HIV co-morbidities – are we measuring and responding them appropriately?
People living with HIV
- Have increased frailty compared with the general population as they age calling for MDT/ holistic approach as a response [Jenifer Hoy]
- More at risk of polypharmacy (>5 meds). Polypharmacy can lead to non-adherence, morbidly, Side effects, and interactions. The PAART study showed that >75% took >1 concomitant medication. The most commonly prescribed concomitant medications included lipid lowering medications, antidepressant, antiviral, PPI, anticoagulant, PDE5i, anti-diabetogenic and anticonvulsant. Many of these have serious interactions with ART. >700 interactions were found and 18.9% were on a CI regimen. Showing the importance of coordinated care, rationalising medications and regular good drug histories to prevent interactions.. [Krista Siefried]
- Increased risk of renal disease (historically due to HIV now shifting to ART and advancing age). Renal disease is associated with worse patient outcome and people with risk factors/ renal disease benefit from early intervention, screening and management. There are no guidelines in Australia that look at monitoring for renal disease in PLHIV. However, there are international guidelines (EACS) that propose U&E and protein creatinine ratio (PCR) to stratify PLHIV into risk categories and then refer to specialist as appropriate. In a retrospective case review n=229 mainly male 30-39 with Low prevalence of known renal disease. Only 34% had PCR despite high prevalence of renal risk factors including smoking, HTN, HCV and low CD4/ high VL. Lack of simple urine dip signified a missed opportunity to pick up early disease/ proteinuria. Screening for renal disease fell below recommendations and should be considered in PLHIV [Tahiya Amin]