HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV
Abstract
:1. Introduction
2. Challenges Pertaining to Existing HIV Guidelines in the Care of Older PWH
2.1. Multifactorial Nature of Conditions
2.2. Measurement Issues
2.3. Lack of Representation in Clinical Trials
2.4. Determining Which Patients to Screen and Apply Guidelines to
2.5. Limited Guidelines Addressing Geriatric Syndromes
3. Strategies on Applying Existing Guidelines to Older PWH
3.1. Use Frailty or Cognitive and Functional Status to Inform Shared Decision-Making on Treatment Goals/Interventions
3.2. Take Time to Benefit into Account
3.3. Eliciting Patient Preferences When Guidelines Clash
4. Future Directions and Conclusion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Centers for Disease Control and Prevention. HIV Surveillance Report. Available online: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html (accessed on 28 August 2021).
- Autenrieth, C.S.; Beck, E.J.; Stelzle, D.; Mallouris, C.; Mahy, M.; Ghys, P. Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020. PLoS ONE 2018, 13, e0207005. [Google Scholar] [CrossRef]
- Althoff, K.; McGinnis, K.; Wyatt, C.; Freiberg, M.; Gilbert, C.; Oursler, K.; Rimland, D.; Rodriguez-Barradas, M.; Dubrow, R.; Park, L.; et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin. Infect. Dis. 2015, 60, 627–638. [Google Scholar] [CrossRef] [Green Version]
- Pathai, S.; Bajillan, H.; Landay, A.; High, K. Is HIV a model of accelerated or accentuated aging? J. Gerontol. A Biol. Sci. Med. Sci. 2014, 69, 833–842. [Google Scholar] [CrossRef] [Green Version]
- Schouten, J.; Wit, F.; Stolte, I.; Kootstra, N.; Valk, M.; Geerlings, S.; Prins, M.; Reiss, P. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: The AGEhIV cohort study. Clin. Infect. Dis. 2014, 59, 1787–1797. [Google Scholar] [CrossRef]
- Guaraldi, G.; Milic, J.; Mussini, C. Aging with HIV. Curr. HIV/AIDS Rep. 2019, 16, 475–481. [Google Scholar] [CrossRef]
- Sangarlangkarn, A.; Avihingsanon, A.; Appelbaum, J.S. Application of geriatric principles and care models in HIV and aging. Interdiscip. Top Gerontol. Geriatr. 2017, 42, 119–133. [Google Scholar]
- Perfect, C.; Wilson, L.; Wohl, D.; Okeke, N.L.; Sangarlangkarn, A.; Tolleson-Rinehart, S. Improving care for older adults with HIV: Identifying provider preferences and priorities. J. Am. Geriatr. Soc. 2020, 68, 891–892. [Google Scholar] [CrossRef]
- Leipzig, R.M.; Whitlock, E.P.; Wolff, T.A.; Barton, M.B.; Michael, Y.L.; Harris, R.; Petitti, D.; Wilt, T.; Siu, A. Reconsidering the approach to prevention recommendations for older adults. Ann. Intern. Med. 2010, 153, 809–814. [Google Scholar] [CrossRef] [Green Version]
- Tinetti, M.E.; Fried, T.R.; Boyd, C.M. Designing health care for the most common chronic condition—Multimorbidity. JAMA 2012, 307, 2493–2494. [Google Scholar] [CrossRef]
- Hamczyk, M.R.; Nevado, R.M.; Barettino, A.; Fuster, V.; Andrés, V. Biological versus chronological aging: JACC focus seminar. J. Am. Coll. Cardiol. 2020, 75, 919–930. [Google Scholar] [CrossRef]
- Pavanello, S.; Campisi, M.; Fabozzo, A. The biological age of the heart is consistently younger than chronological age. Sci. Rep. 2020, 10, 10752. [Google Scholar] [CrossRef]
- Francesco, D.; Wit, F.W.; Bürkle, A.; Oehlke, S.; Kootstra, N.A.; Winston, A.; Franceschi, C.; Garagnani, P.; Pirazzini, C.; Libert, C.; et al. The co-morbidity in relation to AIDS (COBRA) collaboration: Do people living with HIV experience greater age advancement than their HIV-negative counterparts? AIDS 2019, 33, 259–268. [Google Scholar] [CrossRef] [Green Version]
- Gross, A.M.; Jaeger, P.A.; Kreisberg, J.F.; Licon, K.; Jepsen, K.L.; Khosroheidari, M.; Morsey, B.M.; Swindells, S.; Shen, H.; Ng, C.T.; et al. Methylome-wide analysis of chronic HIV infection reveals five-year increase in biological age and epigenetic targeting of HLA. Mol. Cell 2016, 62, 157–168. [Google Scholar] [CrossRef] [Green Version]
- Thompson, M.A.; Horberg, M.A.; Agwu, A.L.; Colasanti, J.A.; Jain, M.K.; Short, W.R.; Singh, T.; Aberg, J.A. Primary care guidance for persons with human immunodeficiency virus. Clin. Infect. Dis. 2020. [Google Scholar] [CrossRef]
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available online: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf (accessed on 10 October 2021).
