FOCUS OF THE WEEK
Providers Face Challenges with Managing Elderly HIV/AIDS Patients
August 8, 2014, 09:56:01 AM
Katie Sullivan, MA
Older patients who are diagnosed with HIV/AIDS present a variety of challenges for providers, especially when it comes to controlling their costs of care. This is because aging patients afflicted with the disease are also likely to have higher rates of cardiovascular disease, diabetes, hypertension, impaired cognitive function, cancer, frailty, and behavioral health disorders when compared with patient populations of the same age without HIV. One 2013 study even found that patients who between the ages of 41 and 50 years who were diagnosed with HIV had higher rates of bone fracture and renal failure than HIV-negative patients over the age of 60 years.

“We're having to get better at chronic diseases because our population is living longer and aging,” said infectious-disease specialist Nicholas Van Sickels, MD, an assistant professor of clinical medicine at Tulane University. “It forces me and other (infectious-disease) physicians to be up-to-date on hypertension guidelines, cholesterol guidelines, and on diabetes-management guidelines.”

Until recently, most providers did not encounter many HIV-positive patients who lived into their 60s or even 80s. Patients with HIV typically begin to show signs of chronic diseases such as diabetes at a much earlier age than those who are not HIV-positive. The population of aging patients with HIV is also expected to increase. As of 2010, 1.3 million people were estimated to be living with HIV in the United States, and the CDC estimates that by 2015, half of them will be 50 years or older. In addition, about 50,000 new cases of HIV are diagnosed each year in the United States.

“We are learning as we go along,” Daliah Mehdi, chief clinical officer at the AIDS Foundation of Chicago stated. “We don't have the body of research around treating and living with HIV in older adults that we do in younger adults.”

Historically, research has focused on younger people living with the disease. This has excluded many older individuals from important research and clinical trials of drug therapies. Living into old age can also equate to larger costs for patients with HIV. Medications range from $2000 to $5000 a month, and other annual healthcare utilization associated with treatment can cost about $23,000. A majority of older HIV patients also receive Medicaid benefits (about 70%). In 2012, Medicaid spent $5.3 billion on HIV care alone, with 36% of that federal spending allocated to treating the disease.
Yet, guidelines for managing this population are lacking.

“Older patients often have multiple things going on, and you need to have kind of a holistic approach to taking care of them and not just focus on the HIV alone,” said Jonathan Appelbaum, MD, a professor of internal medicine at Florida State University, who served as co-principal investigator of the treatment recommendations. “The average clinician perhaps may not be aware of some of the issues about treating older (HIV) patients. We're trying to make them more aware that it is in fact a special population.”

Amy Justice, MD, MSCE, PhD, a professor of medicine at Yale University, added, “Neither older individuals nor their physicians often think of HIV quite the same way younger individuals do.”

Around the Web

Aging HIV/AIDS Patients Pose Challenges for Providers [Modern Healthcare]