B.C. team forecasts the healthcare needs of people living with HIV in the coming decade

Thanks to effective HIV treatment, the proportion of people living with HIV over 60 is growing
B.C. researchers simulated health and healthcare changes for people with HIV to the year 2034
More people with HIV are expected to have cardiovascular issues, cancer or other comorbidities

Thanks to the tremendous power of HIV treatment (antiretroviral therapy, ART), many people with HIV who are taking ART will live well into their senior years. As this population ages, they will become at risk for complications related to aging. What’s more, studies have found that people with HIV are at risk for earlier onset of age-related issues. Additionally, some studies have found that aging people with HIV are at risk for premature death from causes unrelated to HIV.

There are complex reasons for the earlier onset of age-related issues in people with HIV. In some cases, it may be due to excess inflammation caused by chronic HIV infection despite the use of ART and good adherence. In other cases, there may be psychosocial factors, such as isolation and lack of social support. Structural factors—such as access to housing, healthy food, healthcare and medicine—may also play a role. In addition, uncontrolled substance use may be a factor in the overall decline of health with age.

A team of scientists at the BC Centre for Excellence in HIV/AIDS, the University of British Columbia and Simon Fraser University developed a computer simulation to try to understand some of the needs of people with HIV as they age. The scientists incorporated health-related information from several databases in this province. The simulation projected potential changes in issues that people with HIV and health systems could face by the year 2034.

Changes in HIV cases and population aging

The simulation estimated that the number of people living with HIV in B.C. was expected to peak at 9,427 people in 2025 and decline slightly to 9,182 by 2034.

The researchers stated that there was a “pronounced demographic shift towards older age groups” in the HIV population. For instance, in 2019 about 24% of people with HIV in B.C. were aged 60 and older. The simulation estimated that by 2034 nearly 50% of people with HIV will be in this age category.

In 2019, 6% of people living with HIV were 70 years of age or older. The simulation estimated that by 2034, 24% of people with HIV will be in this age category.

Among people with HIV aged 70 and older, the scientists expect that issues such as cardiovascular disease, cancers and high blood pressure will be major health concerns.

Comorbidities

As people age, they become at risk for many complications (comorbidities), including type 2 diabetes, high blood pressure, cardiovascular disease, cancer, thinning bones and mood and anxiety disorders.

The researchers underscored the significance of mood and anxiety disorders, noting that the “proportion of people with HIV experiencing at least one mental health condition will increase from 49% in 2019 to 52% in 2034.” This finding from the simulation highlights what the research team stated is “the persistent need for mental healthcare within this population.” The researchers noted that mood and anxiety disorders will be the chief mental health issues for people with HIV in the future, while other mental health issues, such as schizophrenia and personality disorder, are projected to “increase moderately.”

The simulation found that the proportion of people with HIV who have at least two physical comorbidities will increase from 21% in 2019 to 29% in 2034.

The scientists stated that in 2019, about 9% of people with HIV had been diagnosed with cancer at some point in their past. The simulation projected that by 2034, the proportion with past cancer diagnosis would almost double, to 17% of people with HIV.

Focus on sex of the population

Past research in B.C. has found that males and females with HIV can have different patterns of health issues. This may be related to the greater vulnerability of females with HIV to substance use disorder in this province. As a result, more females are likely to experience chronic obstructive pulmonary disease (COPD) as well as mood and anxiety disorders.

The research team found that males are more likely to get cardiovascular disease than females. However, over time, the team projects that cancer may become a more pressing issue among males than high blood pressure.

These differences in comorbidities by sex indicate that tailored health strategies are needed for different parts of the population of people living with HIV.

Meeting the needs of an aging population

The simulation projected some good news: Many people with HIV will live well into their senior years. However, the simulation also underscored the need for health policy planners to start preparing to design and fund services for an aging population of people with HIV.

The researchers stated that “interventions for females should prioritize access to”:

primary care

harm reduction programs

smoking cessation

liver health management

mental health support

screening for anal, colorectal and lung cancers
cardiovascular risk assessment and management of high blood pressure and abnormal lipid levels in the blood
screening for and treatment of diabetes

Younger people

Although the simulation focused on older people, the team noted that younger people (defined by the researchers as below the age of 50) generally have fewer comorbidities, and the number of comorbidities that they do have tends to remain stable. The researchers stated that this likely arises from earlier initiation of ART and exposure to newer, relatively safer anti-HIV drugs. The researchers added: “However, efforts to promote healthy behaviours and mitigate long-term risks remain essential for this group.”

Integrated services

Based on the results of the simulation, the researchers called for the adaptation and integration of health services to meet the needs of a population of aging people with HIV. They stated: “Integrated care models [that] coordinate HIV care with mental health, geriatrics and chronic disease care [are] urgently needed. Multidisciplinary teams led by primary care providers, possibly including HIV specialists, psychiatrists, cardiologists and oncologists, should manage the complex needs of aging people with HIV. In addition, harm reduction programs for people who use drugs, treatment of opioid use disorder, and psychosocial support should also be accessible through integrated care.”

The researchers added that “behavioural interventions such as smoking cessation, [reduction in] alcohol use, and [encouragement of] physical activity are essential to mitigate key risk factors.”

Bear in mind

Like all studies, the present simulation was imperfect. In part, this arose because the researchers were not able to consider certain factors, such as adherence to ART, the impact of newer formulations of ART such as regimens that contain TAF (tenofovir alafenamide), or HIV treatment regimens with a reduced number of drugs (such as two-drug regimens). In addition, health issues such as osteoporosis and dementia were not taken into consideration. Nevertheless, the researchers’ simulated projections are reasonable and should encourage health authorities in B.C. and other parts of Canada to consider how they will manage the needs of a population aging with HIV.

The B.C. team intends to refine their simulation in the future. They stated that they “plan to test interventions designed to optimize care delivery within primary care settings, such as integrated mental and physical health services, enhanced access to preventive screening [for cardiovascular disease and cancer], and telehealth programs tailored to aging people with HIV.”

The researchers hope to evaluate programs “that provide coordinated geriatric, mental health and HIV care through multidisciplinary teams.” Such evaluation will assess the ability of these programs to reduce the burden of comorbidities and improve the health of aging people with HIV.

Lima VD, Zhu J, Shen T, et al. Forecasting multimorbidity in aging people with HIV using a microsimulation model. Communications Health. 2026;1(1):7.

From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.