title: Impact of age on care pathways of people living with HIV followed up in hospital.
abstract: The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.
authors.affiliation: a Infectious Diseases Department , Clermont-Ferrand University Hospital , Clermont Ferrand , France.
authors.forename: Christine
authors.initials: C
authors.lastname: Jacomet
authors.affiliation: b Clermont-Ferrand University Hospital, EA 4681 PEPRADE, University of Auvergne , Clermont Ferrand , France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Berland
authors.affiliation: c INSERM & Sorbonne Universities, UPMC , Univ. Paris 06, UMRS 1136, Paris , France.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Guiguet
authors.affiliation: d Internal Medicine Department , Pitié-Salpêtrière University Hospital , Paris , France.
authors.forename: Anne
authors.initials: A
authors.lastname: Simon
authors.affiliation: e Center for HIV Care, Strasbourg University Hospital , Strasbourg , France .
authors.forename: David
authors.initials: D
authors.lastname: Rey
authors.affiliation: f Infectious Diseases and Emergency Unit , Rennes University Hospital , Rennes , France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: g Infectious Diseases Unit , Nice University Hospital , Nice , France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pugliese
authors.affiliation: b Clermont-Ferrand University Hospital, EA 4681 PEPRADE, University of Auvergne , Clermont Ferrand , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Gerbaud
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D060085:Coinfection / Q000453:epidemiology; D015897:Comorbidity; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016079:Refusal to Treat / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
keywords: Care pathways; PLWH; aging; disclosure of HIV status; social deprivation