ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
The ageing of PLWHIV calls for new models of primary care.
Rajasthan, R, Malaysia ; HIV and ageing Study.
One of the emerging challenges is the ageing cohort of PLWHIV within Australia. Many of these individuals have complex co-morbidities requiring experienced clinicians and team based models of care.
Dutch data indicates that 2 of 3 HIV positive individuals within Holland will be aged >50 by 2025. Similar trends are expected in Australia.
There were many sessions and posters looking at co-morbidities and ageing.
Many abstracts highlighted the increased prevalence of CKD, atherosclerosis, peripheral neuropathy, neurocognitive decline, diabetes and osteoporosis in PLWHIV. Ruzicka D Japan, Rajasuriar R Malaysia, to name a few of the many presenters.
Reena Rajasuriar presented findings from the Malaysian HIV and ageing Study.
Attempts were made to adequately match study participants. The concept of functional age was a central tenant of the design. Prior studies were highlighted for lack of adequate controls and use of subjective, poorly validated measuring tools. Dr Rajasuriar commented that single entities are often used to measure the ageing syndrome.
The Malaysian study focused on the multi factorial nature of ageing. The use of comprehensive geriatric assessments were utilised to reduce subjectivity bias.
All 10 markers of ageing were increased in the HIV positive arm compared to matched HIV negative participants.
- 2.5 times reduction in QOL indicators.
- 4 fold increase in mortality
- 5 fold greater utilisation of health services.
- Significantly more sarcopenia and functional disability.
New models of care were called for throughout the Asia Pacific region. In particular multidisciplinary teams, including but not limited to, social workers, dietitians, psychologists, nurses, GPs, physiotherapists, podiatrist and exercise physiologists.
Comprehensive geriatric assessments were heralded as ideal.
Much panel discussion was generated through audience participation
- Is this a realistic concept?
- Is the process clinician driven or patient driven?
- What management strategies are cost effective?
- How do we manage the increasing burden of subcortical neurodegeneration?
This session was very informative generating much discussion amongst my Australian colleagues.
As demand for complex services increase service innovation will be required.
Australia is proposing a new patient centric and patient driven model of care. Health care homes as primary care coordinators are also a central theme. This model is well suited to providing innovative care to the ageing population of PLWHIV.
Management of traditional lifestyle risk factors remains central to managing cognitive decline.
Focusing on functional age is increasingly seen as a more useful measure of healthcare needs rather than numbers of co-morbid conditions.