- Dyer, M.; Kerr, C.; McGowan, J.P. Comprehensive Primary Care for Adults with HIV. Medical Care Criteria Committee. Available online: https://www.hivguidelines.org/hiv-care/primary-care-approach/ (accessed on 10 October 2021).
- European AIDS Clinical Society. Guidelines Version 10.0. Available online: https://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html (accessed on 23 June 2020).
- British HIV Association. Current Guidelines. Available online: https://www.bhiva.org/guidelines (accessed on 30 September 2021).
- Sangarlangkarn, A.; Apornpong, T.; Justice, A.C.; Avihingsanon, A. Screening tools for targeted comprehensive geriatric assessment in HIV-infected patients 50 years and older. Int. J. STD. AIDS 2019, 30, 1009–1017. [Google Scholar] [CrossRef]
- Rosca, E.C.; Albarqouni, L.; Simu, M. Montreal cognitive assessment (MoCA) for HIV-associated neurocognitive disorders. Neuropsychol. Rev. 2019, 29, 313–327. [Google Scholar] [CrossRef]
- Sangarlangkarn, A.; Appelbaum, J.S. Comprehensive geriatric assessment in older persons with HIV. Open Forum. Infect. Dis. 2020, 7, ofaa485. [Google Scholar] [CrossRef]
- Erlandson, K.M.; Plankey, M.W.; Springer, G. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med. 2016, 17, 740–748. [Google Scholar] [CrossRef] [Green Version]
- Grinspoon, S.; Corcoran, C.; Lee, K. Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J. Clin. Endocrinol. Metab. 1996, 81, 4051–4058. [Google Scholar]
- Centers for Disease Control and Prevention. Assessment TUG. Available online: https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf (accessed on 1 September 2021).
- Stanton, D.L.; Wu, A.W.; Moore, R.D. Functional status of persons with HIV infection in an ambulatory setting. J. Acquir. Immune Defic. Syndr. 1994, 7, 1050–1056. [Google Scholar]
- Escota, G.V.; Patel, P.; Brooks, J.T.; Bush, T.; Conley, L.; Baker, J.; Kojic, E.M.; Hammer, J.; Önen, N.F. The veterans aging cohort study index is an effective tool to assess baseline frailty status in a contemporary cohort of HIV-infected persons. AIDS Res. Hum. Retrovir. 2015, 31, 313–317. [Google Scholar] [CrossRef] [Green Version]
- American Diabetes Association. 12 Older adults: Standards of Medical Care in Diabetesd 2021. Diabetes Care 2021, 44, S168–S179. [Google Scholar] [CrossRef]
- Soto-Perez-de-Celis, E.; Li, D.; Yuan, Y.; Lau, Y.M.; Hurria, A. Functional versus chronological age: Geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol. 2018, 19, e305–e316. [Google Scholar] [CrossRef]
- Traven, S.A.; Reeves, R.A.; Althoff, A.D.; Slone, H.S.; Walton, Z.J. New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures. J. Orthop. Trauma 2019, 33, 319–323. [Google Scholar] [CrossRef]
- Sarkar, A.; John, A.; Nagarsheth, K.H. Predictive effect of frailty on amputation, mortality, and ambulation in patients undergoing revascularization for acute limb ischemia. Ann. Vasc. Surg. 2021, 73, 273–279. [Google Scholar] [CrossRef]
- Wang, Y.; Zhang, R.; Shen, Y.; Su, L.; Dong, B.; Hao, Q. Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data. Clin. Interv. Aging. 2019, 14, 1187–1197. [Google Scholar] [CrossRef] [Green Version]
- Sangarlangkarn, A.; Merlin, J.S.; Tucker, R.O.; Kelley, A.S. Advance care planning and HIV infection in the era of antiretroviral therapy: A review. Top Antivir. Med. 2016, 23, 174–180. [Google Scholar]
