HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV.

Aroonsiri Sangarlangkarn,Yuji Yamada,Fred C Ko

doi:10.3390/pathogens10101332

Aroonsiri Sangarlangkarn, Yuji Yamada + Show 1 more

Open Access

https://doi.org/10.3390/pathogens10101332

Copy DOI

Abstract

With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.

Highlights

With the invention of antiretroviral therapy, life expectancy among People with HIV (PWH) has significantly increased
Older PWH are at risk of advanced aging [3,4], increased multimorbidity [5], as well as geriatric syndromes [6]
Given the understanding that updated HIV guidelines addressing the above challenges will likely take many years to develop, we offered the following strategies on the application of current guidelines to improve their relevance and effectiveness among older PWH (Table 1)

Summary

Introduction

With the invention of antiretroviral therapy, life expectancy among People with HIV (PWH) has significantly increased. Challenges Pertaining to Existing HIV Guidelines in the Care of Older PWH Despite increasing numbers of older PWH, existing HIV guidelines present multiple challenges in the care of this population These limitations are secondary to various issues associated with clinical guideline development for older adults, some of which parallel those encountered in guidelines for non-HIV related conditions [9]. A guideline on frailty syndrome may explore multiple frailty-related outcomes such as falls, physical function, ambulation, and quality of life With such complexity related to the multifactorial nature of geriatric conditions, clinical studies in older adults may be difficult to standardize and synthesize into systematic reviews and meta-analyses that can be used to inform existing guidelines in older PWH. The European AIDS Clinical Society guideline [18] and the British HIV Association [19] addressed a few geriatric syndromes, it did not provide specific criteria on which patients should be included in said guidelines, making its application in older PWH challenging

Strategies on Applying Existing Guidelines to Older PWH

Take Time to Benefit into Account

Eliciting Patient Preferences When Guidelines Clash

Future Directions and Conclusion