The HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America has issued an update to its 2013 guideline for providing comprehensive, evidenced-based primary care to people living with HIV. The guidelines were published in Clinical Infectious Diseases.
As effective combination antiretroviral treatment as well as other improvements to the care and treatment of people with HIV have allowed this population to steadily age, these individuals encounter new health challenges associated with getting older.
Even people with well-treated HIV have an elevated risk of various health conditions associated with aging, including cardiovascular disease, various cancers, kidney disease, cognitive decline and bone density loss.
Aging in the context of such risks can also give rise to what’s known as polypharmacy—taking numerous medications. In general, taking five or more medications is associated with further health harms, which gives rise to something of a catch-22 for health care providers and their patients seeking to mitigate health risks when such medications are themselves taken to mitigate health risks.
The new HIV treatment guidelines are a reflection of the evolving health challenges people with the virus—and their health care providers—face as their health care needs become more complex and multifactorial.
“As people with HIV live long and productive lives because of effective antiretroviral therapy, it is more important than ever to provide them high-quality, state-of-the art primary care,” Rajesh T. Gandhi, MD, chair of HIVMA, said in a press release. “These guidelines provide clinicians with the updated information they need to prevent and manage co-occurring conditions that are more common in people with HIV and to support regular care engagement—all part of our mission to provide the best primary care for all of those living with HIV.”
The guidelines include a new section about treating COVID-19 among transgender and gender-diverse people with HIV.
They also include sections about how health care providers in HIV primary care can:
- Help people with HIV keep routinely engaged in medical care, taking their medications as prescribed and ultimately ensuring that they achieve and maintain an undetectable viral load
- Conduct an initial medical evaluation as well as routine health care visits thereafter
- Manage health conditions associated with aging in this population
- Care for people with HIV who may become pregnant, including cisgender women and trans men
- Provide care and treatment for children and adolescents living with HIV.
“Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic and individual levels,” the authors of the guideline wrote in its abstract. “As the population ages and noncommunicable diseases arise, providing comprehensive health care for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns.”
To read the new care guidance, click here.
To read a press release about the new care guidance, click here.