Geriatrics

Eugenia L. Siegler, MD, on Aging in People With HIV

Aging people with HIV face a plethora of challenges, both medically and personally. Overcoming these challenges can be easier for patients with the clinician’s guidance, and creating an arsenal of strategies for managing this population is key.

To give us some insight on a geriatrician’s approach to managing the aging population with HIV, Eugenia L. Siegler, MD, answered our questions on this important topic—one she spoke about at IDWeek 2019 as well.1

Dr Siegler is the Mason Adams Professor of Geriatric Medicine in the Division of Geriatrics and Palliative Medicine at Weill Cornell Medicine in New York, New York.

CONSULTANT360: What is your approach to managing older patients with HIV?

Eugenia Siegler: As a geriatrician, I consult on older people with HIV; the vast majority of these people receive their primary care at the Center for Special Studies, the HIV program run by the Weill Cornell campus of New York Presbyterian Hospital. I perform a comprehensive geriatric assessment and make recommendations based on that assessment. Most of the areas we discuss focus on function and cognition, along with more medically focused concerns like smoking cessation, bone health, and polypharmacy, to name a few; I also try to give people a chance to talk about what aging means to them and what their goals are. When applicable, we review the services that are available to them in the community through the aging services network.

CON360: How does this approach differ when managing younger patients with HIV?

ES: Younger people tend not to have as many comorbidities or concerns about their ability to function. While all people with HIV face multiple stigmas, older people, unlike their younger counterparts, must cope with ageism in addition to everything else.

CON360: What challenges do you face with managing HIV in the aging population? How do you overcome those challenges?

ES: Again, I do not manage the HIV specifically. Long-term survivors may be on extremely complicated regimens because of the resistance patterns of their virus, and so older people with HIV may need an experienced HIV specialist. But in my experience, many are able to be controlled on simple regimens.

Often HIV is not the patient’s biggest concern—comorbidities, social isolation, functional decline, memory loss, other aging-related issues like falling are much more worrisome to them. Much of care for older people who are aging with HIV should take place outside of the office. One challenge is in helping them live healthy lives when it is harder for them to get the services and care they need and deserve. The other challenge is helping coordinate care when the older person with HIV is seeing so many subspecialists. Which medications do they really need? How do we avoid drug interactions and adverse effects?  

CON360: What are the key take-home messages from your session?

ES: There are a few take-home messages:

  • Recognize that your patients are aging, and spend some time asking them what aging means to them and what kind of help they need to prepare.
  • Think about how your office will screen for aging-related problems—falling risk, frailty, cognitive decline, and so on. Determine the resources to which your clinical program has access that can help address these problems.
  • Evaluate the patient’s drug regimen—Can you suggest a simpler HIV regimen or one with fewer adverse effects?
  • Talk to your social workers about developing familiarity with services through Area Agencies on Aging and/or Aging and Disability Resource Centers, which may be able to supplement HIV-based community agencies. 

 

Reference:

  1. Siegler E. A geriatrician’s approach to people aging with HIV. Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. https://www.eventscribe.com/2019/IDWeek/fsPopup.asp?efp=Q0NRVktHSkw2ODg2&PresentationID=552429&rnd=0.3676753&mode=sessionInfo