Future challenges for clinical care of an ageing population infected with HIV: a modelling study

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Title: Future challenges for clinical care of an ageing population infected with HIV: a modelling study
Authors: Smit, M
Brinkman, K
Geerlings, S
Smit, C
Thyagarajan, K
Van Sighem, A
De Wolf, F
Hallett, TB
Item Type: Journal Article
Abstract: Background The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. Methods We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs—including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies— and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030. Findings Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug–drug interactions, in 2030, 40% of patients could have complications with the currently recommended fi rst-line HIV regimens. Interpretation The profi le of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These fi ndings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge.
Issue Date: 1-Jul-2015
Date of Acceptance: 9-Jun-2015
ISSN: 1473-3099
Publisher: Elsevier
Start Page: 810
End Page: 818
Journal / Book Title: Lancet Infectious Diseases
Volume: 15
Issue: 7
Copyright Statement: © Smit et al. Open Access article distributed under the terms of CC BY-NC-ND.
Sponsor/Funder: Medical Research Council (MRC)
Funder's Grant Number: MR/K010174/1B
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Age Factors
Anti-Retroviral Agents
Cardiovascular Diseases
Cohort Studies
Diabetes Mellitus
Drug Interactions
HIV Infections
Health Services Needs and Demand
Middle Aged
Models, Theoretical
Population Dynamics
Renal Insufficiency, Chronic
ATHENA observational cohort
1103 Clinical Sciences
1108 Medical Microbiology
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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