HIV care quality has been improving for older adults
More people living with HIV and enrolled in Medicare are taking modern, less toxic antiretroviral drugs than ever before, according to a new study led by Harvard T.H. Chan School of Public Health. The findings signal positive progress in care for people living with HIV, particularly older adults who now make up most of the HIV-positive population in the U.S. Researchers warn, however, that this progress may be upended by recent federal funding cuts to HIV prevention and care programs.
The study was published May 1 in JAMA Network Open. Jose Figueroa, associate professor of health policy and management, was corresponding author. Other co-authors included staff of the Healthcare Quality and Outcomes Lab: Dannie Dai, research assistant and statistical programmer; Ciara Duggan, research assistant; and Jessica Phelan, assistant director of analytics.
In 2017, clinical guidelines for HIV care were updated to recommend discontinuing treatment with older antiretrovirals in favor of newer drugs, which are less toxic and more effective. Not everyone living with HIV transitioned their treatment, however; concerns around cost and comorbidities may have prevented many patients, particularly older adults, from doing so. How many remains unknown.
The researchers sought to learn more by examining 2013-2021 Medicare data from across the U.S. on antiviral prescriptions. Expert clinicians reviewed the prescriptions based on drug toxicity and whether safer, more effective alternatives were available, and classified drugs as “non-recommended” or “preferred.” The researchers then calculated the proportion of people living with HIV who were on preferred antivirals compared to those who were prescribed at least one non-recommended antiviral.
During the study period, 28,019 Medicare beneficiaries living with HIV filled prescriptions for preferred antiretrovirals, while 1,052 patients—the majority of whom lived in the South—filled prescriptions for at least one non-recommended antiretroviral. The researchers calculated that the proportion of people living with HIV who received at least one non-recommended antiviral in a year decreased from 5.1% in 2013 to 0.1% in 2021.
“Because over half of the people living with HIV in the U.S. are now ages 50 or older, monitoring HIV care among aging populations is especially important,” Figueroa said. “Reassuringly, the quality of care for people living with HIV seems to have been improving in recent years.”
But, he added, “Current efforts to cut back on HIV programs and research—including the recent termination the Office of Infectious Disease and HIV/AIDS Policy—endangers this kind of progress.”
