An epidemic in evolution: the need for new models of HIV care in the chronic disease era

Abstract

Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care- and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.

Figure 1

The HIV/AIDS epidemic: major clinical themes over 3 distinct eras, 1981–2011.

Figure 2

Estimated prevalence rates for adults and adolescents living with AIDS (per 100,000 population) in the United States and dependent areas, 2007. Source: Centers for Disease Control and Prevention. Data have been adjusted for reporting delays. *Total rate includes persons whose area of residence is unknown or missing.