Federal Guidelines Provide a Path to Better Health Focus on Viral Load Suppression is Not Adequate

HRSA* (Health Resources & Services Administration) recently released new guidelines titled Optimizing HIV Care for People Aging with HIV: Incorporating New Elements of Care.

This represents a significant awareness by federal agencies that there is an urgent need to shift the sole focus of clinical care from sustained viral load suppression to include providing comprehensive clinical and supportive services for people living with HIV/AIDS (PLWHA) who are aging. This population of older adults living and aging with HIV have complex health needs that have expanded beyond HIV management. These older adults now dominate the HIV epidemic in the USA where more than 50% are age 50 and older.  PLWHA are living longer lives as a result of successful antiretroviral treatments which result in living typical long lifespans. Yet at the same time, these same individuals are more likely to face poor health and increased risk for death as they age. These PLWHA exhibit high rates of multimorbidity (i.e. having two or more chronic diseases). These chronic conditions include cardiovascular diseases, multiple non-HIV related cancers, kidney and liver disease, frailty, cognitive decline, and mental health conditions. HRSA recognized that there was a significant shift in the health needs of those aging with HIV and that care teams must be prepared to meet those challenges. In turn, these HRSA guidelines reflect a significant shift in health policy.

These guidelines are driven by a framework titled “Geriatric Multidisciplinary Approach to Healthcare”. This framework emphasizes the importance of health care teams establishing patient-centered goals driven by physical, mental health and well-being as well as maintaining ability to complete activities of daily living. A primary goal of geriatricians is to sustain function and independence.  At the same time, the guidelines emphasize the importance of coordinated care and the need to address non-medical challenges  For instance, social isolation, food and housing insecurity, trauma (including due to discrimination based on sexual orientation or gender identity) and managing health care benefits. As such, the guidelines recommend appropriate screenings and assessments for people aging with HIV.

This is the first time a federal agency has provided specific guidance for the care of people aging with HIV. Since HRSA predicts that 46% of Ryan White HIV/AIDS Program clients served in 2018 were 50 years old and older, these guidelines are both necessary and significant. Yet delivery of this care will depend on location, resources, and other factors. If you are interested in reading more about these new guidelines, you may do so by clicking here.

HRSA Ryan White HIV/AIDS Program (2020). Optimizing HIV Care for People Aging with HIV: Incorporating New Elements of Care [URL]. Retrieved from https://hab.hrsa.gov/sites/default/files/hab/clinical-quality-management/aging-guide-new-elements.pdf#:~:text=Optimizing%20HIV%20Care%20for%20People%20Aging%20with%20HIV%3A,highlight%20the%20screenings%20and%20assessments%20for%20these%20needs

* Health Resources & Services Administration (HRSA), the agency of the U.S. Department of Health & Human Services that manages the Ryan White Care Act HIV/AIDS Program.