23 March 2016
Older people with HIV face different long-term health challenges
In Canada and other high-income countries, thanks to potent combination anti-HIV therapy (commonly called ART) more HIV-positive people are living longer. The power of ART is so profound that researchers estimate that a young adult who is infected today, diagnosed shortly thereafter and soon begins ART should have a near-normal lifespan. This optimistic forecast depends on the person taking ART every day exactly as directed and the absence of serious pre-existing illness or health conditions.
As more HIV-positive people live longer in an era of widespread use of ART, services will need to be adapted for this population’s changing needs.
Researchers at the University of Waterloo, Ontario, and with the Public Health Agency of Canada (PHAC) collaborated on a massive data analysis project that collected health-related information from more than one million people, a small fraction of whom (less than 1%) had HIV. Participants were assessed in the context of the following three settings (which are explained later in this report):
- home care
- long-term care
- complex continuing care
Researchers found that, overall, HIV-positive people had “more co-infections but fewer chronic diseases” compared to HIV-negative people. Furthermore, they found that HIV-positive people were generally more likely to have experienced “depression and social isolation and the use of psychotropic medicines.”
These findings have implications for policy planners, doctors, nurses, pharmacists, geriatric specialists and others working in the field of caring for HIV-positive people as they transition into their senior years.
Indeed, the Canadian research team stated that “failure to address the unique care needs of [older HIV-positive people] may lead to worse outcomes and increase the strain on health systems.”
The researchers defined the care settings as follows:
This term encompassed “services that included a mix of personal support, home nursing and some rehabilitative care that are provided in a client’s home.” Data for analysis of home care usage were collected from people living in B.C., Manitoba, Ontario, Nova Scotia and the Yukon.
This term encompassed “private, public and charitable nursing homes that provide regulated care to people with stable medical conditions who require 24-hour care.” Data for the analysis of long-term care usage were collected from Alberta, B.C., Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Saskatchewan and the Yukon.
Complex continuing care
This term encompassed “hospitals or units in post-acute hospital settings that provide care to individuals with more severe impairment or more medically complex conditions and/or mental health needs than those typically cared for in nursing homes.” Data for the analysis of complex care usage were collected from Ontario and Manitoba.
In total, data from 1,200,073 people were analysed, of whom 1,608 people (0.13%) were HIV positive. Some data were collected from some participants as early as 1996, but in all cases, data collection ended in 2014.
The distribution of HIV-positive people according to the different categories of care settings was as follows:
- home care – 178 people (0.05%) were HIV positive
- long-term care – 423 people (0.19%) were HIV positive
- complex continuing care – 1,007 (0.16%) were HIV positive
The researchers made the following discoveries:
- HIV-positive people were more likely to have been diagnosed with pneumonia.
- Regardless of the specific care setting, HIV-positive people were more likely to have been diagnosed with tuberculosis (TB).
- Rates of certain antibiotic-resistant bacterial infections of the skin and intestines were more common in HIV-positive people in complex care and long-term care.
- Rates of life-threatening bacterial infections of the blood were generally greater among HIV-positive people.
Overall, the researchers found that “chronic psychiatric conditions…were more common among HIV-positive individuals in home care.” Furthermore, the research teams found that HIV-positive people “experienced significantly more social isolation” than HIV-negative people. Given this, perhaps it should not be surprising that, in general, rates of use of psychotropic medicines were greater among HIV-positive people.
Bear in mind
The present study is the largest of HIV-positive people living in different care settings in Canada. According to the research team, in general, older HIV-positive people had more co-infections and fewer chronic diseases than older HIV-negative people.
The researchers found that HIV-positive people had “substantially higher rates of psychotropic medication use.” They suspect that social isolation among HIV-positive people increased feelings of loneliness and depression. However, due to the study design, they cannot draw firm conclusions linking the use of psychotropic drugs to psycho-social issues.
About psychotropic medicines
These medications can have a positive effect on behaviour and mood and can include the following categories of drugs:
- mood stabilizers
Not just in Canada
A study in Denmark published in 2014 analysed data from 3,615 HIV-positive people who were compared to HIV-negative Danes of the same age and gender. The Danish researchers also found that HIV-positive people were more likely to have been prescribed and used a wide range of psychotropic medicines. In a broad sense, the findings on psychotropic medicines in the Canadian and Danish studies suggest that mental health issues are a growing concern among people with HIV infection.
Denmark—unexpected trends in use of psychotropic medicines – TreatmentUpdate 204
Quantification of biological aging in young adults – Proceedings of the National Academy of Science USA
Management of Human Immunodeficiency Virus Infection in Advanced Age – Journal of the American Medical Association
Dutch doctors explore intersection of aging and HIV – CATIE News
The CIHR Comorbidity Agenda – Canadian Institutes of Health Research (CIHR)
HIV and Aging – Healthy living tips for people 50 and over living with HIV
Mental Health – HIV in Canada: A primer for service providers
HIV and brain-related issues – TreatmentUpdate 204
Longer life expectancy for HIV-positive people in North America – TreatmentUpdate 200
Factsheets on HIV and aging in Canada – Canadian AIDS Society
HIV & Aging: A 2013 Environmental Scan of Programs and Services in Canada – Community Report – Canadian Working Group on HIV and Rehabilitation (CWGHR)
—Sean R. Hosein
- Foebel AD, Hirdes JP, Boodram C, et al. Comparing the care needs of people living with and without HIV in Canadian home and long-term care settings. Canada Communicable Disease Report. 2016;42:52-56. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/16vol42/dr-rm42-3/ar-01-eng.php
- Rasmussen L, Obel D, Kronborg G, et al. Utilization of psychotropic drugs prescribed to persons with and without HIV infection: a Danish nationwide population-based cohort study. HIV Medicine. 2014 Sep;15(8):458-69.
- Legarth R, Ahlström MG, Kronborg G, et al. Long-term mortality in HIV-infected individuals 50 years or older: a nationwide, population-based cohort study. Journal of Acquired Immune Deficiency Syndromes. 2016 Feb 1;71(2):213-8.
- Lohse N, Hansen AB, Pedersen G, et al. Survival of persons with and without HIV infection in Denmark, 1995-2005. Annals of Internal Medicine. 2007 Jan 16;146(2):87-95.
- Lohse N, Hansen AB, Gerstoft J, et al. Improved survival in HIV-infected persons: consequences and perspectives. Journal of Antimicrobial Chemotherapy. 2007 Sep;60(3):461-3.
- May MT, Gompels M, Delpech V, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS. 2014 May 15;28(8):1193-202.
- Samji H, Cescon A, Hogg RS, et al. Closing the Gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013 Dec 18;8(12):e81355.
- Lewden C, Chene G, Morlat P, et al. HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. Journal of Acquired Immune Deficiency Syndromes. 2007 Sep 1;46(1):72-7.