All people with HIV ages 50 or older said they had at least one comorbidity, and one in five reported suboptimal physical, mental, sexual and overall health, according to the results from a North American survey presented at IDWeek 2022.

The HIV population is aging thanks to effective antiretroviral treatment. In the United States, more than half of people living with HIV are now ages 50 or older. Advancing age can bring on a host of physical and mental health concerns, and research suggests HIV-positive people experience such problems earlier than their HIV-negative peers.

Megan Dominguez, PharmD, of ViiV Healthcare, and colleagues conducted a study of self-reported health concerns among older individuals living with HIV in the United States (122 people), Canada (24 people) and Mexico (15 people) who participated in the 2019 Positive Perspectives survey.

Self-rated health was assessed across four domains: physical, mental, sexual and overall. For each domain, health status was classified as optimal (self-reported as good or very good) or suboptimal (self-reported as neither good nor poor, poor or very poor.

The participants were at least 50 years old, including 14% who were 65 or older. About three quarters were men; racial demographics were not reported. Three out of four respondents had been living with HIV for 10 years or more (median 20 years).

All participants were currently on antiretroviral therapy. A majority (73%) were also on at least one non-HIV medication, including 11% who took five or more such medications. Most (80%) had switched antiretroviral regimens at least once, and 45% had done so four or more times. The most common reasons for switching were to reduce side effects (34%); to reduce the number of daily pills (28%) or the number of medications (16%); because the regimen was no longer effective—for example, due to drug resistance (17%;) or to manage drug interactions (11%).

All participants reported that they had at least one additional health problem besides HIV. The most common were high blood pressure (42%), elevated cholesterol (39%), mental health disorders (32%), insomnia (29%), arthritis (27%) and gastrointestinal problems (23%). What’s more, 86% said they had two or more comorbidities, and 66% reported three or more.

Overall, 76% of participants reported suboptimal health in at least one of the four domains. Most common was impaired sexual health, at 60%, followed by suboptimal physical health (48%), overall health (47%) and mental health (35%). Nearly one in five (19%) reported impairment in all four domains, and most of these people had at least two comorbidities. The comorbidities most strongly associated with poor health were mental health disorders, anemia, bone problems, insomnia and substance use disorders.

The good news is that 24% of participants reported optimal health in all four domains, and another 23% reported optimal health in three domains.

“Care for older adults living with HIV requires improved models that ensure the broader impacts of HIV are better managed,” the researchers concluded. “Quality communication is needed to identify poor mental health to enable more effective management of mental health disorders, which may impact quality of life.”

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