An article published today in the New England Journal of Medicine suggests that the world is not yet prepared to deal with an HIV-infected ageing population.
As antiretroviral therapy (ART) coverage continues to expand worldwide, the life expectancy of HIV-infected persons in developing countries will increase. Indeed, ART has reduced mortality rates in sub-Saharan Africa, with 320,000 (or 20%) fewer people dying of HIV-related causes in 2009 than in 2004. So the challenge in coming years will be how to care for these individuals as they grow older.
The article, HIV and Ageing Preparing for the Challenges Ahead, a joint effort by Edward Mills, a professor at the University of Ottawa's Faculty of Health Sciences, Till Bärnighausen of the Harvard School of Public Health, and Joel Negin of the Sydney School of Public Health, emphasizes that, despite the current international focus on non-communicable illnesses like cardiovascular disease and diabetes, the commitment to treating older HIV patients with these conditions is limited. Effectively addressing the needs of ageing HIV-infected populations will require political intervention, stronger health systems, greater human resources and improved clinical infrastructure and expertise.
Professor Mills says, The aging of the HIV epidemic in Africa and in many developing countries is one of the most challenging, yet unrecognized, public health issues affecting AIDS patients. HIV infection and HIV drugs increase a patient's risk for developing cancer and cardiovascular disease. As such, we may save a patient from dying of an immune disorder, only to have them succumb to a common preventable disease that we had not planned for. Strategies that can help aging patients include common and inexpensive drugs, such as statins, blood-pressure medication and aspirin treatment.
Recent modeling using South-African data suggests that HIV among people older than 50 will nearly double in the next 30 years, and the absolute number of similarly aged HIV-infected patients will triple in the same period. Designing programs for aging HIV-infected populations in developing countries will thus be a critical medical and public health challenge very soon.