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What Are the Rules for Starting Treatment Over Age 50?

September 24, 2014

Joel Gallant, M.D., M.P.H.

Joel Gallant, M.D., M.P.H.

You may be surprised to know that 1 in 6 HIV infections in America right now is among people over the age of 50. For those who are newly diagnosed, treatment should begin as close to time of diagnosis as possible, regardless of CD4 counts. Dealing with a new HIV diagnosis can be hard no matter a person's age, but what happens when we factor in the reality of what people over 50 know and don't know about HIV? On his personal tumblr, Dr. Joel Gallant, an HIV doctor at Southwest CARE Center in Santa Fe, New Mexico, answers questions about a host of issues related to HIV treatment and prevention. He recently fielded a question from a concerned child of a recently-diagnosed 57-year-old man.

The anonymous user asked:

My dad is 57 and has had HIV for a year now. He still refuses treatment because he says either way his outlook isn't good. He says that treatment, and the virus itself, still causes life-threatening issues even if it keeps one from getting AIDS. He thinks it's fine for younger people, but older people are already ... prone for the illnesses that normally come along without having HIV -- let alone with it. He says his numbers are good and looking like he still has a good 2-3 years. Is he correct?

Gallant answered:

Your dad couldn't be more wrong. First, he's basing his decision on very old, outdated information. There was a time when antiretroviral therapy (ART) was quite toxic; that's no longer the case. Second, he's either ignoring or unaware of the fact that untreated HIV infection results in earlier manifestations of the normal aging process: it increases the risk of heart attack, dementia, osteoporosis, and malignancy, for example. The risk of those complications can be substantially reduced with ART. Third, older people have poorer CD4 responses to ART than younger people, which is why it's important that they start while their counts are still good. Before U.S. guidelines started recommending ART for everyone regardless of CD4 count, they pointed out that older people should consider starting at higher CD4 counts than younger people. Your father is taking the opposite approach.

Is your 57-year-old father really happy about having only "2 or 3 good years"? Unfortunately, his prediction may be right if he continues to avoid antiretroviral therapy. He can do a lot better than that if he gets treated. Why not aim for 10 to 20 good years?

You can ask Gallant a question directly on his Tumblr page, Ask Dr. Joel.

Copyright © 2014 Remedy Health Media, LLC. All rights reserved.

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This article was provided by TheBody.
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