What Problems Associated With Ageing Are Seen in a Specialist Service for Older People Living With HIV?

Howell T. Jones; Alim Samji; Nigel Cope; Joanne Williams; Leonie Swaden; Abhishek Katiyar; Fiona Burns; Aisha McClintock-Tiongco; Margaret Johnson; Tristan J. Barber

Disclosures

HIV Medicine. 2022;23(3):259-267.

Conclusions

Although older people living with HIV are a heterogeneous group, frailty is common and appears to present earlier. Our data demonstrate a high prevalence of affective and cognitive symptoms within this cohort. 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 of incorporating geriatricians, HIV physicians, physiotherapists, occupational therapists, HIV specialist pharmacists and HIV specialist nurses into a single clinic is successful in identifying problems associated with ageing with HIV and, funding permitting, may be successfully replicated elsewhere depending on local clinic size, demographics and need.

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Funding information
FB has received consultancy fees from Gilead Sciences. TJB has received speaker fees, conference support and advisory board honoraria from Gilead Sciences, ViiV, Roche, MSD and Thera.

Acknowledgements
We would like to thank the patients who attended the Sage Clinic which was supported by an unrestricted grant from Gilead Sciences, Inc.

Table 1. Referral criteria for the Sage Clinic – one or more required
Multiple medical comorbidities (one or more) in addition to HIV
Complex polypharmacy issues (five or more medications excluding those to manage HIV)
Reduced/impaired mobility or reduced muscle strength
More than one fall in the previous 6 months
Inability to maintain activities of daily living
Underweight/unintentional weight loss
Memory problems
Advance care planning

Table 2. Patient-reported outcome measures collected and the adapted Fried frailty criteria used by the Sage Clinic [13]
Frailty assessment	Local adapted version of the Fried Frailty Score [13]
	In the last 12 months have you noticed any of the following?
	1. Inability to grip with hands (e.g. opening a jam jar)	☐ Yes (1)	☐ No (0)
	2. Unexpected decrease (loss) of weight that's worrying you	☐ Yes (1)	☐ No (0)
	3. A slower walking pace than usual	☐ Yes (1)	☐ No (0)
	4. Not feeling full of energy most days of the week	☐ Yes (1)	☐ No (0)
	5. Being less or much less active compared with someone who spends 2 h on most days on activities such as walking, gardening, household chores or do-it-yourself projects	☐ Yes (1)	☐ No (0)
		Total frailty score: _____
Screen for depression	Patient Health Questionnaire-9 (PHQ-9) [15]
Screen for anxiety	General Anxiety Disorder-7 (GAD-7) [16]
Cognitive assessment	Montreal Cognitive Assessment (MoCA) [17]
Quality of life assessment	World Health Organization Quality of Life-HIV BREF (WHOQOL-HIV-BREF) [18]
Disability assessment	World Health Organization Disability Assessment Schedule (WHODAS 2.0) [19]

Table 3. Baseline demographic and clinical characteristics of people seen in the Sage Clinic
Clinical characteristics (n = 35)	Results
Age (years) [median (range)]	69 (53–93)
Male [n (%)]	27 (77)
White ethnicity [n (%)]	22 (63)
Identified sexuality [n (%)]	MSM: 18 (51) Heterosexual: 17 (49)
Time since HIV diagnosis (years) [median (range)]	22 (3–37)
Duration of ART (years) [median (range)]	21 (3–32)
Current ART-based regimen [n (%)]	NRTI: 29 (83) NNRTI: 8 (23) PI: 11 (31) INI: 21 (60) CCR5 antagonist: 2 (6)
HIV RNA < 40 copies/mL [n (%)]	34 (97)
Nadir CD4 (cells/μL) [median (IQR)]	74 (182)
Current CD4 (cells/μL) [median (IQR)]	477 (319)
CD4:CD8 ratio [median (IQR)]	0.8 (0.8)
Previous AIDS-defining condition [n (%)]	21 (60)

Abbreviations: ART, antiretroviral therapy; CCR5, C-C chemokine receptor type 5; INI, integrase inhibitor; IQR, interquartile range; MSM, men who have sex with men; NNRTI, nonnucleoside reverse transcriptase inhibitors; NRTI, nucleoside/nucleotide reverse transcriptase inhibitors; PI, protease inhibitors.

Table 4. Issues identified during assessment of patients in the Sage Clinic
Issue	Number of patients (n = 35)	Percentage of patients (%)
Affective symptoms and depression	18	51
Memory loss	13	37
Falls	10	29
Urinary symptoms	9	26
Pain	8	23
Weight loss	7	20
Breathlessness	5	14
Bowel symptoms	5	14
Haematological problems	5	14
Anxiety	4	11
Isolation and loneliness	4	11
Alcohol use disorder	3	9
Modifiable polypharmacy	3	9
Financial insecurity	2	6
Smoking	2	6
Complications of diabetes mellitus	2	6
Visual symptoms and loss	1	3
Immigration issues	1	3

Table 5. Results of World Health Organization Quality of Life-HIV BREF (WHOQOL-HIV-BREF) domains in the Sage Clinic compared with previous studies [20, 21]
WHOQOL-HIV-BREF domain	Sage clinic Mean (SD)	Pereira et al. (2014)^a Mean (SD)	Meemon et al. (2016)^b Mean (SD)
Physical	12.34 (3.79)	13.48 (1.17)	14.48 (2.68)
Psychological	12.47 (3.05)	16.56 (1.01)	14.99 (2.48)
Level of independence	11.15 (3.75)	13.72 (1.08)	13.35 (2.39)
Social	12.77 (3.10)	13.34 (1.01)	13.32 (2.76)
Environmental	13.95 (2.81)	25.97 (0.96)	13.91 (2.21)
Spiritual	14.24 (3.67)	13.20 (1.28)	14.90 (3.42)

^aPortugal: n = 185; mean age = 57.84 (6.79) years; mean CD4 count = 433.06 (275.65); mean years since diagnosis = 6.34 (5.20) years.
^bThailand: n = 329; mean age = 41.95 (7.82) years; mean CD4 count = 489.51 (249.35); mean years since diagnosis = 10.40 (6.04) years.