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Future challenges for clinical care of an ageing population
infected with HIV: a ''geriatric HIV'' modeling study......
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"According to a modelling study, in 15 years' time multimorbidity in HIV patients will be the norm.....the proportion of HIV-positive patients aged >50 years increasing from 42% in 2015 to 95% in 2030 (Figure 1)...In the same period, the proportion of frail and most frail
patients will increase from 26% to 28% and from 24% to 48% [75% frail - see graph below]......In 2030, we predict that 30% of HIV-positive patients will have geriatric syndrome and 34% will be disabled (Figure 2)."
Reported by Jules Levin
HIV Glasgow Oct 23-26 2016
Davide De Francesco1; Andrea Malagoli2; Olga Theou3; Stefano Zona2; Federica Carli2; Giovanni Dolci2; Cristina Mussini2;
Susan Kirkland4; Chiara Mussi5; Matteo Cesari6; Kenneth Rockwood3 and Giovanni Guaraldi2
1Department of Infection & Population Health, University College London, London, UK. 2Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy. 3Geriatric Medicine Research, Dalhousie University, Halifax, Canada. 4Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada. 5Geriatrics Division, University of Modena and Reggio Emilia, Modena, Italy. 6Centre Hospitalier Universitaire de Toulouse, Ge´rontopole, Toulouse, France
Introduction: According to a modelling study, in 15 years' time multimorbidity in HIV patients will be the norm [1]. In this context frailty, geriatric syndromes and disability will be relevant clinical outcomes.
We aimed at quantifying the scale of change in frailty and its implications for HIV care in Italy in the year 2030.
Materials and methods: An individual-based model of the aging population of the Modena HIV Metabolic Clinic (MHMC) was constructed using data collected between 2009 and 2015 from 3086 patients. The model follows patients enrolled to the clinic up to 2015 and generates new entries on a yearly basis up to 2030. Number, age and gender of new entries were modelled using trends observed in the period 2009 to 2015. Patients were followed as they age and accumulate deficits, resulting in the Frailty Index (FI, quantified as the proportion of deficits present out of a total of 37). FI at enrollment was generated from a gamma distribution with age- and gender specific parameters estimated using the MHMC 2009 to 2015 data.
Patients were classified as non-frail (FI 00.3), frail (0.30.4) and most-frail (FI0.4). Changes in the FI over a 1-year period and death rates were modelled following a validated mathematical model developed in a large Canadian ageing population [2], with parameters adjusted to best represent the changes observed in the MHMC 2009 to 2015 population. Geriatric syndrome was defined as of one or more self-reported falls in the past 12 months. Disability was assessed in eight categories of activities of daily function and defined as impairment in ]1 categories. The relationship between age, gender, geriatric syndrome and disability, observed in 2014 to 2015 at MHMC, was postulated to constant over time.
Results: Our model suggests that the median age of HIV-positive patients on combination antiretroviral therapy will increase from 49 years in 2015 to 59 in 2030, with the proportion of HIV-positive patients aged >50 years increasing from 42% in 2015 to 95% in 2030 (Figure 1). In the same period, the proportion of frail and most frail
patients will increase from 26% to 28% and from 24% to 48%, respectively. In 2030, we predict that 30% of HIV-positive patients will have geriatric syndrome and 34% will be disabled (Figure 2).
Conclusion: The increasing numbers of older patients with frailty, geriatric syndromes and disability depict a ''geriatric HIV'' scenario.
This model suggests evidence-based screening and monitoring protocols to ensure high-quality care.
References
1. Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, van Sighem
A, et al. Future challenges for clinical care of an ageing population
infected with HIV: a modelling study. Lancet Infect Dis. 2015;15:8108.
doi: http://dx.doi.org/10.1016/S1473-3099(15)00056-0
2. Mitnitski A, Song X, Rockwood K. Trajectories of changes over
twelve years in the health status of Canadians from late middle age.
Exp Gerontol. 2012;47:8939. doi: http://dx.doi.org/10.1016/j.exger.
2012.06.015
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