Changing Patient Demographics in HIV and Impacts of Polypharmacy on Treatment

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Viral Suppression in HIV Management

Changing Demographics and Challenges in HIV Care

Key Themes:

• Aging HIV Population
  • HIV patients are living significantly longer due to effective therapies
  • Average age in Dr. Walmsley's clinic exceeds 50 years, expected to surpass 65 soon
  • Survival rates approaching those of the general population
• Comorbidity Management
  • Aging HIV patients develop the same comorbidities as general population but at higher rates and younger ages
  • Common conditions include hypertension, lipid abnormalities, heart disease, diabetes, and frailty
  • Underlying causes may include immune activation from HIV, lifestyle factors, or other unknown variables
• Health Care Delivery Challenges
  • Need for multidisciplinary care beyond infectious disease expertise
  • Polypharmacy issues including drug interactions and side effects
  • Need for coordinated care among multiple specialists
• Psychosocial Concerns
  • Social isolation among older HIV patients who may have lost friends and family
  • Financial insecurity due to early career interruption following diagnosis
  • Ongoing stigma, particularly concerning future long-term care needs
  • Concerns about caregivers' inexperience with HIV in long-term care settings

Notable Insights:

Dr. Walmsley observed that "the HIV part of it is becoming much easier to manage, as many people are on very simple regimens, and they are able to maintain suppression," highlighting how treatment challenges have shifted from viral control to managing age-related conditions and social determinants of health.