Older People and HIV
June 29, 2012
Table of Contents
About 29% of all people with AIDS in the United States are 50 or over. In 2001, this proportion was 17%. Over 50% of people in San Francisco with HIV are older than 50. Overall in the US, the proportion of older AIDS patients increased from 20% in 2001 to 39% in 2009. The number of older people diagnosed with AIDS is increasing. There are three types of older people with HIV: People who have been living with HIV for many years; older HIV-infected people who are just learning their HIV status; and older people newly infected with HIV. About half of the older people with AIDS have been infected for one year or less.
The rates of HIV/AIDS among older people are 12 times higher for African-Americans and 5 times higher for Hispanics compared with whites.
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.
There are several reasons:
The first studies of HIV in older people were done before strong anti-HIV drugs 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 health problems in addition to HIV.
Recent research shows that older people respond well to antiretroviral treatment. Most older patients, unless they are drug users or have mental problems, take their medications more regularly than younger patients. They have better adherence (see Fact Sheet 405).
CD4 cell levels (see Fact Sheet 124) do not recover as quickly in older patients as in younger patients. Unfortunately, we don't have good information on older people because they were usually not included in clinical trials of new drugs.
Treatment side effects (see Fact Sheet 550) 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 that looks similar to the changes caused by lipodystrophy.
Recent research suggests that many of the health problems of older people may progress faster in people with HIV. Inflammation (see Fact Sheet 484) is a major factor in several diseases of aging.
As people age, they develop health issues that continue for the rest of their lives. These can include heart disease (see Fact Sheet 652), depression (see Fact Sheet 558), osteoporosis (see Fact Sheet 557), high blood pressure, kidney problems (see Fact Sheet 651), 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 doctor to choose anti-HIV drugs because of interactions with other medications.
Older people may have more problems with thinking and remembering than younger people. These symptoms can appear to 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 anti-HIV drugs. 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.
See the website of the National Center for HIV and Aging at www.lgbtagingcenter.org/.
The number of people over 50 with HIV or AIDS is growing rapidly. About 40% 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 anti-HIV medications. They can also be confused with some of the side effects of HIV drugs.
HIV drugs seem to work as well in older people as in younger people, although their CD4 cell counts may be lower. Also, older people may be better about taking their medications than younger people.
This article was provided by AIDS InfoNet. Visit AIDS InfoNet's website to find out more about their activities and publications.