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At the 24Th International AIDS Conference (2022) Montreal, Canada. Several sessions focused on healthcare implications of HIV/AIDS ageing. This article contains a summary from a panel discussion about key issues facing older HIV-positive people (PWH; ie). ≥50 years of Age)fiIn terms of psychosocial and medical treatment considerations, the cally are a bit nebulous. Positive pooled results of several studies on antiretroviral regimens older PWH are also presented. These findings may help to lower the medication burden in this group.
The aging PWH population
The Joint United Nations Programme GAP Report 2014: HIV/AIDS (UNAIDS).
Estimated to be approximately 4.2 Million People over 50 are eligible
≥50 years ago, they were still living with them HIV in 2013 (ie. 13 percent of all adults)
Living with HIV at the time
This number is expected continue. To increase globally. For instance,
Estimated modelling study in the Netherlands that >70 percent of PWH will
Be ≥By 2030, 50 years old These important healthcare implications have important implications.
Particularly in high burden countries resource-constrained settings. [Lancet
Infect Dis 2015;15:810-818]
Psychosocial concerns for older PWH
“Several key challenges encountered PWH becomes even more prominent
as we get older,” Marc Thompson opined.
PrEPster was founded in London by Cofounder, UK.
HealthHIV is available in the USA’According to the Second Annual State of Aging with HIV national study, July 2021, discrimination (i.e., stigma, homophobia and racism) remains a key barrier to accessing HIV care for people with HIV.
“It is important to address loneliness in older PWH. This is especially true as mental health conditions are more common in the elderly population than in younger PWH.” Thompson was also included. [Gerontologist 2013;53:963- 972; AIDS Behav 2008;12:244-254; AIDS Care 2009;21:742-753;
AIDS Patient Care STDS 2006;20:350-358]
“The COVID-19 pandemic has made older PWH more isolated and lonely over the past two years.” Ms Melanie Reese, Older Women Embracing Life, Baltimore, Maryland, USA.
“This pandemic has also adversely affected access to care, mental and social health, as well as other important protection factors for PWH, particularly in the older population.” [HealthHIV Second Annual State of Aging with HIV National Survey, July 2021]
“Accessing social support for older PWH is more difficult for women than it is for men, especially in countries with limited resources like ours.” Ms Dorothy Onyango, Kenya National AIDS Council in Nairobi (Kenya), shared this article.
“It is not uncommon for HIV-positive women over 50 to live alone in poorer nations. This can lead to isolation, neglect, loneliness, and depression.” Dr Lydia Mungherera, Uganda AIDS Commission, Kampala, Uganda. “A community-based initiative to target these vulnerable individuals is lacking, especially in resource-poor regions.”
Older PWH: Medical concerns
“Multimorbidity, Polypharmacy [ie, ≥5 medications] If not addressed, frailty and other medical concerns are common in older PWH. This can lead to poorer health outcomes.”
Jonathan Appelbaum, Florida State University College of Medicine in Tallahassee (Florida), USA. “Multimorbidity is important because management of one condition may have a negative impact on the outcome of another. It is important to adopt a holistic approach, with HIV clinicians being responsible for providing geriatric care for this vulnerable population.” [www.hiv.gov/hiv-basics/living-well-with-hiv/takingcare-of-yourself/aging-with-hiv;
J Int AIDS Soc 2020;23:e25449; Eur Geriatr Med 2019;10:219-226;
Pathogens 2021;10:1332]
The challenge of HIV treatment is still faced by polypharmacy. Increased medication use can lead to increased pill fatigue, decreased compliance, increased risk of adverse drug effects, drug-drug interactions, and geriatric issues like falls, cognitive impairment, frailty and increased mortality. [J Int AIDS Soc 2020;23:e25449]
Although frailty is an emerging indicator of vulnerability, it’s often overlooked in older PWH. It is associated with a multitude of adverse consequences, including falls, delayed recovery of illnesses, functional impairment, increased risk of hospitalization, and mortality. [J Gerontol A Biol Sci Med Sci 2001;56:M146-M156; AIDS Res Ther 2018;15:19]
“HIV-positive older women have additional health concerns such as decreased bone mineral density and menopause.”
