Are health problems of aging HIV patients being underserved in Stanislaus County?
HIV infections proved fatal for more than 100,000 people in the United States in the 1980s. But the life expectancy today for people living with the virus is not much less than for the general population.
Because of anti-retroviral therapies, the average lifespan for those living with HIV is between 71 and 74.6 years, instead of one or two years during the worst of the AIDS epidemic.
Still, many of those in this aging population struggle with limited financial resources, disability and health complications, some of which are related to decades of treatment and stress, according to the “State of Aging with HIV” annual report.
Jeffrey Lewis, chief executive officer of the Legacy Health Endowment, summarized the HealthHIV report in an opinion piece in the Turlock Journal. The Legacy endowment aligns funding and technical support for improved wellness in Stanislaus and Merced counties.
“One thing that stands out for me is that the medication has helped them live longer lives, but (for many) over the years, the impact on them individually has been devastating,” Lewis said. “Many of these people find themselves without any kind of community-based support.”
HealthHIV, a national nonprofit, points out that more than half of those living with HIV in the country are 50 years or older. Healthcare providers are managing “an increasingly medically complex HIV population that presents with geriatric needs earlier than the general population,” the report’s executive summary says.
HIV impacts biological changes of aging
Studies by UCLA and other centers have shown HIV hastens the biological changes of human aging, apparently due to the immune system’s prolonged battle with the virus, inflammation and side effects of drugs that treat it, Lewis wrote.
A national survey of long-term patients for the HealthHIV study found that in 98% of cases, the drug therapies suppressed the virus. But the data also showed realities of aging with HIV, including multiple health conditions, risks of becoming medically frail, mental health issues and the struggles of daily life, along with uneven support from health providers and others.
“Many respondents report good quality of life,” the study concluded. “Yet mental health stress is widespread and often hidden. Medication coverage is largely intact for now.”
While the health system is succeeding in suppressing the virus, many patients are not being screened for geriatric health problems, chronic health conditions and mental health needs.
Lewis cited Kaiser Permanente research finding the risks of dementia is higher among HIV-infected older adults. California residents with HIV have higher risks of developing certain types of cancer or struggle with the effects of long-term treatment, such as nerve pain in the hands and feet.
Long-term survivors who were born with HIV are vulnerable to heart disease, kidney damage and anemia, according to The Well Project.
Almost 40% of patients who are HIV-positive report symptoms of depression. In addition, AIDS survivor syndrome may profoundly affect older patients who lost friends to AIDS. Those with the syndrome are known to experience depression, anger, low self-esteem, social withdrawal and survivor’s guilt.
About 5% of respondents in the HealthHIV survey said they had no support system, while 30% could rely on support from only one or two people. “It is a glaring reminder that the HIV isolation symbolic of the early 1980s still exists for far too many, even 46 years later,” Lewis wrote.
Legacy Health Endowment working toward expanded care
Lewis said Tuesday that he’s working on an analysis to expand a community care program. People aging with HIV could be included in a program expansion in 2027 to help them be independent and keep them out of costly long-term care facilities. He doesn’t have the data yet to illustrate the need in Stanislaus County.
The annual HealthHIV study said the payment system for HIV medications is showing signs of fragility. Ten of the AIDS Drug Assistance Programs for low-income people in states have financial deficits, and that number is expected to grow to 19 next year.
At least two states have waiting lists for ADAP assistance.
The HealthHIV report recommends:
- Improving geriatric health screening, care planning and fall risk assessments for patients 50 and older.
- Funding nutrition, transportation and case management for older adults with HIV.
- Making mental health screening a routine part of HIV primary care.
