October 2, 2014
Table of Contents
Worldwide, more than three and a half million people 50 years and older are living with HIV (HIV+). According to UNAIDS, the proportion of HIV+ older adults continues to increase in all regions. For the first time since the HIV pandemic began, one in ten HIV+ adults is 50 or over in low- and middle-income countries.
In the US, HIV began mostly as a disease of young men, but today the epidemic impacts people of all ages, including older people (age 50 and over). While 50 may not seem 'old,' it is often the age currently used by organizations that keep track of health-related statistics (e.g., the US Centers for Disease Control and Prevention, or CDC). The CDC estimates that half of all HIV+ people in the US will be 50 and over by 2015. As a result, issues related to getting and being older with HIV are receiving more and more attention as this population grows.
The aging HIV+ population is growing for two reasons: 1) powerful HIV drugs are allowing many HIV+ people to live into their 50s and beyond; and 2) while most new HIV infections occur in younger people, people 50 and older are being infected at increasing rates. As a result, while only one in four HIV+ people in the US was at least 50 years old in 2007, that number is expected to double by 2015.
Many of the medical problems facing HIV+ people now have more to do with diseases of aging than HIV-related illnesses. More middle-age and older HIV+ people are experiencing medical problems related to aging. Research shows that almost two-thirds of deaths among HIV+ people are currently the result of non-AIDS-related causes.
Recent advancements in HIV drugs have been successful at keeping people's immune systems healthy with fewer side effects and fewer pills. Despite the tremendous improvements in HIV drugs that now enable most HIV+ people to live long and healthy lives, there are several ways in which living and aging with HIV are different compared to aging while HIV-negative. Some of the health problems of older people appear to happen earlier and faster in HIV+ people (this is sometimes referred to as "accelerated aging").
Scientists are not sure why this happens. It may be that simply being infected with the virus leads to many of the chronic medical conditions associated with aging. HIV infection decreases the ability of the immune system to fight off infections; in this sense, the immune system is 'suppressed.' However, because the immune system of an HIV+ person is always struggling to get rid of the virus, the immune system of HIV+ people is always activated, or "turned on." After many years of being constantly activated, the immune system of people living with HIV may show signs of premature aging.
In addition, an activated immune system produces inflammation. Ongoing inflammation appears to be related to many conditions, including heart disease and cancer.
The drugs used to treat HIV may also contribute to the aging-related health conditions seen in HIV+ people. Although the HIV drugs used now are more effective and less toxic than in previous years, they still may have long-term effects that we do not yet fully understand.
Life expectancy: In most countries, women in the general population live four to five years longer than men. HIV+ women, however, have life expectancies equal to HIV+ men. In other words, HIV+ women lose their usual longer life expectancy compared to men.
Co-morbidities: Co-morbidities refers to medical conditions that people have in addition to HIV. These include things like diabetes, liver disease, anemia, and high blood pressure. Compared to HIV-negative people, HIV+ people are more likely to have co-morbid conditions.
Heart disease: As people get older, their risk of heart attack and stroke goes up. Among post-menopausal women, heart disease can be especially serious because most women who die suddenly from heart disease had no previous symptoms. Research shows that the risk for heart attacks and strokes in HIV+ people is higher than in similar HIV-negative people.
For good heart health, HIV+ people should talk with their health care providers about checking cholesterol levels, blood pressure, and blood sugar. Also consider heart-protective habits such as exercising, stopping smoking, and eating a healthy diet. For more information, see The Well Project's article, Caring for Your Heart.
Cancers: HIV has long been recognized as increasing the risk of certain AIDS-related cancers. Research now shows that HIV also increases the risk of non-AIDS-related cancers. These cancers include anal cancer, liver cancer, lung cancer, and Hodgkin's lymphoma.
It is important to get regular screening for cancers known to occur more often in HIV+ people (such as cervical cancer) and for common cancers that do not appear to occur more frequently in HIV+ people (including breast, colon, and prostate cancer).
