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Growing Old with HIV

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Growing Old with HIV Growing Old with HIV Private and public healthcare challenges grow as an aging population grapples with the ramifications of increasing numbers of HIV-positive senior citizens. By Trudie Mitschang 18 BIO SUPPLY TRENDS QUARTERLY | Winter 2018 IT’S BEEN 30 years since the human immunodeficiency virus health and risk behaviors with their older patients,” says Mark (HIV) and acquired immunodeficiency syndrome (AIDS) Brennan-Ing, PhD, director for research and evaluation at the epi demic first made headlines. In the ensuing years, medical AIDS Community Research Initiative. 1 breakthroughs and strides in HIV treatment and management Another influencing factor includes more effective HIV drug have resulted in diagnosed individuals living longer and relatively therapies that have allowed many who contracted the virus healthy lives. As a result, the HIV-positive population that just decades ago to survive well into their senior years. Many of these decades ago was not expected to survive is aging into senior adults are managing their HIV status successfully, although they cit izen status at an alarming rate, creating unique challenges for may face other health challenges related to the long-term effects healthcare providers and public health officials. Actually, not all of the virus and/or side effects of their medications. “The individuals over age 55 who are living with HIV contracted the challenges of caring for the patient with HIV who is aging disease when they were younger; many new cases are occurring are similar to those of caring for other aging patients,” says in an aging population that remains sexually active and HIV- Dr. Brennan-Ing. “The difference is that older adults with HIV ignorant. According to data presented at the 125th Annual may be confronting [age-related health] issues decades earlier Convention of the American Psychological Association, older than their non-infected peers; older adults with HIV are much adults make up almost half of all people living with HIV. And more likely to die from chronic conditions associated with aging these numbers are on the rise. 1 than an AIDS-related condition.” 1 Information presented at the 2016 White House AIDS and Aging Meeting stressed that misperceptions about risk have contributed to the uptick in HIV diagnoses: “Older age is not a Longer lifespans, rising safety net that protects people from getting HIV. Many issues surrounding older adults will only increase as our country faces the continuing graying of our nation’s HIV epidemic.” 2 divorce rates and lack Perceptions and Lifestyle Increase Risk Factors of education are all factors Longer lifespans, rising divorce rates and lack of education are all factors in the rising HIV rates among seniors. A recent Medscape article noted in the rising HIV rates that older adults who are sexually active may be at higher risk of contracting the virus, in among seniors. part because as a population they are over - looked when it comes to HIV education and prevention: “The lack of information about Social trends such as rising divorce statistics that put older HIV risk directed to older adults is com - individuals back in the dating scene also contribute to HIV pounded by the fact that HIV risk exists infection rates. In addition, the widespread availability of drugs in a context of secrecy, especially later like Viagra means seniors are much more likely to be sexually in life.” 3 In addition, certain behav - active with multiple partners, not realizing that advanced age can iors, such as older men intentionally make them even more vulnerable to infection. Some of the hiding sexual orientation, extramar - age-related risks include: ital sex, sex with commercial sex • An aging immune system is less resistant to infection. workers and substance abuse involv - • Underlying health conditions common in older individuals ing needles, create a perfect storm of can create increased vulnerability to communicable disease. vulnerability and denial. • Thinner skin as a result of aging may make it easier for the Infection risk may also be increased by virus to enter the bloodstream. an aging and potentially compromised When it comes to minimizing risk factors for HIV, knowledge immune system or other age-related is clearly power. For older adults, ignorance about risk can make health condi tions. “HIV is still perceived as them less likely to ask potential partners about HIV status, less a young person’s disease, so healthcare likely to be tested themselves and reticent to broach the subject providers may not regularly address sexual of sexual activity with their healthcare providers. BIO SUPPLY TRENDS QUARTERLY | Winter 2018 19 Aging Populations Experience Dual Diagnosis of federal spending on HIV care. 5 The cost of medications makes Thanks to advances in research and treatment, an HIV up a bulk of that figure. The addition of the Part D prescription diagnosis today does not automatically mean an AIDS diagnosis drug benefit for Medicare resulted in spending on HIV surpassing is soon to follow. However, the older one is at the time of federal Medicaid spending. diag nosis, the higher the probability of a dual diagnosis of HIV Medicare spending for HIV has increased over the years and, and AIDS, with the larger proportion of those dual diagnoses in fact, the program now serves as the single largest source of due to late-stage testing. According to the Centers for Disease fed eral financing for HIV care and treatment. 