20th International AIDS Conference - Melbourne, Australia


THBS01 Biomedical and Psycho-social Issues Faced by People Ageing or on Long Term Treatment for HIV: Is it Age, is it HIV, or is it Antiretrovirals (ARVs)?
  Bridging Session
Venue: Plenary 1
Time: 24.07.2014, 11:00 - 12:30
Chair: Rob Moodie, Australia

This session will explore how the shifting demographics of the HIV and AIDS epidemic demands a new focus to reach and treat people aged 50 and over who are currently underserved by HIV services, whether they have been living with HIV for a long time or newly diagnosed. The session will offer a multi-focus perspective on the issue. From the community perspective, two PLHIV speakers, one from a resource-limited setting, one from a resource-rich setting, will explain their lived experience of aging with HIV and their expectations regarding support from the health system. From the leadership perspective, it will review health services barriers to quality of life for older PLHIV and identify possible strategies for healthcare systems to cater for their specific needs. From the science perspective, the session will provide the latest research data regarding how HIV and its treatment affect the aging process and outline a way forward.
11:00
THBS0101
Webcast
Introduction

11:05
THBS0102
Powerpoint
Webcast
Disentangling biological aging, the inflammatory effects of long term HIV infection and adverse effects of ART
P. Reiss, Netherlands

11:20
THBS0103
Powerpoint
Webcast
Transition to aged care services - the lived experience of aging with HIV: what kind of specialized long term care services are required by the community?
D. Menadue, Australia

11:30
THBS0104
Powerpoint
Webcast
Transition to aged care services - the lived experience of aging with HIV: what kind of specialized long term care services are required by the community?
C. Nawina Nyirenda, Zambia

11:40
THBS0105
Powerpoint
Webcast
HIV and aging: shaping the health systems response
W. El-Sadr, United States

11:55
THBS0106
Powerpoint
Webcast
Addressing the psychosocial and behavioural aspects of aging with HIV and the impact of long-term treatment
M. Brennan-Ing, United States

12:10
THBS0107
Webcast
Questions and answers

12:23
THBS0108
Webcast
Closing remarks

Powerpoints presentations
Disentangling biological aging, the inflammatory effects of long term HIV infection and adverse effects of ART - Peter Reiss

Transition to aged care services - the lived experience of aging with HIV: what kind of specialized long term care services are required by the community? - David Menadue
Transition to aged care services - the lived experience of aging with HIV: what kind of specialized long term care services are required by the community? - David Menadue

Transition to aged care services - the lived experience of aging with HIV: what kind of specialized long term care services are required by the community? - Carol Nawina Nyirenda

HIV and aging: shaping the health systems response - Wafaa El-Sadr

Addressing the psychosocial and behavioural aspects of aging with HIV and the impact of long-term treatment - Mark Brennan-Ing



Rapporteur report

Track B report by Mark Bloch



Peter Reiss spoke of the ongoing research aimed at distentangling normal ageing from the inflammatory effects of longterm HIV and the adverse effects of ART. Cormorbidities are all higher in HIV. The same applies to having multiple comorbidities, particularly with ageing.  In patients with HIV, there are multiple causative factors – including lifestyle, but also chronic immune dysregulation and inflammation. Predictors of comorbidity include age, family history, smoking and duration of immunodeficiency (CD4<200). Persistent inflammation and innate immune activation add to this risk.

David Menadue, a 60 year old activist diagnosed with HIV in 1984 with history of AIDS, described the burden of illness in those older with HIV, commonly having multiple comorbidities and needing a good medical coordinator of their care. Ageing with HIV poses challenges of slower recovery from illness, less home support and potential discrimination in the general aged health care services.

Carol Nawinda Nyirenda from Zambia who created a patient-based NGO, spoke of the increasing proportion of HIV in people >50yrs (currently globally >30%), in low and high income countries, due to ART as well as older people at risk of contracting HIV.

Wafaa El-Sadr examined the health system response to HIV and ageing. She noted that in people >50yrs, enrolment into care was at a lower CD4 count and there was more rapid CD4 loss over time, and less robust CD4 response to ART. In addition there were more comorbidities and polypharmacy in older patients.  More data was available in high income countries for HIV as well as non-communicable diseases (NCD).  The ideal model of care for those older with HIV – parallel services, coordinated services or integrated with general services - was still be determined.

Mark Brennan - Ing from the ROAD project in New York (also conducted in Uganda), described the psychosocial aspects of living with HIV and ageing.  There was an interconnection of depression and mental illness, substance abuse, comorbidities and ability to adhere to ART. Self-reported and assessed depression was similar in New York and Uganda, and significantly higher in HIV than in the general population. Social networks were crucial to health in older people and were more depleted in those with HIV.
 

 




   

    The organizers reserve the right to amend the programme.