Department of Health and Human Services updates HIV treatment guidelines
The US HHS has updated the treatment guidelines for HIV, including a section on issues specific to aging with HIV. In order to be informed consumers of care and to help guide our conversations with our providers, it’s important we understand these guidelines and are able to ask informed questions as we work with our providers to manage our care.
Here are some of the key guidelines, taken from the HHS summary document here:
Diagnosis of HIV at a later stage of disease is more common among older people. Early diagnosis and treatment of HIV and counseling to prevent secondary HIV transmission remain important in the clinical care of older people with HIV.
Antiretroviral therapy (ART) is recommended for all people with HIV. ART is especially important for older individuals because they have a greater risk of serious non-AIDS complications and potentially a blunted immunologic response to ART.
Compared to people without HIV, people with HIV have a twofold higher risk of developing atherosclerotic cardiovascular disease (ASCVD), and their age at incident ASCVD diagnosis is about a decade younger. In addition to current American Heart Association (AHA)/American College of Cardiology (ACC)/Multisociety Guidelines, the Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) recommends initiating at least a moderate-intensity statin in people with HIV aged 40 to 75 years who have 10-year ASCVD risk estimates of 5% to <20%. See Statin Therapy in People With HIV for the Panel’s additional recommendations on the use of statin therapy as primary prevention for people with HIV.
Polypharmacy is common in older people with HIV, and all drugs, supplements, and herbal treatments should be assessed regularly for appropriateness, potential for adverse effects, proper dosing, and drug interactions.
Potential for drug–drug interactions between antiretroviral drugs and concomitant medications (including statins, supplements, and herbal medicines) should be assessed regularly, especially before a new ART regimen or concomitant medication is started. In this context, it is also important to inquire and counsel about the use of non-daily medications, including long-acting injectables and as-needed medications.
Adverse drug events from ART and concomitant drugs may occur more frequently in older people with HIV than in younger individuals with HIV. Therefore, the bone, kidney, metabolic, cardiovascular, cognitive, and liver health of older individuals with HIV should be monitored closely.
HIV infection is associated with immunologic aging and systemic inflammation, which may contribute to the development of comorbidities across multiple organ systems as well as aging phenotypes like frailty. HIV experts, primary care providers, and other specialists should work together to optimize the medical care of older people with HIV, including adhering to treatment and prevention guidelines for different medical comorbidities.
Age-related decline in neurocognitive function is faster in people with HIV compared to those without. Cognitive impairment in people with HIV—with manifestations including problems with memory, attention, and executive function—is associated with reduced adherence to therapy and poorer health outcomes, including increased risk of death. For people with progressive cognitive impairment, referral to a specialist (e.g., neurologist, neuropsychologist, geriatrician) for evaluation, testing, and management may be warranted.
Mental health disorders, including an increased risk of anxiety and depression, are a concern among aging people with HIV. Screening for depression and management of mental health issues are important when caring for older people with HIV.
Given that the burden of aging-related diseases is significantly higher among people with HIV than in the general population, additional medical and social services may be required to effectively manage both HIV and comorbid conditions.
My advice in dealing with the information such as this that we consume is to:
Write down the things you find that you think might be relevant to your care or for which you have questions
When you visit your provider you are then less likely to forget to bring them up and can work through the questions with them
You can also send them to the providers offe ahead of your visit. This may allow them to prepare and catch up on things they may not have seen yet.
Always remember that the best care is based on a partnership with your providers, it should never just be something that is done to you, always with you.
The full report on updated treatment guidelines can be found here.
