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Recently two high impact medical journals included Editorials on HIV and Aging (Mohammadi 2017, Guaraldi 2017). The Editorials observe that as the number of older adults with HIV increases, clinicians and people living with HIV, need to assess what it means to have a “healthy life expectancy.” The Editorials conclude that older adults with HIV can benefit from models of integrated care developed by geriatricians. Rather than focusing on disease, those tested clinical principles focus on function. Diagnosing and treating comorbidities occurring in this aging HIV population is not sufficient to address the complexities of aging. Providers need to recognize frailty as well as syndromes of dementia, compromised mobility, risk for falls, and polypharmacy. This is uncharted territory which PLWH recognize. They have “complained that some GPs were unsure of the combined effects of HIV, ageing, and other comorbidities….nobody tells us what to expect from HIV and ageing (Mohammadi 2017).”
Adapting geriatric care principles to the aging HIV+ adult is needed. The older adult with HIV is unique. Care delivery must consider the social vulnerability of these patients who confront the toxic impact of both HIV and aging stigmas that are too often manifested in increased vulnerability to disability and loss of function. Structural barriers to care are likely to increase as these older adults seek treatment from providers not sensitized to their needs and associated stigma driven fears. When and how best to embrace geriatric care, principles needs to be answered by research into the still unknown interactions between HIV and other comorbid illnesses and social vulnerabilities.
This website (www.HIV-AGE.org) reflects the recognition by the expert panel of the HIV and Aging Consensus Project (Aging Consensus Project 2012) in 2010 of the need to change the principles for managing the health of older adults with HIV. That panel recommended embracing geriatric care principles. The Clinical Recommendations of the project, found on this site, have been modified and expanded as new research data has become available. Those recommendations have been distilled into a patient centered booklet Staying Healthy with HIV as You Age (https://www.acria.org/achieve). In addition, the site now offers CMEs that address many of the multiple issues the two Editorials emphasize.
Stephen Karpiak PhD, New York University and HIV-AGE editorial staff