Long‐term success for people living with HIV: A framework to guide practice

Abstract

Objectives: In recent decades, the needs of people living with HIV have evolved as life expectancy has greatly improved. Now, a new definition of long-term success (LTS) is necessary to help address the multifaceted needs of all people living with HIV. Methods: We conducted a two-phase research programme to delineate the range of experiences of people living with HIV. The insights garnered from these research phases were explored in a series of expert-led workshops, which led to the development and refinement of the LTS framework. Results:The insights generated from the research phases identified a series of themes that form a part of LTS. These themes were subsequently incorporated into the LTS framework, which includes five outcome pillars: sustained undetectable viral load, minimal impact of treatment and clinical monitoring, optimized healthrelated quality of life, lifelong integration of healthcare, and freedom from stigma and discrimination. A series of supporting statements were also developed by the expert panel to help in the achievement of each of the LTS pillars.

Ageing well with human immunodeficiency virus

“…4 Early screening and management of risk factors and predictors of comorbidities and frailty will directly impact on improving health-related quality of life for our ageing cohorts. 11 Comorbidities: HIV-related or Ageing-related?…”

“…There is more incident comorbidity in patients who have long-term cumulative exposure to ART, despite being switched to a contemporised ART regimen with fewer adverse effects. 11,13 Modern HIV management cannot negate years of cumulative mitochondrial toxicity and lipodystrophy associated with earlier agents (i.e. thymidine analogues, early nucleoside reverse transcriptase inhibitors [NRTIs], protease inhibitors).…”

“…Considerations for ART initiation and switch strategies should be patient-centred and consider individual factors, for example virologic efficacy, adverse effect profile, pill burden and dosing frequency, adherence risk, interaction potential, comorbid conditions, cost, access, and known or suspected genotypic resistance, avoiding a 'cookie cutter' approach to treatment. 11,24 INSTIs form the basis of all first-line ART in Australia. Initial regimens will typically be based on a second-generation INSTI (i.e.…”

Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV from the Canadian cohort of the observational BICSTaR study

“…Factors driving long-term success in people with HIV include sustained undetectable viral load, minimal impact of treatment/monitoring, and optimized health-related quality of life. [7] Optimal regimens need to demonstrate long-term virologic suppression, high tolerability, a favorable safety profile, a high resistance barrier, low potential for drug-drug interactions, and low pill burden. [3,7,8] Simplifying treatment to reduce pill burden and the potential for drug-drug interactions is an important consideration for improving treatment adherence, persistence, and quality of life, [3,7,9] particularly in older people who often have greater rates of comorbidity and polypharmacy.…”

“…[7] Optimal regimens need to demonstrate long-term virologic suppression, high tolerability, a favorable safety profile, a high resistance barrier, low potential for drug-drug interactions, and low pill burden. [3,7,8] Simplifying treatment to reduce pill burden and the potential for drug-drug interactions is an important consideration for improving treatment adherence, persistence, and quality of life, [3,7,9] particularly in older people who often have greater rates of comorbidity and polypharmacy. [10,11] Therefore, in addition to virologic control, managing comorbidity and polypharmacy has become increasingly important for healthcare professionals providing care for people with HIV.…”