This older man is living with HIV, but leads a healthy life thanks to evolving medical care.Credit: HIV in View - Shutterstock Studios
“Treating HIV effectively requires a comprehensive multidisciplinary response,” says Alan Winston, Professor of Medicine at Imperial College, and an HIV consultant at St Mary's Hospital in London. “As people living with HIV grow older, they present new challenges for physicians to address. The needs of individuals living with the virus evolve, and so must the ways we treat each person.”
Since the mid-1990s, antiretroviral therapy (ART) has enabled people living with HIV to live longer, healthier lives than before. For the vast majority, taken as prescribed, ART suppresses the virus such that it becomes undetectable and untransmittable via sexual transmission.1 However, there are health-related challenges beyond viral suppression that still need to be addressed. For example, people living with HIV may be more likely to suffer from the early onset of other health conditions, including heart disease, high blood pressure and metabolic disease.2,3 Treating those associated comorbidities can increase the likelihood of polypharmacy, where multiple medications are needed to manage other long-term health conditions. For people living with HIV, taking a number of medications alongside those prescribed for HIV can add significantly to the complexities of overall care.
Winston researches these longer-term complications in people living with HIV. “We are beginning to understand more about how the body responds to chronic HIV infection and ART, but we have yet to determine why other health conditions are more prevalent,” he says.
Gathering insights from people living with HIV can guide health-care providers to improve services. The Positive Perspectives study, produced by ViiV Healthcare, a pharmaceutical company focused on the development of new medicines for the treatment and prevention of HIV, compiled patient-reported data from more than 2,000 people living with the virus worldwide. Results shared throughout 2020 explored how respondents rated their own health, their relationships with health-care providers, and how HIV and ART influenced their daily lives.
Many participants expressed a wish to be more involved in their long-term treatment decisions. Common anxieties included coping with depression and loneliness, and the long-term impacts of ART. Of the 2,112 respondents, 68% cited worries about the long-term effects of HIV medications, and 73% said they were willing to try HIV treatments with fewer individual drug components, providing their viral load remained suppressed.4
Addressing all these issues requires different specialties, says Winston. “Co-ordinated collaboration within a multidisciplinary team allows us to provide tailored consultations and treatment.”
Winston recommends that, where required, patients should be able to access HIV-specialist-pharmacists, physicians from other disciplines, and psychologists, as well as their GP. “Covering differing health-care topics at different consultations will help maximize clinical interactions,” he says. “If you get to know patients well, you get an intuitive sense of how they are coping, both with HIV treatment and care, and from a mental health perspective.”
A 2020 study named Aging with Dignity, Health, Optimism & Community (ADHOC) found that more than half of people aged 50-59 living with HIV feel consistently lonely.3 Depression, anxiety, coping with at least four co-morbidities, and feeling distanced from friends all contribute to loneliness.5 The COVID-19 pandemic has compounded these issues further; Winston notes that providing continuity of care during these times has become even more challenging. “Isolation, mental-health issues and recreational drug use have risen in our community,” he says. “Ensuring people have ongoing access to care via online and telephone communication is vital and must continue beyond the pandemic.”
Winston believes that virtual consultations can make HIV care more flexible. Providing access to blood test results remotely can also free up time in consultations. This way, time spent directly with patients can focus on themes beyond viral suppression, including mental and sexual health, disclosure challenges and other potential stressors.
Despite great advances in HIV education and care over the last 20 years, HIV stigma remains. Winston encourages open conversations about living and ageing with HIV to extend into the wider public domain. “Doctors must be advocates for our patients, and ensure we understand all aspects of a person’s life with HIV — and any effects on treatment.”