Aging HIV Patients Face Comorbidities and Hospitalizations

Jenny Blair

June 23, 2022

Thanks to effective treatment, people with HIV are living longer. But as they age, they face higher rates of age-related comorbidities and hospitalizations, according to a recent study of hospitalized patients.

Decisionmakers will need to allocate resources, train providers, and plan ways to manage chronic diseases, such as diabetes and cancer, among geriatric HIV inpatients, according to the authors.

"There will be more [HIV] patients with age-related chronic conditions at an earlier age and who will utilize or will have a unique need for [healthcare for] these geriatric conditions," said first author Khairul A. Siddiqi, PhD, University of Florida College of Medicine in Gainesville, in an interview with Medscape Medical News. "Eventually, that may increase inpatient resource utilization and costs."

The study was published online June 8 in HIV Medicine.

Aging With HIV

Analyzing the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project, the authors compared characteristics and comorbidies linked to hospital stays among people with HIV (HSWH) to those linked to hospital stays among people without HIV (HSWOH).

The NIS is a database of hospital records that captures 20% of discharges in the US and covers all payers. Data in this analysis covered the years 2003 to 2015.

Among HSWH, patients aged 50 or older accounted for an increasing proportion over time, from fewer than 25% in 2003 to over 50% by 2015, the authors found. The subgroup aged 65 to 80 had risen from 2.39% to 8.63% by 2015.

The authors also studied rates of eight comorbidities, termed HIV-associated non-AIDS (HANA) conditions: cardiovascular, lung, liver, neurologic, and kidney diseases; diabetes; cancer; and bone loss.

The average number of these conditions among both HSWH and HSWOH rose over time. But this change was disproportionately high among HSWH aged 50 to 64 and those aged 65 and older.

Over the study period, among patients aged 65 or older, six of the eight age-related conditions the researchers studied rose disproportionately among HSWH in comparison with HSWOH; among those aged 50 to 64, five conditions did so.

The researchers are now building on the current study of HSWH by examining rates of resource utilization, such as MRIs and procedures, Siddiqi said.

Study limitations included a lack of data from long-term facilities, potential skewing by patients hospitalized multiple times, and the inherent limitations of administrative data.

A Unique Group of Older People

Among people with HIV (PWH) in the United States, nearly half are aged 50 or older. By 2030, this group is expected to account for some 70% of PWH.

"We need to pay attention to what we know about aging generally. It is also important to study aging in this special population, because we don't necessarily know a lot about that," said Amy Justice, MD, PhD, professor of medicine and of public health at Yale University, in an interview with Medscape Medical News. Justice was not involved in the study.

The HIV epidemic has disproportionately affected people of color, men who have sex with men, and people with a history of injection drug use, Justice said.

"We don't know about aging with [a] past history of injection drug use. We don't even know much about aging with hepatitis C, necessarily," she said. "So there are lots of reasons to pay some attention to this population to try to optimize their care."

In addition, compared with their non-HIV-affected counterparts, these individuals are more susceptible to HANA comorbidities. They may experience these conditions at a younger age or more severely. Chronic inflammation and polypharmacy may be to blame, said Justice.

Given the burden of comorbidities and polypharmacy in this patient population, Siddiqi said, policymakers will need to focus on developing chronic disease management interventions for them.

However, Justice added, the risk for multimorbidity is higher among people with HIV throughout the age cycle: "It's not like I turn 50 with HIV and all of a sudden all the wheels come off. There are ways to successfully age with HIV."

Geriatric HIV Expertise Needed

Justice called the study's analysis a useful addition to the literature and noted its implications for training.

"One of the biggest challenges with this large bolus of folks who are aging with HIV," she said, "is to what extent should they be cared for by the people who have been caring for them — largely infectious disease docs — and to what extent should we really be transitioning their care to people with more experience with aging."

Another key question, Justice said, relates to nursing homes and assisted-living facilities, whose staff may lack experience caring for HIV patients. Training them and hospital-based providers is crucial, in part to avoid key errors, such as missed antiretroviral doses, she said: "We need to really think about how to get non-HIV providers up to speed."

That may begin by simply making it clear that this population is here.

"A decade ago, HIV patients used to have a lower life expectancy, so all HIV studies used to use 50 years as the cutoff point for [the] older population," Siddiqi said. "Now we know they're living longer."

Added Justice: "Previously, people thought aging and HIV were not coincident findings."

The study was funded by the Office of the Vice President for Research at the University of South Carolina. The authors and Justice have disclosed no relevant financial relationships.

HIV Med. Published online June 8, 2022. Abstract

Jenny Blair, MD, is a journalist, writer, and editor in Vermont.

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