Dr. Cristina Mussini of University of Modena & Reggio Emilia, Modena (Italie) was also included.
“For HIV-positive women, it is crucial to continue assessing these areas.” [Midwifery Womens Health 2015;60:146-225]
For older PWH, please get involved
“We must ensure that the changing world continues to evolve. Psychosocial and medical needs
Not to be forgotten are older PWH, especially At the policy level” Mungherera.
Table 2 summarizes our call to action The expert panel has formulated the following.
Options for ART in older PWH
Polypharmacy is very common PWH older than 50 years old are effective and safe
Antiretroviral Therapy (ART) Options With minimal medication burden
This ageing population is highly desirable. [AIDS Res Hum Retroviruses 2015;31:85-97;
HIV Res Clin Pract 2021;22:46-54] The once-daily fixed-dose
Combination of dolutegravir (DTG). plus lamivudine (3TC), as well as the long-acting
injectable combining cabotegravir (CAB and rilpivirine) are two examples.
There are two possible options. For older PWH. [Walmsley S, et al, AIDS
2022, abstract PESUB21; Elliot ER, et al, AIDS 2022, abstract EPB180]
SALSA/TANGO: Effective for older PWH, switching to DTG/3TC
A pooled analysis using 48-week data Phase III SALSA and TANGO
Studies evaluated the efficacy of the ef.fiSafety and cacy
Participants aged between 18 and 34 years old can use DTG/3TC ≥50 years. [Walmsley S, et al, AIDS 2022, abstract
PESUB21]
SALSA has previously shown that switching to DTG/3TC is not less effective at maintaining virologic suppressiveness than continuing to use various three- or patrul-drug current antiretroviral regimes (CARs). TANGO, on the other hand, demonstrated benefits for switching to DTG/3TC vs. continuing to use tenofovir alafenamide–based regimens in treatment-experienced adults with HIV-1. [Clin Infect Dis 2022;doi:10.1093/cid/ciac130;
Clin Infect Dis 2022;doi:10.1093/cid/ciac036]
Pooled results showed that participants over the age of 18 had more ART success despite taking more comorbidities and concomitant medications.
≥50 years, DTG/3TC maintained high rates of virologic suppression (HIV-1 RNA <50 copies/mL) after treatment switch, with no reported resistance, similar changes in CD4+ cell count and CD4+/CD8+ ratio, and favourable lipid profiles vs continuing CAR. (Figure 1) [Walmsley S, et al, AIDS 2022, abstract PESUB21]
These results indicate that switching to DTG/3TC is effective in maintaining virologic suppressive effects with acceptable safety and tolerance in older PWH.
FLAIR and AtLAS-2M: Long-acting CAB+ RPV that is effective in HIV suppression, regardless of your age
CAB + RPV are the first Complete Long-acting regimens are recommended
HIV-1 virologic suppression maintained. [JAMA 2020;324:1651-1669]
A pooled analysis of phase III FLAIR and ATLAS-2M studies are available through
Week 96 stratified by age group (ie)
<50 and ≥50 year-old CAB + RPV showed high efficacyfiCacy across
Both age groups, with 87–94 percent Participants with HIV-1 virologic status
Suppression at week 95. (Figure 2) [Elliot ER, et al, AIDS 2022, abstract
EPB180]
Safety and tolerability of long acting CAB + RPV were comparable in both age groups. Injection-site reactions were usually mild or moderate, short-lasting, short-lasting, and less common over time. There were also few withdrawals. FLAIR found that participants who received CAB+ RPV were more satisfied with their treatment than those who received daily oral therapy, regardless of age.
These results prove that long-acting CAB+RPV dosed Q4W/Q8W is a complete regimen to maintain HIV-1 virologic suppression in adults, including older PWH.
