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Why we need to re-define long-term success for people living with HIV
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15 March 2023
Maria J. Fuster-RuizdeApodaca 1,2 | David A. Wohl 3 | Mario Cascio 4 | Giovanni Guaraldi 5 | Jurgen Rockstroh 6 | Matthew Hodson 7 | Bruce Richman 8 | Gina Brown 9 | Jane Anderson 10 | Jeffrey V. Lazarus 11,12
• "prevention and management of comorbidities has become a priority objective for most healthcare professionals (HCPs) caring for people living with HIV where ART is freely accessible.
• Often, mental health conditions are undetected and remain untreated
• The physical and mental health issues that people living with HIV encounter as they age can be compounded by societal forces, such as stigma and discrimination
• poverty and isolation, can further challenge the well-being of people living with HIV
• HCPs and people living with HIV note a lack of continuity of healthcare service provision between primary and speciality care [37, 38]. Poorly integrated care can be time consuming, waste resources, result in conflicting advice and, ultimately, reduced adherence to treatment and loss of engagement in care
• controlling viraemia alone is not a sufficient defining point for achieving long-term success (LTS) for people living with HIV…...all people affected by HIV still must confront both persisting and new challenges to their HRQoL and overall well-being. Therefore, there is a need for HCPs, policymakers, and commissioners of HIV services and treatments to adjust their focus from viral suppression alone to a broader vision that considers control of viraemia as a minimum and essential contributor to LTS. With this in mind, Lazarus and colleagues proposed a fourth target to complement the three aforementioned UNAIDS targets [45]. This additional target aims for 90% of people living with HIV to have good HRQoL and is directed at three key domains focussing on multimorbidity, self-perceived QoL, and stigma and discrimination [12]."
"As a complement to the traditional management and monitoring of HIV, more person-centred, self-reported assessments of health and well-being (e.g., patient-reported outcomes) should be harnessed to help identify priority issues that could then be addressed [46, 47]. This holistic approach recognizes HIV treatment as one part of a larger vision that defines LTS in living and thriving with HIV. In our subsequent article, we detail a new framework developed to help guide clinical practice, incorporating elements of holistic care alongside effective treatments, and establishing LTS as a new goal in the next phase of HIV management. Reaching this goal will require the HIV community and wider society to work together to make LTS a reality for everyone living with HIV."
Abstract
Over the past few decades, the life expectancy of people living with HIV has markedly improved due to the advances in HIV diagnosis, linkage to care, and treatment. However, with these advances, a new set of challenges has emerged that must be addressed to ensure the long-term well-being of people living with HIV. In this article, as part of a wider journal supplement, we explore the unmet needs and challenges across the HIV continuum of care and re-define what long-term success looks like to support the healthy ageing of all people affected by HIV.
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