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.