Evaluation of a clinic dedicated to people aging with HIV at Chelsea and Westminster Hospital: results of a 10-year experience.

Abstract

Background Successful management of HIV infection as a chronic condition has resulted in a demographic shift where the proportion of people living with HIV (PLWH) over 50 years of age is steadily increasing. A dedicated clinic to PLWH over 50 years of age was established at Chelsea and Westminster Hospital in January 2009 and then extended to HIV services across the directorate. We report the results of a service evaluation reviewing 10 years of activities of this clinic. Aims and Methods Retrospective cross-sectional analysis of clinical records from patients attending the HIV over 50 service between January 2009-2019. We aimed to estimate the prevalence of major non-infectious comorbidities, polypharmacy [≥5 medications] and multi-morbidity [≥2 non-HIV related comorbidities] and describe algorithms devised for use in HIV outpatient clinics across the directorate. Results A cohort of 744 PLWH over 50 years of age attending this service were analysed (93% male; mean age of 56 ± 5.5 years; 84% white ethnicity); 97.7% were on antiretroviral treatment and 95.9% had undetectable HIV-RNA at the time of evaluation. The most common comorbidities diagnosed were dyslipidaemia (50.1%), hypertension (21.5%), mental-health disorders (depression and/or anxiety disorders, 15.7%), osteoporosis (12.2%), obesity (11.9%), chronic kidney disease (7.5%) and diabetes (5.8%). Low vitamin D levels were found in 62% of patients (43% with vitamin D deficiency [<40 mmol/L] and 57% with vitamin D insufficiency [40-70 mmol/L]. The overall prevalence of polypharmacy and multi-morbidity was 46.6% and 69.3%, respectively. Conclusions This study showed significant rates of non-HIV related comorbidities and polypharmacy in PLWH over the age of 50, leading on to the implementation of clinical care pathways and new joint HIV/specialty clinics (cardiology, nephrology, neurology, metabolic, menopause, geriatric) to improve prevention, diagnosis and management of major comorbidities in people aging with HIV.