Keeping Up With a Changing Epidemic: Reconnecting an Aging HIV-Infected Population to Palliative Care Services (SA508): Pediatric/HIV/Safety Net SIGs

Abstract

1.Increase understanding of current epidemiologic and clinical issues involved in HIV and aging and of the special relevance for palliative care for aging patients with HIV/AIDS in this phase of the epidemic.2.Increase knowledge about how to integrate palliative and disease-specific interventions for aging patients with HIV/AIDS in the current era.3.Increase awareness of the issues for vulnerable populations with HIV/AIDS compounded by the challenges of aging and multiple comorbidities. Advances in antiretroviral therapy have resulted in prolonged survival of HIV-infected patients in the United States. Rapid demographic shifts have resulted in many patients with HIV living into their 60s and beyond. A phenomenon of “accelerated aging” has also been described among even younger patients with HIV, with increased risk of cardiovascular disease, diabetes and dyslipidemias, osteopenia, non-AIDS-defining cancers, and frailty. The pre-HAART era was defined by the intense end-of-life care needs of young adults dying from a relentless, rapidly fatal illness. In contrast, in the current treatment era, as the population of HIV-infected individuals ages, a different set of important palliative care issues have come to the fore. These include: (a) pain and symptom management for multiple medical comorbidities, (b) high prevalence of chronic non-malignant pain, (c) polypharmacy involving HIV-related medications and those used for comorbidities, (d) dementia and neurodegenerative disease associated with aging as well as HIV, (e) depression and other psychosocial stressors in an often socially isolated and stigmatized population, and (f) complex decision making reflecting a different developmental life cycle stage than when the epidemic mostly affected younger adults. Recent immigrants presenting newly diagnosed with advanced HIV disease and no prior treatment, may also present special challenges in management. In addition, a unique population of long-surviving, perinatally infected children born in the 1980s is now reaching adulthood with complex disease management and palliative care needs. This session will involve a combination of short didactic and case-based interactive presentations highlighting the important role for palliative care providers in caring for HIV-infected patients in the current phase of the epidemic. Specific models for integrating HIV and palliative care as well as practical suggestions for how to strengthen contacts between HIV and palliative care treatment services will be discussed.