Response from Dr. Frascino
Hi,
First off, I must point out that 50 is the new 30. Next, we are continuing to accumulate data on "HIV-Daddies" year by year as more of us survive into our midlife crisis years. At this point all the news is "positive," so to speak. I see no reason you shouldn't plan on dying of old age. As a good friend who is also virally enhanced recently told me, "I plan to live forever. So far so good."
I'll print some basic information about HIV in older folks below.
Stay well. See ya in the old folks' home, OK?
Dr. Bob
Older People and HIV
How Many Older People Have AIDS?
About 78,000 people age 50 or over have AIDS in the United States. This is about 10-15% of all people with AIDS. In some cities, 15-25% of people with AIDS are 50 or over. The number of older people diagnosed with AIDS is increasing. About half of the older people with AIDS have been infected for one year or less.
Many people don't consider age 50 to be "old." However, age 50 is being used more often to keep statistics on "older people" with HIV and AIDS.
Why Are Older People Getting Infected?
There are several reasons:
Health care providers may not test older people for HIV infection
Older people may lack awareness of the risk factors for getting HIV (see Fact Sheets 150 and 152)
Many older people are newly single. They get divorced or lose their mates. While they had a partner they may have ignored HIV prevention messages.
Lack of HIV prevention education targeted at older people
Belief that HIV only affects younger people
No training in safer sexual activities (see Fact Sheet 151)
Sharing needles with infected people (about 17% of infections of people over 50)
Unprotected sexual activity. This may be heterosexual or homosexual sex. Viagra and other drugs that help men get and maintain an erection may contribute to increased rates of sexual activity and sexually transmitted diseases among older people, as they do for younger people.
Is HIV Disease Different for Older People?
The first studies of HIV in older people were done before strong antiretroviral drugs (ARVs) were available. Most of them showed that older people got sicker and died faster than younger people. This was thought to be due to the weaker immune systems of older people. Also, older people usually have more health problems besides HIV.
Normal aging leads to a decline in the immune system. Older people still tend to have long-term health problems. They may not do as well as younger patients with HIV. However, ARVs strengthen the immune system. Also, most older patients, unless they are drug users or have mental problems, take their medications more regularly (have better adherence, see Fact Sheet 405) than younger patients.
Is HIV Treatment the Same in Older People?
ARVs seem to work the same in older people as in younger people. Unfortunately, we don't have good information on older people because they were usually not included in clinical trials of new drugs. People who become infected when they are over 50 seem to do about as well as people who started receiving HIV treatment before age 50 and then got older.
Treatment side effects may not be any more frequent in older people. However, changes caused by aging can resemble or worsen treatment side effects. For example, aging is a major risk factor for heart disease and for increasing fat in the abdomen. Some older people without HIV lose fat in a way that looks similar to the changes caused by lipodystrophy.
What Other Health Problems Are Common?
As people age, they develop health issues that continue for the rest of their lives. These can include heart disease, depression, osteoporosis (see Fact Sheet 557), high blood pressure, arthritis, diabetes, Alzheimer's disease and various forms of cancer.
Older people often take many different medications to deal with their health problems. This can make it more difficult for a health care provider to choose ARVs, because of interactions with other medications.
Some ARVs may increase the risk of diabetes, high blood pressure, or osteoporosis. This makes it harder to choose the right HIV regimen.
Mental Problems
Older people may have more problems with thinking and remembering than younger people. These symptoms can be the same as HIV-related mental problems. Fact Sheet 505 has more information on HIV and nervous system problems.
These problems, sometimes called dementia, are less severe than they were before the use of strong ARVs. It is difficult to know what is causing mental problems in older people with HIV. Is it normal aging, or is it HIV disease? Research studies have linked both age and higher viral load (see Fact Sheet 125) to mental problems.
Rates of depression and substance use haven't been well studied in older people. However, these problems may be related to HIV disease, aging, or both. They need to be diagnosed and treated correctly.
The Bottom Line
The number of people over 50 with HIV or AIDS is growing rapidly. Between 10% and 15% of people with AIDS in the United States are over age 50.
Older people get HIV the same way as younger people. However, they may not be aware that they are at risk of HIV infection. They also may not know how to protect themselves from HIV transmission.
Older people have to deal with other health issues. These can complicate the selection of ARVs. They can also be confused with some of the side effects of ARVs.
ARVs work about as well in older people. Also, older people may be better about taking their medications than younger people.
This article was provided by AIDS InfoNet.
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