular cancer are more common among those aging with HIV .…”

“…Liver and kidney disease are more common in PLWH in nursing homes than in uninfected individuals. 10 Many common forms of cancer including lung, anal, lymphoma, and hepatocellular cancer are more common among those aging with HIV. 11 The proportion of PLWH who develop end-stage diseases requiring transplant, dialysis, surgery, repeated rounds of chemotherapy, and/or radiation is likely to grow, and long-term placement for these levels of care may be particularly challenging.…”