5 HIV patients Control and Prevention, as of 2014, 40 percent of those aged 55 under age 65 often qualify for Medicare because of their disability and older already had late-stage AIDS infections at the time of status, while a growing share of the HIV population is over age their HIV diagnosis. 4 Sadly, an older person could live for years 65 and already aged into the program. Other sources of financial with HIV without seeking medical attention, attributing the support for patients include Medicaid and state or community symptoms to other age-related conditions: assistance programs, AIDS Drug Assistance Programs (ADAP) • Fatigue and weight loss associated with AIDS could be inter - and other low-income subsidies. 5 preted as normal aging symptoms. • AIDS-related pneumonia is sometimes mistaken for congestive Evaluating the Emotional Toll heart failure in older patients. The mental health landscape for older adults living with HIV • HIV-related dementia can be mistaken for Alzheimer’s or is complex, with the population five times more likely to experi ence Parkinson’s disease. depression than those of a similar age who do not have the virus. In addition, some conditions, including heart disease, cancer, One study found 27 percent of HIV-infected older adults had dementia and kidney disease, may develop earlier in patients considered suicide, while a 2010 study found 39 percent of with HIV, and HIV-positive status can also worsen conditions HIV-infected older adults exhibited symptoms of major depressive common to seniors, including diabetes, osteoporosis, arthritis disorder. 6 and high blood pressure. 4 Compared to their younger counterparts, HIV-positive older adults have a lower survival rate following an AIDS diag - nosis and fewer social supports to help navigate the daunting task of disease care and management. Not surprisingly, all Medicare spending for people living with HIV are at increased risk of developing mood, cognitive or anxiety disorders, and depression’s ramifi - HIV has increased over cations can extend beyond emotional health, often leading to decreased levels of medication compliance. In a U.S. News and World Report article citing the psychological effects of HIV, the years and, in fact, Sheryl Catz, PhD, a clinical psychologist and professor who researches HIV, health behavior and chronic disease man - the program now serves agement, states, “We did find across the board that people who were depressed had a more difficult time with their as the single largest source [medication] adherence.” 7 Social isolation and post-diagnosis rejection by family and even partners can compound the overwhelming feelings of loss of federal financing for associated with a positive HIV diagnosis. While there is no one- size-fits-all coping strategy, finding a support group or at least HIV care and treatment. one trusted individual who can serve as a confidant can help alle viate some of the stigma and shame associated with HIV. “I’m a big believer [that], psychologically, it is important people Counting the Health and Financial Costs not be entirely isolated with their HIV diagnosis and they are Anyone living with HIV, regardless of age, faces extremely not living entirely alone with it,” said Robert Remien, PhD, a high medical costs, with the lifetime cost of care often totaling professor of clinical psychology and director of the HIV Center hundreds of thousands of dollars. Medicare serves as a significant for Clinical and Behavioral Studies at Columbia University. source of health coverage for people living with HIV. “We never recommend people disclose or not disclose,” adds According to a 2016 report published in the Henry J. Kaiser Dr. Catz. “But we do see a tremendous burden lifted off people Family Foundation titled “Medicare and HIV,” 2016 Medicare when they have a network of [supporters] who are aware of spending on HIV totaled $10 billion and represented 51 percent their status.” 7 20 BIO SUPPLY TRENDS QUARTERLY | Winter 2018 THE ONLY SUBCUTANEOUS INJECTION FOR THE PREVENTION OF HAE ATTACKS HELPING PATIENTS BREAK FREE FROM HAE HAEGARDA REDUCED HAE ATTACKS BY 95%* Patients also reduced rescue medication use while on HAEGARDA by >99%†1 HAEGARDA is the only subcutaneous injection for the prevention of HAE attacks HAEGARDA was found to be safe and effective *Median reduction in number of attacks vs placebo. †Median reduction in rescue medication use vs placebo.
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