Impact of age on care pathways of people living with HIV followed up in hospital

ABSTRACT

The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40–54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11–6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients’ lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.

KEYWORDS:

• Care pathways
• PLWH
• social deprivation
• aging
• disclosure of HIV status

Acknowledgements

We would like to thank all the investigators: N. Decaux, JL. Schmit (Amiens), S. Rehaiem, P. Fialaire (Angers), J. Gerbe, P. Genet, V. Masse (Argenteuil), V. Favret, JL. Delassus (Aulnay-sous-Bois), C. Roche, A. Foltzer (Besançon), P. Honore, O. Bouchaud (Bobigny), M. Coupard, C. Michaud (Bondy), E. Reimann, E. Rouveix (Boulogne-Billancourt), JC. Duthé, L. de Saint Martin (Brest), S. Dydymski, H. Laurichesse (Clermont-Ferrand), F. Zeng, E. Mortier (Colombes), L. Richier (Créteil), S. Gothier, M. Buisson (Dijon), P. Choisy, F. Bonnevie (Dunkerque), C. Baringthon, A. Cabié (Fort-de-France, Martinique), H. Berthe, P. de Truchis (Garches), V. Favret, D. Troisvallets (Gonesse), S. Tassi, E. Froguel (Lagny-sur-Marne), H. Durand, P. Perre (La Roche-sur-Yon), P. Camps, E. Brottier Mancini (La Rochelle), M. Ruquet, A. Greder Belan (Le Chesnay), P. Choisy, E. Aissi (Lens), E. Garcia, A. Boibieux (Lyon Croix-Rousse), N. Benmakhlouf, A. Boibieux (Lyon Edouard Herriot), JL. Ecobichon, F. Granier (Mantesla-Jolie), A. Ivanova, I. Poizot-Martin (Marseille), V. Gregoire (Meaux), T. Akpan (Meulan), MA. Bucher, B. Christian (Metz), C. Crisol, J. Reynes (Montpellier), M. Benomar, G. Beck Wirth (Mulhouse), V. Daneluzzi (Nanterre), H. Hue, E. Billaud (Nantes), R. Doncesco, A. Sotto (Nîmes), MP. Pietri, D. Salmon (Paris Cochin), I. Turpault, W. Rozenbaum (Paris Saint- Louis), C. Lupin, A. Simon (Paris Salpêtrière), JL. Ecobichon, H. Masson (Poissy-Saint-Germain), M. Mallet, M. Medus (Perpignan), D. Plainchamp, G. Lemoal (Poitiers), JC Duthé(Quimper), J. Rohan, C. Arvieux (Rennes), C. Beuscart (Saint-Brieuc), V. Ronat, A. Frésard (Saint-Etienne), MC. Duronea, P. Poubeau (Saint-Pierre, La Réunion), A. Germane, C. Gaud (Saint-Denis, La Réunion), T. Pasdeloup (Saintes), D. Bornarel, D. Zuckman (Suresnes), P. Fischer, D. Rey (Strasbourg), MA. Bucher, P. Muller (Thionville), P. Choisy, A. Cheret (Tourcoing), G. Fajole (Tours), E. Racamier, B. Ponceau (Valence), P. Choisy, C. Fontier (Valenciennes), and M. Delestan, Briault (Vandoeuvre-lès-Nancy).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported and conducted by the Clermont-Ferrand University Hospital and the Société Française de Lutte contre le SIDA (SFLS).