- Erlandson, K.M.; Karris, M.Y. HIV and aging: Reconsidering the approach to management of comorbidities. Infect. Dis. Clin. N. Am. 2019, 33, 769–786. [Google Scholar] [CrossRef]
Guideline Issues and Corresponding Strategies | Recommended Tools | Domains Addressed | Tool Details |
---|---|---|---|
Chronological age | |||
Use frailty or cognitive/functional status to inform shared decision-making on goals/interventions | Montreal Cognitive Assessment (MoCA) | Cognition | - Utilized in prior research in People with HIV (PWH) [20,21]; - Can screen for cognitive impairment of all causes (HIV-associated neurocognitive disorders as well as other causes) [22]. |
Mini-cog | Cognition | - 3-word recall coupled with clock-drawing test: 3/3 recall = normal; 1 − 2/3 recall + normal clock = normal; 1 − 2/3 recall + abnormal clock = impaired; 0/3 recall = impaired. | |
Timed get-up-and-go (TUG) test | Function | - Utilized in prior research in PWH [23,24]; - Explore multiple components of mobility (gait speed, balance, and proximal muscle strength); - Correlate with function and more formal tests on balance and gait speed; - Patient is timed while he/she rises from a chair, walks 3 m, turns, walks back, and sits down again; - At risk of falling if ≥12 s [25]. | |
Activities of daily living (ADL) and instrumental activities of daily living (IADL) | Function | - Utilized in prior research in PWH [20,26]; - Minimal training required; - Practical, focus on daily task deficits that can guide interventions and directly improve quality of life [22]; ADL: bathing, dressing, grooming, toileting, transferring, and eating; IADL: cooking, shopping, managing medications, using the phone, doing housework, doing laundry, driving or using public transportation, and managing finances. | |
Residing in a long-term care facility vs. the community | Function Cognition | - Used by the American Diabetes Association to guide A1c goal | |
Veterans Aging Cohort Study the (VACS) index | Frailty | - Developed specifically for PWH; - Utilizes commonly drawn lab values in PWH; - Easily accessible on MDCalc (https://www.mdcalc.com/veterans-aging-cohort-study-vacs-index) (accessed on 9 September 2021) - At risk of frailty if >18 [27]. | |
Take time to benefit into account | Higher number and severity of comorbidities | Mortality | - Used by the American Diabetes Association to guide A1c goal |
Veterans Aging Cohort Study the (VACS) index | Mortality | - Provide all-cause 5-year mortality risk | |
Multifactorial nature of conditions | |||
Elicit patient preferences when guidelines clash | Geriatric 5M model | Multimorbidity | - Explore “Matters Most to Me” component; - Weigh patient’s desired goals and aversions to related side effects to guide decisions. |
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Sangarlangkarn, A.; Yamada, Y.; Ko, F.C. HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV. Pathogens 2021, 10, 1332. https://doi.org/10.3390/pathogens10101332
Sangarlangkarn A, Yamada Y, Ko FC. HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV. Pathogens. 2021; 10(10):1332. https://doi.org/10.3390/pathogens10101332
Chicago/Turabian StyleSangarlangkarn, Aroonsiri, Yuji Yamada, and Fred C. Ko. 2021. "HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV" Pathogens 10, no. 10: 1332. https://doi.org/10.3390/pathogens10101332