Experts estimate that 10 to 17% of AIDS cases in the United States occurs in people over 50 years of age. Between 1990 and 2001, the cumulative number of AIDS cases reported to the U.S. Centers for Disease Control and Prevention in people aged 50 or older quintupled, from just over 16,000 to more than 90,000.¹

Studies show that older patients respond well to highly active antiretroviral therapy (HAART) both virologically and immunologically, although mortality is higher.² This retrospective study from Spain compared older HIV-infected patients (>60 years old) to younger ones (<35 years old).

There were 31 patients in the older group and 71 patients in the younger group. Patients were seen over a period of 7 years. The older patients were more likely to be male (100% vs. 84%). The HIV risk factors for the younger group were sexual route and intravenous drug use whereas the risks were mostly unknown for the older patients. The older patients usually presented later, with a lower CD4+ cell count (209 cells/mm³ vs. 405 cells/mm³). Once on HAART, the older patients tended to have more drug-related side effects, which eventually required treatment modification. There were no differences in the rates of opportunistic infections, however, the mortality rate was higher for the elderly. The older patients also had a higher rate of hospitalization.

Older patients may not perceive themselves to be at risk for HIV, and may not seek HIV testing, while primary care providers taking care of older patients may overlook this issue and feel it is unnecessary to discuss sexually transmitted diseases and safe-sex practices with them. All prevention, support and treatment services must begin to address the specific needs of the older population. In addition, clinical trials for antiretrovirals should be designed to look specifically at this group of patients.

Footnotes

1. Centers for Disease Control and Prevention. United States: Aging With AIDS. June 11, 2004.

2. Moore R, Keruly J, Gebo K, Lucas G, Chaisson R. Response to HAART in HIV-infected persons older than 50 years. In: Program and abstracts of the 11th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2004; San Francisco, Calif. Abstract 556.