Anemia: While anemia is no longer as serious a problem as it was early in the HIV epidemic, close to one-third of all HIV+ women still experience mild anemia due to a variety of factors. Even mild anemia has been shown to decrease the chances of one's survival while living with HIV. In older people, anemia is associated with less muscle strength, difficulty thinking, and an increased risk for falls.
Blood tests for anemia are fairly simple, and can help point to its cause. Depending on the source of your anemia, your provider will recommend appropriate treatment. Most providers regularly screen for anemia when doing routine blood work to monitor HIV disease. For more information, see The Well Project's article Anemia and Women.
Bone disease: Weakened bones can occur with age, especially in women after they stop having menstrual periods. Loss of bone density can lead to osteoporosis, which weakens bones and raises the risk that bones may break. HIV+ people of both sexes are more likely to develop osteoporosis than HIV-negative individuals.
An easy and painless test called a DEXA scan can help you and your health care provider monitor your bone health and determine if you are at risk for a serious fracture. Vitamin D and calcium supplements may be recommended. Prescription medications to help reverse bone loss are also available.
For more information on specific conditions for which HIV+ people are at risk, see The Well Project's articles in the Health and Medical Issues section of our website.
While these health challenges may seem discouraging, they really show that HIV+ people are now living long-enough, healthy-enough lives to die of the same types of conditions that cause death in the general population. Because people living with HIV may encounter these medical issues sooner, it is important that both HIV+ people and their providers stay aware of them and take appropriate action. There is still plenty you can do to stay healthy and live a full life. Here are some suggestions to get you started:
Psychologists have shown that there is actually some truth in this. Having a positive attitude toward one's age can have a positive effect on one's health. Additionally, those who feel younger than their actual years tend to avoid many of the downsides associated with aging. The more credit you give yourself for wherever you are in life and the more you highlight what you CAN do, the more likely you will be to remain 'young at heart.'
Recent US treatment guidelines recommend that all HIV+ people older than 50 start HIV treatment, regardless of their CD4 cell count.
Many older people are already taking medications for other conditions. It is important to know if HIV drugs will interact with these medications, such as those used for high blood pressure or high cholesterol. Therefore, it is important to tell your health care provider about any over-the-counter medications, prescription drugs, herbs, vitamins, or supplements that you take so that you can identify any possible drug interactions.
It is important for anyone over 40 to pay close attention to their health and get regular checkups. If you are HIV+, it is important to begin to keep an eye out for problems early so that you can make healthy choices as soon as possible. In addition to getting regular checkups that look for signs of the conditions listed above, be sure your checkups also look for cognitive problems (changes in thinking or memory), liver disease, kidney disease, metabolic and body shape abnormalities, diabetes, and mental health issues, including depression.
The aging process itself can lower energy levels, restrict social encounters, and cause decreased physical and mental abilities. This means that older HIV+ people may suffer more emotional problems and physical stresses than others do.
Stigma can also make things difficult. There is the stigma of living with HIV disease and the stigma of ageism. This can make it difficult for older people to find support. First of all, they may be ashamed and hesitate to tell anyone that they have HIV. Second, they may not be comfortable in support groups and choose not to join them.
However, it is important for older people living with HIV to seek out support. A lack of support can lead to depression. A mental health counselor, health educator, or peer counselor can help. Some peer counselors may have had similar experiences and can share healthy ways to cope.
You may find it helpful to hear the stories of older people living with HIV – of women and men, some of whom have been HIV+ for years, and some of whom have been recently diagnosed as HIV+. There are several stories of older Americans living with HIV at The Graying of AIDS.
There is a lot of research and attention focused on aging and HIV. With it may come advances in the care and treatment of older people living with HIV. In the meantime, it is important that both middle-aged and older HIV+ people get checked regularly for signs of changes with their HIV as well as signs of diseases associated with aging. This includes testing for cancer, heart problems, bone disorders, and other health issues that are becoming more common among HIV+ people as they get older.
Lastly, one of the most valuable things you can do is tend to your attitude. Having a positive or upbeat attitude can positively affect your body and overall health. You may find it helpful to pay attention to the things for which you are grateful, to the abundance of life around you, or to the intention with which you hope to live. In this way, you may connect with a greater sense of aliveness, no matter what your actual age.