New HIV Care Models, Apps Emerging as Patients Age

Marcia Frellick

November 15, 2019

BASEL, Switzerland — Half the patients with HIV in many countries are now older than 50 years. and that shift has inspired new care models.

"We've had a number of successes in the reduction of HIV transmission and infection, particularly among men who have sex with men in urban areas, but we still need to learn the lessons of people who have lived with HIV for a long time," said Tristan Barber, MD, a consultant in HIV and sexual health at the Royal Free Hospital in London.

"They may have had previous toxic drugs to treat their HIV and also opportunistic infections and are aging in an accelerated way with different comorbidities," he pointed out here at the European AIDS Conference 2019.

Clinics that combine services targeted toward aging patients with HIV are cropping up across Europe, each with a different focus.

It's important to evaluate the risks and needs of the aging local population with HIV because patients can have very different patterns of comorbidity, Barber told Medscape Medical News.

"In my own service, we found better physical assessment with physical therapy was needed," he said. "That helps people who are prefrail to avoid becoming frail as they age with HIV. We offer them an hour and a half appointment when they see myself, an older care physician, an occupational therapist, a physiotherapist, a specialist pharmacist, and a dedicated clinic nurse. They have three stations that they rotate through in our frailty service."

In Poland, a primary concern is with older intravenous drug users, said Justyna Kowalska, MD, PhD, from the Medical University of Warsaw. Many have survived the early HIV epidemic with opioid-substitution therapies, primarily methadone.

However, no existing long-term care facilities in Poland will dispense methadone, she said, and active drug users in hospital care do not get substitutes, so a high number of patients request discharge.

"We need to do more for patients aging with drug abuse," she said, "not only those with HIV."

Each year has a much greater effect on people living with HIV than on those aging normally, said Giovanni Guaraldi, MD, director of the Modena University Centre for Cooperation and Development in Italy, a dedicated HIV-aging clinic that focuses on metabolic syndromes.

Patients at that clinic are screened for functional measures such as gait speed, balance, and grip strength, he said.

"My approach is that frailty is an umbrella in which all the comorbidities get inside," Guaraldi explained.

Apps Help Aging Patients

Apps are emerging for aging patients with HIV. One is MySmartAge, developed by the Modena HIV Metabolic Clinic, and another is the EmERGE mHeath platform.

MySmartAge is more about collecting information, such as frailty assessments, and sending it to healthcare providers so they can track their patients' progress, said Jaime Vera, MD, PhD, from the Silver Clinic in Brighton, one of the first dedicated HIV-aging clinics in the United Kingdom.

The EmERGE app helps clinicians monitor patients, get blood test results, and track CD4 counts and viral loads while engaging patients in their own care, he explained.

The technology can help patients reduce in-person visits and can send physician alerts to patients telling them to come to the clinic when their numbers become concerning.

"It's exciting, but it's not for everybody," said Vera.

Susan Cole, from NAM aidsmap, an HIV information charity, leads workshops for people living with HIV and said aging with HIV has become a popular session.

Good holistic care needs to go beyond biometrics, she noted. Older people living with HIV, for instance, have significant fears about entering long-term care and the potential stigma they will face.

They also have financial concerns as they face retirement years. "Many of us, when we were diagnosed with HIV, didn't actually think we would live into old age, so many people don't have pensions," she said.

But Cole emphasized, "it's not all doom and gloom."

"We need to speak to people about living well with HIV," she said.

European AIDS Conference (EACS) 2019. Presented November 7, 2019.

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