Abstract and Introduction
Objectives: By 2030 the majority of the people living with HIV in the United Kingdom will be over the age of 50. HIV services globally must adapt to manage people living with HIV as they age. Currently these services are often designed based on data from the wider population or from the experiences of HIV clinicians. This article aims to help clinicians designing inclusive HIV services by presenting the most common needs identified during the first year of a specialist clinic for older people living with HIV at the Ian Charleson Day Centre, Royal Free Hospital in London, United Kingdom.
Methods: The records of all thirty-five patients attending the inaugural nine sessions were reviewed.
Results: The median age of attendees was 69 (53–93) with 77% being male, 63% being White, 49% being heterosexual and 97% being virally suppressed respectively. The majority (83%) met the criteria for frailty using the Fried frailty phenotype. Eighteen issues linked to ageing were identified with the most common being affective symptoms (51%), memory loss (37%) and falls (29%).
Conclusions: Whilst older people living with HIV are a heterogeneous group frailty is common and appears to present earlier. HIV services either need to adapt to meet these additional needs or must support users in transitioning to existing services. We feel that our multidisciplinary model is successful in identifying problems associated with ageing in people living with HIV and could be successfully replicated elsewhere.
Ageing is at the forefront of current health policy, with the United Nations branding 2020–2030 the 'decade of healthy ageing'. Conventional ageing research considers older people to be over the age of over 65; however, in HIV research, age > 50 years classes you as older due to the precedent set by the US Centers for Disease Control's original age stratification of HIV/AIDS. Data from 2018 showed that in the UK 39% of those accessing HIV services were over the age of 50, which consisted of people ageing with HIV as well as those who were diagnosed at an older age, and it is expected that by 2030 this will increase to 70%.[3–5]
Ageing is associated with increased rates of frailty in both the general population and the HIV population as is, defined as 'a condition in which a person has reduced homeostatic reserves resulting in increased vulnerability to both endogenous and exogenous stressors leading to them being at increased risk of negative outcomes'.[6,7] Frailty is associated with increased rates of multi-morbidity, disability, long-term residential care placement, hospitalization and death and can present earlier in those living with HIV.[8,9] Frailty can be assessed for and managed by undertaking what is known in geriatric medicine as a 'comprehensive geriatric assessment' (CGA), which is a multidisciplinary assessment that covers domains including physical, psychological, functional and social abilities and has been shown to improve outcomes for older people.
Currently there is no gold standard model for managing people living with HIV as they age. Several models have been proposed internationally including joint HIV and geriatric medicine clinics such as the 'Silver Clinic' in Brighton, UK, and the 'Golden Compass Programme' in San Francisco, US.[11,12] As many HIV physicians may be unfamiliar with frailty, while geriatricians lack experience of HIV, joint services such as these may allow for more holistic care.
This paper explores our experience in establishing a specialist service for older people living with HIV as well as describing the main aspects of ageing with HIV identified in our cohort in the inaugural year.
HIV Medicine. 2022;23(3):259-267. © 2022 Blackwell Publishing