People Living With HIV in U.S. Nursing Homes in the Fourth Decade of the Epidemic

Abstract

As the number of persons living with HIV (PLWH) will continue to increase in the coming years, it is critical to understand factors influencing appropriate nursing home (NH) care planning. This study described the sociodemographic characteristics as well as the antiretroviral therapy treatment and physical and mental health among Medicare-eligible PLWH in NHs. Persons living with HIV were identified and summarized using a 2011-2013 nationwide data set of Medicare claims linked to NH resident health assessments and a prescription dispensing database, comparing new admissions in 2011-2013 with those from 1998 to 2000. We identified 7,188 PLWH from 2011 to 2013 in NHs of whom 4,031 were newly admitted. Of the total, 79% were prescribed antiretroviral therapy. Most were male (73%), Black/African American (51.1%), and a plurality resided in southern NHs (47%). Comparing the data sets, new admissions were older (60 vs. 44), had higher prevalence of viral hepatitis (16.2% vs. 7.5%), and anemia (31.1% vs. 25.1%) but had less pneumonia (11.0% vs. 13.6%) and dementia (8.7% vs. 21.0%). NH nurses can better anticipate health care needs of PLWH using these health profiles, understanding that there have been changes in the health of PLWH at admission over time.

Figure 1.

Proportion of PLWH in Nursing Homes receiving ART by DHHS recommendation categories, 2011–2013 (N = 7,188) Note: ART=antiretroviral therapy; DHHS=Department of Health and Human Services. DHHS recommendations are a hierarchy in the order: Preferred, Acceptable, Second Line, Not recommended, No ART; Second line=regimens recommended for individuals that no longer respond to preferred or acceptable regimens; Not DHHS recommended=ART regimens that were not recommended by DHHS