The ageing of HIV: implications for geriatric medicine

Abstract

The prevalence of human immunodeficiency virus (HIV) in the over 50 age group is increasing as a consequence of younger adults ageing with HIV, in addition to new diagnoses in later life. We conducted searches in MEDLINE for English language studies published between January 1984 and January 2010 using search terms 'HIV', 'AIDS', 'HIV testing' and 'HIV complications' and selected articles relevant to adults aged 50 years and over. The prevalence, natural history and complications of HIV infection and treatment in older adults are reviewed. In 2007 the Centers for Disease Control and Prevention in the United States reported that 16.8% of new diagnoses of HIV that year were in individuals aged over 50 years. Older adults are vulnerable to late or missed diagnosis, and poorer treatment outcomes, due to the misconception that they are not at risk. A heightened awareness of HIV as a possible diagnosis in older adults is becoming increasingly important. As the HIV population ages, the emergence of disease and treatment complications such as cardiovascular disease, osteoporosis and dementia are evident. Management of older adults with HIV and multiple co-morbidities presents challenges to infectious diseases physicians and geriatricians alike. Inclusion of older adults in future HIV clinical trials will help design healthcare models to provide for this growing population.

Perfil de pessoas idosas vivendo com HIV/aids em Pelotas, sul do Brasil, 1998 a 2013

“…Aventa-se que esses idosos contraíram o vírus antes de entrarem para a terceira idade e, beneficiados por um tratamento farmacológico, que modifica a gravidade e a letalidade da aids, têm a oportunidade de aumentar sua expectativa de vida mesmo quando infectados pelo HIV. 2,25 O principal modo de transmissão relatado foram as relações heterossexuais, em concordância com outro estudo sobre idosos portadores do HIV. 12 Esse resultado deve ser considerado nas abordagens de prevenção.…”

HIV pada Geriatri HIV in Geriatrics

“…41 Pada umumnya, saat mulai terapi, pasien usia lanjut mempunyai viral load yang lebih tinggi dan hitung limfosit CD4+ yang lebih rendah karena keterlambatan diagnosis. 42 Penilaian respons terhadap terapi antiretroviral dapat dipengaruhi oleh berbagai faktor.…”

HIV and ageing: what the geriatrician needs to know

“…13,26 In general terms, people aged over 50 initiating cART tend to have higher viral loads and lower CD4+ cell counts, which may partly reflect later diagnosis. 27 Although data on response to cART in older adults are sometimes conflicting with the heterogeneous nature of trials making comparisons difficult, 26,28,29 the general consensus is that older patients achieve at least as good, if not better, virological outcomes than younger patients, but that the immunological (i.e.…”

“…In addition, increased global travel, later-life divorce and enhanced treatment of erectile dysfunction may contribute to acquisition or risk of HIV. [11][12][13] In the older HIV+ group, though sexual activity decreases, inconsistent condom use remains a problem, risking transmission and highlighting the need for ongoing patient education. 8 A further issue in the epidemiology of older age and HIV is that older people are more likely to be diagnosed with advanced immunosuppression.…”