Growing Older and Frailer… With HIV
Date: 01/12/2015 Host: @rehabHIV
Final month of the year and we only have three #OTalks left. Once again a huge thanks to our extra team for supporting us. This week @Nnikki_Duffy will be supporting @Esthermmc who will be tweeting from @rehabHIV.
Thanks for inviting me back to present another #OTalk. I’ve just read through the transcript from last year’s Tweetchat and am amazed at how many things we touched on, although briefly. You can refresh your memory here https://otalk.co.uk/2014/07/21/otalk-22nd-july-2014-hiv-and-occupational-therapy/.
This year I thought we would focus on HIV, Ageing and Frailty, which is a growing issue within HIV care.
But going back to basics first, HIV was first diagnosed in the early 80’s, with first treatments available in the early-to-mid 1990s. These anti-retroviral drugs are often referred to as ARVs, ART, or HAART (highly active anti-retroviral therapy), and are different types of drugs that interrupt different stages of the replication process. People take a combination of the drugs to stop the virus in as many ways as possible. Prior to the introduction of these, a person diagnosed with HIV would develop various complications of an impaired immune system, leading to eventual death (thought to be about ten years after infection).
Since the introduction of more and more effective drug therapy, people are living longer with HIV, and someone diagnosed today at an early stage of infection could expect a normal lifespan with good adherence to treatment. Early infection is indicated by a high CD4 count (immune system marker) and low viral load (copies of the virus in the blood). 40% of new diagnoses in 2014 were ‘late’ with a CD4 less than 350, previously the cut off point for starting treatment. There is a ten-fold increased risk of death within in one year when diagnosed late.
We are however now seeing the long term effects of living with HIV. Research shows that HIV causes the immune system to age faster, so conditions of ageing are seen in younger populations of positive people. ‘Older’ adults are considered those over the age of 50 in HIV care! There is also thought to be a link between some of the ARVs and these comorbidities. Some of the common co-morbidities include bone health, cardiovascular problems, and cancer.
People living with HIV (PLH) over the age of 50 fall into two categories – those who have been living for many years with HIV, so are sometimes referred to as long-term survivors (often from pre-ARV times), and those who are newly diagnosed as an older adult. In 2014 30% of new diagnoses of HIV were in those over 45, compared to 16% in 2005, and 1 in 4 PLH in the UK is now aged over 50.
And thinking about frailty (taking into account this year’s research that older people don’t like the term frailty – see the ‘I’m still me’ link found here http://www.uclpartners.com/our-work/academic-health-science-network/integrated-co-morbidities/what-matters-most) how do we define it and how does it relate to PLH?
So, why does this matter for occupational therapists?
- You’re more likely to see someone who has HIV as a co-morbidity in your service
- Services are sometimes still ‘ageist’ – making it difficult to access required rehabilitation because PLH aren’t old enough, even if they have all the co-morbidities expected in someone much older
In this Tweetchat I’d like to explore some of these issues – why the premature ageing, which co-morbidities, and how to approach the occupational therapy process when working with someone living with HIV.
People seen for HIV care by age group over time; 2005-2014 – PHE 2015