What is the measure of success in HIV? The fourth 90: quality of life or healthy aging?
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Key summary points
The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success for people living with HIV (PLWH) both in clinical and research settings.
This review critically discusses epidemiological, clinical, patient reported and public health outcomes in older adults living with HIV beyond the viro-immunological success. They include health adjusted life expectancy (HALE), frailty, health related quality of life (HRQoL), intrinsic capacity, all of which capture important aspects of the complexity of aging with HIV.
HIV outcomes should go beyond viral undetectability, and be patient-centred.
In the short time frame of 30 years, HIV research has been able to modify AIDS from a rapidly progressive disease leading inevitably to death to a chronic condition. Even more, the health status of people living with HIV (PLWH) has significantly improved reducing the burden of symptoms and improving quality of life (QoL). After introduction of the UNAIDS agenda on the “90–90–90 targets”, it remains unclear what should be the next target in HIV care and research. The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success in PLWH both in clinical and research settings.
To better portray potential outcomes, we will critically discuss epidemiological and clinical outcomes, patient-reported outcomes (PRO), and public health outcomes reported in literature. These outcomes intersect with one another which may suggest contemporary use of different outcomes depending on goals we want to achieve. New outcomes should go beyond undetectability, be patient-centred, and similar to those in geriatric medicine and the general population.
HIV care can take advantage of experience from geriatric medicine and teach-back by describing aging trajectories in PLWH that may be accentuated in comparison to general population. However, we still need to improve tools to measure quality of life, PROs, and healthy aging. Healthy aging assessment will allow us to recognize unmet needs in PLWH and represents an integrated model between community, the person, and healthcare providers, wherein all stakeholders are linked, increasing possibilities for effective intervention.
KeywordsQuality of life Healthy aging Measure of success Patient related outcomes Intrinsic capacity Frailty
There was no dedicated funding for this study.
Compliance with ethical standards
Conflict of interest
All other authors report no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study formal consent is not required.
- 1.Joint United Nations Programme on HIV/AIDS (UNAIDS) (2014) 90–90–90—an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS. (http://www.unaids.org/en/resources/documents/2014/90-90-90); Assessed 2 Sept 2018
- 2.Joint United Nations Programme on HIV/AIDS (UNAIDS) (2017) Ending AIDS: progress towards the 90–90–90 targets. Geneva: UNAIDS. (http://www.unaids.org/en/resources/documents/2017/20170720_Global_AIDS_update_2017). Assessed 2 Sept 2018
- 5.Porta M (2008) A dictionary of epidemiology, 5th edn. Oxford University Press, New YorkGoogle Scholar
- 11.Hogg RS, Eyawo O, Collins AB, Zhang W, Jabbari S, Hull MW, Lima VD, Ahmed T, Kendall CE, Althoff KN, Justice AC, Barrios R, Shoveller J, Montaner JSG, Comparative Outcomes And Service Utilization Trends (COAST) study (2017) Health-adjusted life expectancy in HIV-positive and HIV-negative men and women in British Columbia, Canada: a population-based observational cohort study. Lancet HIV. 4(6):e270–e276CrossRefGoogle Scholar
- 15.Kooij KW, Wit FW, Schouten J, van der Valk M, Godfried MH, Stolte IG, Prins M, Falutz J, Reiss P, AGEhIV Cohort Study Group (2016) HIV infection is independently associated with frailty in middle-aged HIV type 1-infected individuals compared with similar but uninfected controls. AIDS 30(2):241–250CrossRefGoogle Scholar
- 16.De Francesco D, Wit FW, Bürkle A, Oehlke S, Kootstra NA, Winston A, Franceschi C, Garagnani P, Pirazzini C, Libert C, Grune T, Weber D, Jansen EHJM, Sabin CA, Reiss P, The Co-morbidity in Relation to AIDS (COBRA) Collaboration (2019) Do people living with HIV experience greater age advancement than their HIV-negative counterparts? AIDS 33(2):259–268CrossRefGoogle Scholar
- 19.Guaraldi G, Falutz J, Mussi C, Silva AR (2016) Managing the older adult patient with HIV. Springer International Publishing, Switzerland. ISBN: 9783319201306, 9783319201313Google Scholar
- 21.Roebuck J (1979) When does old age begin?: the evolution of the English definition. J Soc Hist 12(3):416–28. http://jsh.oxfordjournals.org/content/12/3/416.full.pdf+html. Accessed 13 Dec 2018
- 25.Kane RL, Kane RA (2000) Assessing older persons: measures. Meaning, and practical applications, 2nd edn. Oxford University Press, OxfordGoogle Scholar
- 26.Elsawy B, Higgins KE (2011) The geriatric assessment. Am Fam Physician 83:48–56Google Scholar
- 27.Higgins JPT, Greene S (eds) (2018) Cochrane Handbook for systematic reviews of interventions. The Cochrane collaboration; version 5.1.0 [updated March 2011]. https://training.cochrane.org/handbook. Accessed 28 Dec 2018
- 28.Implementing patient-reported outcome measures (2018) https://catalyst.nejm.org/implementing-proms-patient-reported-outcome-measures/. Accessed 28 Dec 2018
- 30.Wohl D, Clarke A, Maggiolo F et al (2018) Patient-reported symptoms over 48 weeks among participants in randomized, double-blind, phase III non-inferiority trials of adults with HIV on co-formulated bictegravir, emtricitabine, and tenofovir alafenamide versus co-formulated abacavir, dolutegravir, and lamivudine. Patient 11(5):561–573CrossRefGoogle Scholar
- 32.World Health Organisation (2014) Basic documents. Forty Eighth Edition. http://apps.who.int/gb/bd/PDF/bd48/basic-documents-48th-edition-en.pdf-page=7. Accessed Mar 2018
- 39.Miners A, Phillips A, Kreif N, Rodger A, Speakman A, Fisher M, ASTRA (Antiretrovirals, Sexual Transmission and Attitudes) Study et al (2014) Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV 1:e32–e40CrossRefGoogle Scholar
- 40.World Health Organization (WHO) (2015) World report on ageing and health. Geneva: WHO. http://www.who.int/ageing/events/world-report-2015-launch/en/. Assessed 15 Aug 2018
- 42.Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity, WHO (2017). https://www.who.int/ageing/WHO-ALC-ICOPE_brochure.pdf?ua=1. Accessed 28 Dec 2018
- 46.My smart age with HIV: smartphone self-assessment of frailty (MySAwH) ClinicalTrials.gov Identifier: NCT02663856 (2018) https://clinicaltrials.gov/ct2/show/NCT02663856?term=My+Smart+Age+with+HIV&rank=1. Accessed 28 Dec 2018