Meeting the Changing Medical Needs of the Aging Population with HIV

Due to improvements in treatment and other factors, the number of HIV-positive patients over age 50 is growing rapidly. With their greater risk for serious comorbidities such as depression and addiction, these patients represent a unique challenge for clinicians and caregivers.

During a Sunday seminar at the 2013 United States Conference on AIDS (USCA), Mark Brennan-Ing, PhD, provided an overview of the growing percentage of HIV-positive individuals who are over the age of fifty. Dr. Brennan-Ing, the Director for Research and Evaluation at AIDS Community Research Initiative of America (ACRIA), told the audience, “This has been a real success story that so many people are aging with HIV, but there are a number of challenges to this success.”

Dr. Brennan-Ing noted that the demographics of AIDS in America have shifted markedly since the introduction of successful antiretroviral drugs. “By 2015, half of all people living with HIV in this country will be age 50 or over,” he said. Though these medications account for the bulk of this trend, Dr. Brennan-Ing also thinks it is important to realize that approximately eleven percent of all new HIV infections are occurring in people over the age of 50.

Many of these older adults with HIV are also sexually active. The ROAH study (Research on Older Adults with HIV) was one of the first studies to look at sexual activity in older adults with HIV. It found that about twenty percent of these adults were having unprotected sex with people without HIV (or of unknown status).

One of the key findings of the ROAH study was that these individuals have about three times as many additional comorbidities as elderly community members without HIV. For example, Dr. Brennan-Ing noted that, for unknown reasons, the percentages of older adults with vision or hearing loss is much higher in those with HIV. Arthritis, hypertension, broken bones, and depression are other conditions that are more common in older adults with HIV.

A very concerning finding from the ROAH study was that two-thirds of older adults with HIV report either moderate or severe depression. Hispanics also had significantly higher rates of depression than other ethnic groups. “This is such a concern, because depression is the single greatest predictor of medication nonadherence,” he said. Older adults with HIV are also much more likely to have substance abuse problems, especially with alcohol.

Support group structure also differs in many older adults with HIV, many of whom rely more on friends than on family members for support. These support systems are often more limited than those of older individuals without HIV. Many of these older HIV-positive individuals have battled social stigma and rejection. “Often, people say they are going to rely on their friends, but we know about half of their friends also have HIV and are of the same age and may not be able to provide support,” he said. This average age of this group is about 55 now. Dr. Brennan-Ing added, “Think about what this is going to look like ten years from now, or twenty years from now. We’re very concerned about their needs going forward.”

Older individuals with HIV also tend to use more social services than other older adults, partly due to their increased medical morbidities, and partly because their social supports are often not as robust.

Dr. Brennan-Ing concluded by looking at similar trends that have appeared in other countries where antiretroviral drugs have been available. In other places with more limited access, the trend has not yet taken hold. “In Sub-Saharan African, adults fifty and older account for only ten percent of people with HIV, but that’s 3 million people—about three times the size of the entire epidemic in the US. Very little has been done that focuses on the issues that these people are facing,” he said.