Rethinking HIV and ageing
The first generation of people with HIV in Australia and around the world, infected decades ago, are now growing old.
Dr Lucette Cysique, the NeuroHIV Group Leader at Neuroscience Research Australia (NeuRA), has identified an urgent need for extra resources for the cognitive and mental health care of ageing HIV positive populations.
By 2020, 40 per cent of the Australian HIV population will have reached their 60s due to the success of combined antiretroviral treatment, enabling those infected to live almost as long as the general population. However, the ageing HIV population lives with a greater age-related disease burden compared to people their age without the virus. Their ageing syndromes also appear to accelerate.
Dr Cysique’s work has shown that 30 to 50 per cent of people with HIV with an undetectable viral load can still experience mild forms of neurocognitive difficulties despite being on successful HIV treatment.
“It is mild in the sense that it is not severe enough to be called dementia, however this kind of mild memory deficit will interfere with the most demanding aspects of everyday life,” says Dr Cysique.
“Also, 15 to 30 per cent may slowly progress towards more serious neurocognitive problems across several years. The variance in prevalence is mostly associated with whether HIV people experienced AIDS or not and how early they received treatment.”
Research has shown that HIV associated dementia can still be detected in 2 to 4 per cent of people with HIV.
“There is concern among the NeuroHIV research community, as it is unclear how mild forms of neurocognitive difficulties will progress when people approach their late 60s, the age at which the risk of dementia starts to increase in the general population.
“We need to support, and must not abandon this first generation who are getting older, and help prepare a commensurate healthcare response,” says Dr Cysique.
In addition to mild forms of neurocognitive problems, the HIV positive population in Australia and globally has a higher lifetime prevalence of anxiety and depression compared to the general population.
In Australia, there has been a lack of comprehensive research on the mental health of HIV-infected people in the last decade. Overseas research has identified that suicidal ideations occur in one in four people with HIV. There is no current data for Australian people living with HIV, and in addition, the general mental health care in Australia has not adapted to support our ageing HIV population.
Dr Cysique says the sudden closure of H2M, the only dedicated mental health service for HIV people in Sydney, at St Vincent’s Hospital has impacted the community.
“There needs to be more targeted and stigma-free health services for people getting older with HIV that is delivered by HIV physicians trained in geriatrics or geriatricians trained in HIV. We also need renewed support for HIV community programs that will tackle age-related social isolation whether it is in LGBTQI people with HIV or other vulnerable HIV populations such as migrants from high HIV prevalent countries, and women.
“Our goal is to produce the required epidemiological data for Australia on those issues to help form an adequate healthcare policy response,” says Dr Cysique.
“We will also continue to work with HIV community organisations to test a diverse set of interventions that we hope will benefit the neurocognitive health and emotional wellbeing of people living with HIV and ageing.”
Dr Cysique and her team are working with research groups in the Asia-Pacific region to extend this research program to areas that have high HIV prevalence and have started to demonstrate ageing accelerated syndromes in their HIV population.
“It is an issue that has global relevance for which we have been developing cross-culturally valid methods of assessment,” says Dr Cysique.