Aging and human immunodeficiency virus (HIV) infection were once considered mutually exclusive conditions. Older people did not “get AIDS” (acquired immunodeficiency syndrome) and the younger people who did never had a chance to grow old. Now, thanks to the success of combination antiretroviral therapy (CART), people aged 50 years and older represent a growing proportion of all those living with HIV infection; from 2001 to 2004, the proportion grew from 17% to 23%. The U.S. Senate Subcommittee on Aging now predicts that by 2015, 50% of the U.S. population living with HIV infection will be 50 years of age or older.
As the prevalence of HIV infection grows in older population groups, the risk of new HIV infections is also likely to increase. This increased risk may be exacerbated by several factors. First, the use of sildenafil (Viagra) and related medications to effectively treat erectile dysfunction and enhance sexual performance may increase risky sexual behavior. Additionally, postmenopausal women may be less likely to request that condoms be used as they face no risk of pregnancy. Finally, age-associated erectile changes may make condom use difficult and age-associated declines in immunity may place older individuals at higher risk of transmission with each exposure.
Research in age, aging, and HIV has focused on comparing outcomes among persons aged 50 years and older to their younger counterparts. This cut point is supported in HIV for both sociological and medical reasons: people aged 50 years and older with HIV state they feel marginalized because of age and this group experiences a shortened survival and greater burden of comorbid disease. Additionally, some data suggests that chronic HIV infection causes an accelerated aging process; an HIV infected 50-year-old person may have more physiologically in common with an uninfected individual aged 60 or 70 years.
While few geriatricians are likely to choose to manage antiretroviral agents, geriatricians need to be aware of the new Centers for Disease Control and Prevention recommendations for HIV screening. Geriatricians will also be increasingly needed to comanage the effects of aging and cumulative frailty; comorbid medical and psychiatric conditions; and drug interactions and toxicities in people with HIV infection. Further, the study of HIV infection among aging individuals may provide a template for improving the management of complex chronic disease more generally especially among special populations of aging individuals—people of color, sexual minorities, those with few socioeconomic resources, and those aging with heavy substance use histories. These groups are often ignored or understudied when more common conditions of aging are addressed.
Little is known about the presentation of acute HIV infection in older patients. In younger patients, acute infection may be completely asymptomatic or present as a flu-like syndrome. Like older HIV-negative individuals, older people with HIV infection underreport symptoms as compared to younger individuals, and this underreporting may be especially pronounced in older black patients. In addition, the symptoms associated with HIV infection are also common among ...