HIV Services, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Imperial College London, London, UK.
HIV Services, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Lancet HIV. 2022 Mar;9 Suppl 1:S1. doi: 10.1016/S2352-3018(22)00066-2.
The introduction of antiretrovirals has resulted in a demographic shift with an increasing proportion of people living with HIV older than 50 years and a change in the spectrum of diseases affecting this population. A specialised clinical service dedicated to older people living with HIV was implemented at Chelsea and Westminster Hospital, London, UK in 2009, following training of health-care providers in HIV, ageing, comorbidity, and polypharmacy management. We report the results of a service evaluation reviewing 10 years of activity of this specialised clinic, including lessons to be applied in routine practice.
We estimated the prevalence of multimorbidity and polypharmacy and described algorithms devised for use across our HIV outpatient services following implementation of the specialised clinical pathway. The service evaluation was approved by our local clinical governance system and data relative to the period 2009-19 were collected on a secured trust database.
Dedicated time was created for senior and junior doctors, a nurse, and a pharmacy to create clinical appointments for older people living with HIV referred by all service care providers. The team would review different clinical scenarios, book follow-up appointments to review results, refer to different specialists or to complex multidisciplinary teams when necessary. 744 people with HIV aged 50 years and older attended our services (93% [691] male, 7·1% [53] female; mean age 56·5 years [SD 5·5]; 84·2% [622] White, 7·5% [56] Black, 0·9% [7] Asian, 7·5% [56] other race or ethnicity). The prevalence of multimorbidity was 69·3% and of polypharmacy was 46·6%. The most common comorbidities were vitamin D deficiency (428 of 690, 62%), dyslipidaemia (373, 50·1%), hypertension (157, 21·5%), depressive or anxious disorders (117, 15·8%), osteoporosis (91, 12·2%), obesity (98, 13·2%), chronic kidney disease (56, 7·5%), and diabetes (43, 5·7%). Patients with dyslipidaemia, osteoporosis, and metabolic disorders were referred to a live well pathway clinic focusing on targeted lifestyle interventions, including diet and physical exercise, under the supervision of a dietician and a physiotherapist.
We have described how our HIV over-50 clinic was organised and implemented, and we reported data showing high rates of comorbidities and polypharmacy, which led to the establishment of a specialised care pathway for all HIV care providers and to the implementation of further joint HIV and specialty clinics (cardiology, metabolic, menopause, nephrology, neurology, and geriatric).
None.
抗逆转录病毒药物的引入导致了人口结构的变化，越来越多的艾滋病毒感染者年龄在 50 岁以上，影响这一人群的疾病谱也发生了变化。英国伦敦切尔西和威斯敏斯特医院于 2009 年专门为老年艾滋病毒感染者设立了临床服务，此前对医疗保健提供者进行了艾滋病毒、衰老、合并症和多药治疗管理方面的培训。我们报告了专门诊所 10 年活动的服务评估结果，包括在常规实践中应用的经验教训。
我们估计了合并症和多药治疗的患病率，并描述了在实施专门临床途径后为我们的艾滋病毒门诊服务制定的算法。该服务评估得到了我们当地临床管理系统的批准，并在一个安全的信托数据库中收集了 2009-19 年期间的数据。
为高级和初级医生、护士和药剂师专门安排时间，为所有服务提供者转介的老年艾滋病毒感染者创建临床预约。该团队将审查不同的临床情况，预约后续检查以审查结果，并在必要时向不同的专家或复杂的多学科团队转诊。共有 744 名年龄在 50 岁及以上的艾滋病毒感染者在我们的服务中接受治疗（93%[691]为男性，7.1%[53]为女性；平均年龄 56.5 岁[标准差 5.5]；84.2%[622]为白人，7.5%[56]为黑人，0.9%[7]为亚洲人，7.5%[56]为其他种族或民族）。合并症的患病率为 69.3%，多药治疗的患病率为 46.6%。最常见的合并症是维生素 D 缺乏症（690 例中有 428 例，62%）、血脂异常（373 例，50.1%）、高血压（157 例，21.5%）、抑郁或焦虑障碍（117 例，15.8%）、骨质疏松症（91 例，12.2%）、肥胖症（98 例，13.2%）、慢性肾脏病（56 例，7.5%）和糖尿病（43 例，5.7%）。血脂异常、骨质疏松症和代谢紊乱患者被转介到一个注重生活方式干预的生活良好途径诊所，包括饮食和体育锻炼，由营养师和物理治疗师监督。
我们描述了我们的艾滋病毒 50 岁以上诊所是如何组织和实施的，并报告了数据，显示出合并症和多药治疗的高发病率，这导致为所有艾滋病毒护理提供者建立了专门的护理途径，并实施了进一步的艾滋病毒和专业联合诊所（心脏病学、代谢、更年期、肾病学、神经病学和老年医学）。
无。
