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Disease presents unique challenges for older Americans
Since 1988, December has been the month to bring attention to the HIV epidemic, to increase HIV awareness and knowledge, to speak out against the HIV stigma, and to call for an increased response to move toward ending the disease.
At the start of the epidemic more than 30 years ago, people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after diagnosis. This has meant that the issues of aging were not a major focus for people with HIV. Older people are less likely than younger people to get tested, so they may not know they have HIV. As a result, a growing number of older people are living with HIV/AIDS, as well as coping with other diseases.
For this reason, nearly half of people living with diagnosed HIV in the U.S. are aged 50 and older. Older Americans are more likely than younger Americans to be diagnosed with HIV infection late in the course of their disease, meaning they get a late start for treatment, which can cause more damage to their immune system. This leads to poorer prognoses and shorter survival after an HIV diagnosis. Late diagnoses can occur because health care providers may not always test older people for HIV infection, and older people may mistake HIV symptoms for those of normal aging and don't consider HIV as a cause. According to the Centers for Disease Control and Prevention (CDC), in 2018, 35% of people aged 50 and older already had a late-stage infection of AIDS when they received a diagnosis.
Many senior adults have been living with HIV for years; others are recently infected or diagnosed. It is important for people aged 50+ to know their HIV status so they can begin treatment. Improvements in the effectiveness of antiretroviral therapy (ART), which suppresses the virus and can make viral loads undetectable, means people with HIV who are diagnosed early, who get and stay on ART, are able to live longer and healthier lives. Anyone at risk should have regular testing for HIV.
Some older people are less likely to discuss sexual or drug use behavior and may feel ashamed or afraid of being tested, and doctors do not always think to test older people for HIV. By the time an older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS. For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low.
At the end of 2018, an estimated 1.2 million Americans were living with HIV, of which 51% diagnosed were 50 and older. Though new HIV diagnoses are declining among this age group, one in six HIV diagnoses were in this group, consisting mostly of men.
Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and treatment can affect other parts of the body, such as the brain and the heart. People living with HIV are significantly more likely to develop cardiovascular disease and have an increased risk of dementia than people without HIV. While effective HIV treatments have decreased the likelihood of someone developing AIDS, other conditions are more common for those with long-standing HIV infection, including: cardiovascular disease, lung disease, certain cancers, HIV-associated neurocognitive disorders (HAND), and liver disease, among others.
In addition, HIV appears to cause chronic inflammation throughout the body, which may be associated with some conditions such as lymphoma and type 2 diabetes. Researchers are working to better understand inflammation, even in people receiving ART to manage HIV.
HIV and its treatment may have profound effects on the brain. AIDS-related dementia, once relatively common among people with HIV, is now rare. Researchers estimate that of those with HIV, more than 50 percent develop HAND, which can include deficits in attention, language, motor skills, memory, and other cognitive functions that significantly affect a person's quality of life. People who have HAND may also experience depression or psychological distress. Researchers are studying how HIV and its treatment affects the brain, including the effects on older people living with HIV.
Older adults over age 50 with HIV make up 46% of the half a million clients served by the Ryan White HIV/AIDS Program, which provides support for approximately 1,000 individuals in Nebraska with HIV with little to no access to health coverage. The program provides access to necessary medications, case management services, the AIDS Drug Assistance Program, and works in conjunction with the state's Medicaid program.
People aged 50 and older diagnosed with HIV are living longer, healthier lives if they receive treatment and maintain a suppressed viral load. Along with this longer life expectancy, individuals living with long-term HIV infection exhibit many clinical characteristics commonly observed in aging, such as multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors.
Living with HIV presents certain challenges, no matter your age. Older people with HIV may face different issues than younger counterparts, such as greater social isolation and loneliness. The stigma of the disease is a particular concern among older people with HIV, and negatively affects their quality of life, self-image and behaviors. Therefore, it is important for older people with HIV to get linked to HIV care and have access to mental health and other support services to help them stay healthy and remain engaged in HIV care. Support services are available through health care providers, local community centers, or an HIV service organization.