A Website & Smart Phone App to Promote Healthy Aging with HIV
A Website & Smart Phone App to Promote Healthy Aging with HIV Amy C. Justice, MD, PhD Section Chief, General Internal Medicine VA Connecticut Healthca...
A Website & Smart Phone App to Promote Healthy Aging with HIV Amy C. Justice, MD, PhD Section Chief, General Internal Medicine VA Connecticut Healthcare System Professor, School of Medicine and Public Health Yale University
Why Do We Need A Risk Index for HIV?
Projected Proportion of those Living With HIV in United States 50+ Years* 2001-2017 Projected
US VA in 2003 As of 2008: •San Francisco •NY City
33% 25%
17%
19%
21%
27%
27%
35%
37%
39%
41%
44%
45%
47%
50%
29%
22%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Data from 2008, onward projected based on 2001-2007 trends (calculated by author), 2001-2007 data from
CDC Surveillance Reports 2007. New York and San Francisco data from their Departments of Public Health
Where Ever ART Available, People with HIV are Ageing • An estimated 14% of adults with HIV infection in Sub Saharan Africa are >50 years • AIDS is leading cause of death among >50 yrs. in Nyanza Providence, Western Kenya • As prevalence increases, incidence will rise
Projected HIV Prevalence by Age in Hlabisa Sub-district of KwaZulu-Natal, South Africa
What Drives Patient Outcomes Among those Aging with HIV? Not AIDS Defining Events Not Only “Immune Deficiency” Outcome Disparities Growing
AIDS Events Increasingly Rare
ART-CC, Archives Int Med 2005: 165 416-423
AIDS Events Variably Associated with CD4 and Survival By Median (IQR) CD4
ART-CC, CID 2009;48:1138-51
By Relative Hazard of Death
>50% of Deaths Attributed to Non-AIDS Events
Cumulative Mortality by COD Among Those on cART (1996-2006) ART-CC, CID 2010: 1387-1396
Death Rate Disparities by HIV, Race/Ethnicity and Age
HIV Epidemiology & Field Services Semiannual Report,
Strategies for Management of ART (SMART)
*More AIDS and “Non-AIDS” Events Among Rx. Sparing Arm (HR 1.7 in SMART) NEJM 2006;355:2283-96
General Observations on HANA • Multiple interacting HIV and non HIV causes – HIV typically not the most influential risk factor – cART appears to decrease risk (SMART)
• What is common and what has the greatest relative risk for HIV differ • Relative risk HIV+/- highly variable – Association with CD4 variable – Competing risk of death is changing and unmasking risk associated with HIV
Case: Routine Follow Up • 52 yr. old black male HIV+, on stable cART (2 yrs) • Undetectable HIV-1 RNA since starting cART • Hepatitis C infected, never treated
HIV Guideline Care Screening: – Behaviors • Adherence • Risk of transmission
Findings: – No difficulty with cART – 1 partner, no condoms