Diagnosis Reinforces Need for HIV Testing in Older Adults

"Wanda, a 68-year-old widow and retired bank worker, was admitted to the hospital by her family physician, who was worried about her diarrhea and 30-pound weight loss. ...

"On the second day of her hospitalization, the hospitalist ... explained that he needed to share with her some bad news. ...

"The doctor told her she had HIV, and her white blood cell counts were very low, a sign that the infection had been present in her body for some time. Her jaw dropped. 'HIV? Me? But how could that have happened? I don't use drugs.' Her primary care doctor had never tested her for HIV.

"While doctors often are aggressive about checking old people for cholesterol, blood sugar, and thyroid hormones, they often forget about HIV. Perhaps that is because they are uncomfortable talking with older people about their sexual behaviors, or perhaps doctors stereotype those with HIV as young people who engage in high-risk behaviors.

"Doctors have overlooked the fact that 73 percent of people in their late 50s and 60s engage in sexual activity, and the percentage who are sexually active drops only slightly as people get older.

"In addition, as lifetime partners die from any number of causes, the survivors often seek out new partners without thinking about, or even knowing, the risk of [STDs] like HIV. They are often not aware of the need to use condoms, feeling that there is no reason to fear an unwanted pregnancy.

"When we delay diagnosis of HIV in older adults, this often leads to poorer outcomes as the infection has a chance to cause more damage to the immune system.

"It makes sense for doctors and their patients to talk about sexual behaviors and to consider requesting permission from the person for an HIV test along with other tests that are intended to look for hidden diseases."

The author is a professor of medicine at the University of California-Davis. Identifying characteristics were changed to protect patient confidentiality.

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