HIV Care in an Aging Population

An increasing number of patients with HIV are 50 or older, which comes with new challenges for health care providers.

Approximately 10.8% of new HIV infections each year are in patients 50 years or older. The prevention of new HIV infections in this population has proven difficult for health care providers.

A recent study outlined the challenges providers are now facing with these emerging issues.

The reasoning behind why so many older adults are developing HIV infection is likely to be multifactorial. Older adults who could have been recently widowed or divorced may not have a good understanding of their risk for a disease they may still believe only affects young people or gay men, according to a study published by the American Journal of Public Health.

A small portion of patients over 50 years have discussed sexual activity with care providers who are poor at recording the patient’s sexual histories. Care providers may believe this population to be at low risk for infection, they could fear insulting the patient or are uncomfortable asking since this group may remind care providers of their parents or grandparents, according to the study.

Researchers also found that a majority of older patients do not use a condom with casual partners, friends, or new acquaintances.

A risk of a new HIV infection is increased in postmenopausal women, since decreased estrogen leads to a thinner vaginal epithelium and decreased mucus production. These factors and immune changes in the cervix may make transmission easier.

The CDC currently does not recommend universal opt-out testing for patients 65 years and older, since this group falls below the threshold of cost-effectiveness, according to the study. However, this may change since the amount of HIV-infected patients 65 years and older is growing.

There have been no national HIV prevention programs designed for older Americans, but there have been efforts made by individual organizations to inform this population about their risk for HIV.

Researchers estimate that by 2020, more than 50% of the HIV-infected population will be 50 years old or above due to increases in new infections, as well as longer lifespans from combination antiretroviral therapy (cART), according to the study.

Older adults with HIV are more likely to be males, Black, men who have sex with men, and from urban areas. These patients are also less likely to be diagnosed early, which does not allow these patients to prevent immune system damage.

Conditions such as cardiovascular disease, renal and hepatic disorders, osteopenia and bone fractures, endocrine and metabolic abnormalities, and some non-AIDS-defining cancers occur at increased rates in HIV-infected adults compared with the general population, the researchers wrote. HIV infection may contribute to the frequency and severity of chronic diseases, although it may not accelerate the aging process.

Researchers believe that primary care visits and preventative care is especially important in this population since a significant portion of these patients die from causes related to drug abuse and poor mental health. This population could benefit from case management and care to help them deal with the physical and psychosocial aspects of HIV, as well as reducing the stigma.

Researchers state that careful monitoring of older patients taking HIV medication since older age is associated with adverse events and polypharmacy. To prevent new cases of HIV infections, general practitioners should improve their assessment of the patient’s risk and increase HIV screening.

General practitioners should also increase awareness about the risk of a new HIV infection and stress the importance of early diagnosis. For elderly patients with HIV, general practitioners should improve coordination of care and continue preventative screening of patients.

Researchers conclude that HIV prevention should be included in HIV care in order to prevent new cases of HIV in this population.