Impact of age on care pathways of people living with HIV followed up in hospital

Abstract

The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older. ARTICLE HISTORY

Pharmacist’s role in HIV care in France. Implication for clinical improvement of people living with HIV worldwide

“…However, they seem to present more numerous comorbidities than those previously reported. 1,7 Though, as we noted in the present study, our self-questionnaire focused more closely on "disorders" than on identified organ diseases. Nevertheless, the HIV Outpatient Study deleterious interactions with ARVs.…”

“…6 This is especially important because after the infection stabilizes, a current care pathway only require bi-annual or annual hospital consultations where an ARV prescription is given for the following 6 months, or year. 7 During this 6-month or 12-month period, the pharmacist (hospital pharmacist or community pharmacist, according to the patient's preference) is often the only health professional a PLHIV will meet monthly, and who must ensure adherence to the treatment regimen. Another major challenge for the pharmacist can be patient therapeutic education (PTE) in conjunction with the various actors involved.…”

“…It is likely that PTE, despite being recommended in HIV care, is only infrequently offered by the hospital care actors or solicited by the patients: in our precedent study, specialized HIV care nurses provided therapeutic education to only 5% patients. 4,6,7 Some other features of the French health system can complicate a patient's care pathway, such as the coexistence of public and private care or the existence of private additional insurances. The coordination of care requires a complex collaborative effort to ensure the patients' free circulation within the care system.…”

Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients

“…Our study has some limitations; some comorbidities may have been underestimated because of a non declaration in the patient’s medical chart. However results of a recent French study evaluating comorbidities in HIV patients over 60 years find similar prevalence of the major comorbidities (cardiovascular diseases 30%, hypertension 27% and diabetes 15%) [ 35 ]. Furthermore individuals who died before Dec 31, 2015 were not included in the study and this does not allow to evaluate the frequency and reasons of death in this aging population.…”

Derivation and internal validation of a mortality risk index for aged people living with HIV: The Dat'AIDS score

“…Comorbidities, especially chronic renal disease and cardiovascular diseases, are becoming increasingly determinant in aging PLHIV, with a prognostic role that is as important as HIV-related prognostic factors such as CD4 cell count [ 14 ]. The burden of comorbidities is high in this population, and will continue to increase in the future [ 6 , 15 ]. This different epidemiology with lifestyle confounders and higher comorbidity burden suggests that a specific score to estimate mortality risk, specifically designed for aged PLHIV, and including HIV-related factors and comorbidities, would be of major clinical and research interest [ 2 , 7 ].…”