This symposium highlighted the enormous importance of considering the unique issues associated with ageing with HIV, and how we may go about addressing them to ensure the ageing population can be best supported to live a full life. We need to aim for the 4th 90: good health.
The most persuasive reasons for considering this issue is the extent of the need and the number of people involved – I was shocked to realise that in high income countries 31% of people living with HIV (PLHIV) are over 50.
The specific challenges to ageing with HIV identified included survivor guilt, isolation, depression, stigma and discrimination, access other to services, decreased functional capacity as well as HIV and age related comorbidities. Non AIDS related events like cardiovascular disease, metabolic disorders, liver or renal disease etc are more common in PLHIV, even considering age and other risk factors, and number of comorbidities increase with age. This also creates an additional pill burden for many ageing PLHIV. Cultural factors are also of consideration – in countries like Sinapore where the elderly are most commonly cared for by their children, there may be a large cohort of MSM who will not have family or financial support for their care as they age. Stigma can impact preparation for death and funerals – families may ask for status not to be placed on the death certificate.
All speakers discussed various models of care and service delivery, and seem to be on the same page as to thinking about the ageing population living with HIV and how the they can be best supported to Iive a full life. They all in different ways indicated the key is to teach and to collaborate, maintaining links with the main provider and a partnership with the person – important to listen to individual needs and empower older adults living with HIV to engage with their own care.
Education and Training was named as an essential factor to allow this to happen – GPs, geriatricians, nursing home and aged care staff, social workers, community workers to have education, s100 prescribers to be trained.
The ASHM presentation proposed a set of services and information of PLHIV aged 50 and over, which incorporated
- risks (cardiovascular diseases, frailty, depression, smoking)
- age appropriate HIV services (ARTs, HIV prevention and harm reduction, gender responsive sexual health care)
- other general services (dietry counselling and support, nutrition assessment, smoking cessation, exercise promotion, blood pressure monitoring, cholesterol management, mental health care, palliative care, and
- the need for further research on ageing with HIV, improved epi data on HIV in people over 50 and improved understanding of HIV incidence among people over 50
The population of people living with HIV is ageing. We as clinicians and services must be better prepared to meet their needs in order to reach that 4th 90.
