title: Future challenges for clinical care of an ageing population infected with HIV: a modelling study.
abstract: BACKGROUND
  The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future.
  
  
  METHODS
  We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs-including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies-and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030.
  
  
  RESULTS
  Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug-drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens.
  
  
  CONCLUSIONS
  The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge.
  
  
  BACKGROUND
  Medical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK. Electronic address: mikaela.smit@imperial.ac.uk.
authors.forename: Mikaela
authors.initials: M
authors.lastname: Smit
authors.affiliation: Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Brinkman
authors.affiliation: Division of Infectious Diseases, Amsterdam Medical Centre, Amsterdam, Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Geerlings
authors.affiliation: Stichting HIV Monitoring, Amsterdam, Netherlands.
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.affiliation: independent consultant, London, UK.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Thyagarajan
authors.affiliation: Stichting HIV Monitoring, Amsterdam, Netherlands.
authors.forename: Ard van
authors.initials: Av
authors.lastname: Sighem
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology*; D019338:Polypharmacy; D011157:Population Dynamics / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*
chemical_list: D044966:Anti-Retroviral Agents