Mainstreaming Care For HIV-Infected Individuals with Comorbidities

With 36.7 million individuals living with HIV worldwide, it continues to be a major public health issue. Although antiretroviral therapy has allowed those with HIV to live longer, healthier lives, they tend to run into other issues.

HIV-infected individuals are at increased risk of developing chronic complications and comorbidities. Increasingly, HIV-infected individuals also have comorbid noncommunicable diseases including cardiovascular disease, hypertension, and diabetes.

The good news is, care for HIV-infected individuals is shifting to encompass care for these conditions in addition to the specialized care those individuals need for their infection.

The journal AIDS Care has published a systematic review that looks at the opportunity to provide coordinated care for HIV and noncommunicable conditions. The authors reported that it's feasible to integrate services, and indicated that building on existing protocols and community advocacy is prudent.

The authors noted that 4 primary models integrate HIV/AIDS care with diabetes, hypertension, and/or cardiovascular disease. These include:

• Provision of diabetes services at HIV clinics
• Provision of hypertension and diabetes services with HIV services (which was the most commonly reported model)
• Integration of cardiovascular and HIV services
• Thorough integration of all 4 conditions in the local care model

The authors, who examined primarily low-income countries that had high rates of HIV infection, indicated that the models varied considerably in what they provided to this population. Some provided screening and case detection/referral, while others added monitoring, patient education, and consolidated treatment.

The authors advocated for incorporating treatment for comorbidities into the HIV treatment model. This addresses patients’ needs all in one place—a form of one-stop shopping—and simplifies the healthcare delivery system. However, the authors noted that leadership is needed to catalyze change and promote service integration to ensure that patients with HIV are receiving the care that they need for their comorbidities.

“Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists,” the authors write.

The key takeaway is this: patients with HIV need to be mainstreamed into the healthcare system so that they receive the same range of services that other patients receive. All countries, including the United States, need to plan for the increasing number of patients with HIV who have comorbidities as they live longer lives.

To this end, the researchers call for more “robust and well-designed studies at all levels-particularly macro-level studies,” as well as more research dedicated to analyzing long-term outcomes of integration, in “a more diverse range of countries.”