Antiretroviral therapy (ART) has increased life expectancy of individuals with HIV and therefore patients with HIV are living longer.1 Individuals who begin ART at age 20 can expect to be on treatment for many years.2

Older adults with HIV chart

OLDER ADULTS LIVING WITH HIV IN THE UNITED STATES1

The number and percentage of people ≥50 years old living with diagnosed HIV continue to increase (2011–2015)3

increase of people 50+ living with hiv in us

Get more information about supporting older patients living with HIV.

low risk

A modelling study suggests that…

there will be up to a 23% increase in the number of people living with HIV by 2025, if current rates of screening, linkage, and retention in care persist4

elder people, age concerns

AGING-RELATED CONCERNS

Older patients (>50 years of age) should be initiated on treatment as soon as possible after diagnosis because this population1:

  • Experiences accelerated CD4 loss
  • Has decreased immune recovery
  • Is at increased risk of serious non-AIDS illnesses

As people age, they typically have more comorbidities, take more medications, and are more vulnerable to side effects—complicating management of their disease.1

  • Age-associated noncommunicable comorbidities (including hypertension, myocardial infarction, and peripheral artery disease) were numerically more prevalent among people living with HIV than HIV-uninfected controls5
  • Aging people with HIV often develop inflammation and cardiovascular, kidney, liver, bone, and neurologic disease6-8
  • Potential side effects and drug-drug interactions for aging-associated comorbidities can further complicate ART management1
person health effects

Long-Term Health Effects Associated with HIV Infection5,6

Prevalence of comorbidities in people living with HIV5

Age-associated noncommunicable comorbidities (AANCCs) in patients ≥45 years old (AGEhIV Study, 2010-2012)

Commordities on 45+ age chart desktop Commordities on 45+ age chart mobile

Continuous screening of elderly patients is critical because they have a perceived low risk of HIV infection, and often are not screened—allowing for HIV to go undetected.1

Potential health complications6,7

Commordities on 45+ age chart desktop
Pills treatment regimen

TREATMENT CONSIDERATIONS

A cross-functional approach to long-term medical care for people living with HIV is ideal. While the life span of people living with HIV has been extended since the advent of highly active antiretroviral therapy (HAART), other non-AIDS-related comorbidities persist in these patients.5,9

Therefore, people living with HIV should receive ongoing assessment for the following risks:

  • Persistent inflammation8
  • Neurocognitive function1,10
    • Alcohol and substance abuse, cognitive function, and psychosocial status assessed annually
    • Sleep habits, appetite, and suicidal/violent intent should be assessed during every visit
    • Certain medications have adverse events related to the central nervous system
  • Cardiovascular disease5
    • Immune activation and inflammation are believed to contribute to cardiovascular disease1
    • Cardiovascular events/disease are associated with adverse events from certain medications1
  • Drug-induced renal impairment and chronic kidney disease11,12
  • Hepatic function1
    • High-risk individuals should receive annual HBV and HCV screenings
  • Bone disease13
    • Age and gender should establish need for screening or fracture risk/BMD calculation

REFERENCES:

  1. US Department of Health and Human Services. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl.pdf. Updated May 30, 2018. Accessed June 4, 2018.
  2. Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8(12):e81355.
  3. Centers for Disease Control and Prevention. HIV surveillance report, 2016. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2016. Accessed May 14, 2018.
  4. Shah M, Perry A, Risher K, et al. Quantifying the impact of the US national HIV/AIDS strategy targets for improved HIV care engagement in the US: a modelling study. Lancet HIV. 2016;3(3):e140-e146. doi:10.1016/S2352-3018(16)00007-2.
  5. Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59(12):1787-1797.
  6. HIV.gov. Aging with HIV. https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/aging-with-hiv. Accessed June 4, 2018.
  7. US Department of Health and Human Services. HIV medicines and side effects. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/22/63/hiv-medicines-and-side-effects. Accessed June 4, 2018.
  8. Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633-645.
  9. Marcus JL, Chao CR, Leyden WA, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr. 2016;73(1):39-46.
  10. New York State Department of Health. Mental health screening: a quick reference guide for HIV primary care clinicians. http://www.hivguidelines.org. June 2012. Accessed June 4, 2018.
  11. Pazhayattil GS, Shirali AC. Drug-induced impairment of renal function. Int J Nephrol Renovasc Dis. 2014;7:457-468.
  12. Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(9):e96-e138.
  13. Brown TT, Hoy J, Borderi M, et al. Recommendations for evaluation and management of bone disease in HIV. Clin Infect Dis. 2015;60(8):1242-1251.