People with HIV have a greater risk of comorbidities including heart disease, cancers, osteoporosis, and neurocognitive impairment, often manifested at younger ages. It is thought that HIV contributes to more rapid ageing due to prolonged immunodeficiency, chronic inflammation, and immune activation. Side-effects of treatments are also believed to contribute to earlier ageing in those with HIV.
Research indicates that older people with HIV have multiple co-occurring diseases (comorbidities or sometimes multimorbidities), experience anxiety about ageing, high rates of depression, reduced self–esteem (sometimes related to altered body shape and image), and feel the need to carefully manage disclosure of their HIV status (and sexuality) in the face of stigma and perceived stigma.[19] The nursing literature on ageing people with HIV also emphasises comorbidities, long–term medication toxicities and drug interactions, erectile dysfunction, diabetes, peripheral neuropathy, hepatitis C and renal disease as concerns requiring attention.[20] [21]
One large international case-control study showed that, compared with HIV–negative controls, HIV–positive people have a higher rate of comorbidities at all ages; however, the most significant rate was among those over 60 years, where the rate of comorbidities in people with HIV was 63% compared with 12% for HIV–negative controls.[22] In addition, comorbidities may appear from 10 to 20 years earlier than they do among HIV-negative people.[23] [24] [25] Non–acquired immune deficiency syndrome (AIDS)-related conditions or comorbidities that disproportionately affect people with HIV include cardiovascular disease, diabetes, osteoporosis, liver and kidney disease, mental health issues, cognitive problems, drug and alcohol problems to name a few. Cardiovascular disease can be related to untreated HIV infection and certain antiretroviral therapies.[26]
Cancers
People with HIV are at a higher risk of some types of cancers. This is believed to be due to several factors, including immune deficiency, co-infection with other viruses such as human papillomavirus (HPV) or hepatitis viruses[27] and higher rates of smoking.[28] Certain cancers - Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer are classified as AIDS-defining illnesses. HIV-associated cancers that are mostly infection-related occur at relatively high rates in people with HIV - anal cancer, vulvovaginal cancer, penile cancer, and liver cancers.[29]
Some cancers can be prevented. Nurses’ roles in preventing both HIV-related and other cancers focuses on health promotion and client education (advice and referrals for smoking cessation, safety in the sun to minimise the risk of skin cancers), promotion of appropriate screening for cancers, and antiretroviral adherence support to maintain optimal immune health. The START study results indicate that the risk of at least some cancers is reduced if people start treatment early.[30]
While AIDS–defining cancers remain the most common cancers in people with HIV, both HIV–related and non–AIDS–defining cancers are increasing and are much more prevalent among people with HIV than within the general population.[31] Hospitalisation rates for people with HIV have been reported as 50–300% higher in a cohort of HIV patients in Australia than in comparable groups (by age and sex) in the general population, with age being significantly associated with hospitalisation.[32] Mortality rates among people with HIV are still around 10–fold higher than in the general population.[33]
Thus, as people with HIV live longer, the prevalence of comorbidities increases significantly, and negatively affects health-related quality of life – people with HIV require enhanced community support.[34]
Palliative care skills and knowledge are still important in the care of people with HIV. Referral to palliative care services and collaborative care between HIV and palliative care services can ensure quality care at the end of life.
Respite and long-term care
People with HIV may be concerned about accessing services such as respite and long-term aged care, due to fear of stigmatisation and discrimination when their HIV status is disclosed, and to a perceived lack of knowledge and experience of carers and care workers in caring for this group.[35]
Nurses working in the HIV sector can provide assistance in advocating for people with HIV and in navigating services, in residential, respite or community care.
Community-based and district nurses, carer support agencies in various states and territories and general practitioners can advise on options for people with HIV in their local areas, as well as services that can help carers. The Commonwealth Home Support Program helps facilitate respite in a person or their family member’s home, in community centres or aged-care facilities.
http://www.myagedcare.gov.au/#!/aged-care-services/commonwealth-home-support-programme
Home care packages are now consumer-directed: that is, people and carers can choose how their home care package of services is provided: see My Aged Care website for further information. Assessment for respite and for home care packages are obtained via My Aged Care:
http://www.myagedcare.gov.au/
To download a guide for carers of older people with HIV see:
https://livingpositivevictoria.org.au/wp-content/uploads/2016/09/PositiveCaringHandbook.pdf