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What is the measure of success in HIV? The fourth 90: quality of life or healthy aging?

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Key summary points

AbstractSection Aim

The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success for people living with HIV (PLWH) both in clinical and research settings.

AbstractSection Findings

This review critically discusses epidemiological, clinical, patient reported and public health outcomes in older adults living with HIV beyond the viro-immunological success. They include health adjusted life expectancy (HALE), frailty, health related quality of life (HRQoL), intrinsic capacity, all of which capture important aspects of the complexity of aging with HIV.

AbstractSection Message

HIV outcomes should go beyond viral undetectability, and be patient-centred.

Abstract

In the short time frame of 30 years, HIV research has been able to modify AIDS from a rapidly progressive disease leading inevitably to death to a chronic condition. Even more, the health status of people living with HIV (PLWH) has significantly improved reducing the burden of symptoms and improving quality of life (QoL). After introduction of the UNAIDS agenda on the “90–90–90 targets”, it remains unclear what should be the next target in HIV care and research. The objective of this paper is to critically discuss potential new outcomes to be used as a measure of success in PLWH both in clinical and research settings.

Methods

To better portray potential outcomes, we will critically discuss epidemiological and clinical outcomes, patient-reported outcomes (PRO), and public health outcomes reported in literature. These outcomes intersect with one another which may suggest contemporary use of different outcomes depending on goals we want to achieve. New outcomes should go beyond undetectability, be patient-centred, and similar to those in geriatric medicine and the general population.

Conclusions

HIV care can take advantage of experience from geriatric medicine and teach-back by describing aging trajectories in PLWH that may be accentuated in comparison to general population. However, we still need to improve tools to measure quality of life, PROs, and healthy aging. Healthy aging assessment will allow us to recognize unmet needs in PLWH and represents an integrated model between community, the person, and healthcare providers, wherein all stakeholders are linked, increasing possibilities for effective intervention.

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Authors and Affiliations

  1. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy

    Giovanni Guaraldi

  2. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    Jovana Milic

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Albert W. Wu

  4. Department of Medicine and Medical Specialties, Infectious Diseases Clinic, School of Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy

    Giovanni Guaraldi

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  1. Giovanni Guaraldi
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Correspondence to Giovanni Guaraldi.

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Guaraldi, G., Milic, J. & Wu, A.W. What is the measure of success in HIV? The fourth 90: quality of life or healthy aging?. Eur Geriatr Med 10, 267–274 (2019). https://doi.org/10.1007/s41999-019-00168-2

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