Growing Older With HIV/AIDS: New Public Health Challenges

At present, the health care infrastructure is ill-equipped to handle the unique treatment and care needs of HIV-positive older adults.The long-term effects of antiretroviral use are still being discovered and have been associated with a number of comorbidities. Stigma presents challenges for those in need of services and health care, and can significantly affect mental health and treatment adherence.The training of elder service providers and health care providers in meeting the needs of HIV-positive older adults, including gay and transgender people, is needed as the population ages. HIV-related and antigay stigma should be challenged by social marketing campaigns. Continued research and key policy changes could greatly improve health outcomes for HIV-positive elderly persons by increasing access to treatment and support.THE ADVENT OF ANTIRETROVIral medications (ARVs) has enabled HIV-positive people to live increasingly longer lives. Those in the developed world who begin highly active antiretroviral treatment (HAART) at an initial CD4 count above 200 can expect to live well into their 70s.1Worldwide the leading cause of death among people living with HIV/AIDS is tuberculosis.2 In the United States tuberculosis is very rare. Less than one third of deaths among people with HIV/AIDS in the United States are now attributed to diseases traditionally associated with HIV infection, such as Kaposi’s sarcoma.3 Liver disease and cardiovascular disease, both associated with long-term use of ARVs, are leading causes of mortality among older people living with HIV.Longer life expectancy is already evident; by 2015 more than half of the HIV-positive population in the United States will be aged 50 years and older.4 Most older adults living with HIV/AIDS were infected in youth or middle age; only 1 in 9 new HIV infections in the United States occurs among people aged 50 years and older.5Aging with HIV/AIDS presents biomedical complexities only now beginning to reveal themselves. Higher rates of comorbidities are among the more severe biomedical issues facing older adults with HIV/AIDS.6 Widespread cognitive impairment among people on treatment of a long time could be caused by “chronic HIV-driven inflammation in an aging brain.”7^(p1) Answers to critical research questions regarding how HIV medications interact with medications to treat other conditions are still in the nascent stages. In this article, we examine what we know about growing older with HIV/AIDS, identify gaps in knowledge, and provide recommendations to enable public health professionals to better treat and care for the burgeoning population of HIV-positive older adults, and reduce infections among older adults.