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Results of a Multi-Disciplinary Approach Involving Geriatricians of a Clinic for Older People Living with HIV
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Download the PDF here
Download the PDF here
5 May 2023
Aylin Cansu Ates,1,* Andrei Bachnak,1,* Yana Murateva,1,* Yarden Toiber Kent,1,*
Sophie Blackburn, BMBS,2 Marta Boffito, MD, PhD, FRCP,1,2 Ana Milinkovic, MD, PhD,1,2
Tim Tong, MBBS, FRCP,2 and Maithili Varadarajan, MBBS, MSc2
Excerpts from h=full paper pdf attached.
To the Editor:
Older people (>50 years) living with HIV (PLWH) experience a high burden of multi-morbidity, which presents a need for co-ordinated care provided by a multi-disciplinary team to help effectively manage their conditions. To provide such care, a dedicated joint specialty HIV and geriatric clinic, named the PLUS50 clinic, was established at Chelsea and Westminster Hospital in 2015, with further specialty HIV clinics (cardiology, metabolic, menopause, renal, neurology, etc.) introduced to meet additional needs as identified by an analysis of 10 years of clinic activity.1 We present the findings from a retrospective analysis of patient records from the aforementioned clinic with the aim of providing support and advocate for the importance of specialist HIV geriatric clinics, as well as identifying and discussing potential improvements to the care of older PLWH.
Two years of retrospective data going back from first attendance at the PLUS50 clinic was collected from patient records of PLWH who attended between November 2019 and May 2022 to identify trends in multi-morbidity (≥2 non-HIV-related comorbidities), and subsequent antiretroviral therapy (ART)-excluded polypharmacy (≥5 non-ART co-medications),2 as well as frequency and nature of specialty visits in the patient population. The COVID-19 pandemic coincides with the period of interest in our letter, and we assume this reduced the number of patients (n = 68) attending the clinic.
Our study utilizes data from the health care experiences of almost 70 patients to identify four key factors to improve health outcomes for older PLWH, making it one of the largest sample-sized studies to address the health care needs of the aging population of PLWH. We found that a lack of effective collaboration between the different specialties handling and prescribing to older PLWH contributed to the causes of poor health outcomes, including inefficient and uncomfortable patient experiences, and nonattendance resulting thereof.
These findings further emphasize the need for a holistic multi-disciplinary approach to the care of older PLWH. Within a multi-disciplinary system, three further key factors stated in this report for improved outcomes for older PLWH were frailty assessment, modifiable health factor analysis, and deprescribing. The data presented and discussed support the suggestion that with the implementation of these key factors in the management of aging PLWH, both the patient experience, and outcome can be greatly improved.
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