HIV began mostly as a disease of young men, but today the epidemic impacts people of all ages, including older people (age 50 and over). Issues related to HIV and older people are receiving more and more attention as this population grows. In fact, on September 18, 2009, the first National HIV/AIDS and Aging Awareness Day was held to recognize the need to:

• Prevent HIV infection in this age group
• Understand the unique health effects of the virus in older HIV+ people
• Improve the health and quality of life of older HIV+ people
• Increase research on HIV and aging issues

The aging HIV population is growing for two reasons: 1) Powerful HIV drugs are allowing many HIV+ people to live into their 50s and beyond and 2) While most new HIV infections are in younger people, people 50 and older are also being infected. As a result, about one in four HIV+ people in the US in 2007 was at least 50 years old. By 2015, nearly half of HIV+ people in the US will be over 50.

Many of the health problems of older people appear to happen earlier and progress faster in HIV+ people. This may be because HIV infection activates (sets off) the immune system and causes inflammation (the body’s response to infection). HIV drug treatment reduces immune activation and inflammation, but does not bring back the normal pre-HIV state. On-going inflammation appears to be related to many conditions associated with aging.

Some of the chronic conditions of aging facing HIV+ people include:

• Cardiovascular disease: As people age, the risk of heart attack or stroke increases. HIV and HIV drugs may further increase the risk.
• Cancers: Having HIV increases the risk of some cancers such as KS, lymphoma, cervical, anal, lung, and skin cancers.
• Bone problems (osteopenia and osteoporosis): Weakened bones can occur with age, especially in women after they stop menstruating. Bone thinning has also been linked to HIV and its treatment.
• Cognitive problems: Mental function, including memory and concentration, tend to decline as people age, but cognitive problems can also be due to HIV infection and some HIV drugs.

HIV+ people also may be at risk for:

• Liver disease (often related to hepatitis B or C)
• High blood pressure
• Kidney problems
• Metabolic and body shape abnormalities (lipodystrophy)
• Diabetes

For more information, see TWP sheets in the Diseases and Conditions section of our website.

As more older people are becoming infected with HIV, more HIV+ people are reaching older age, and more middle-age HIV+ people are experiencing diseases of aging, many of the medical problems facing HIV+ people have more to do with diseases of aging than HIV-related illnesses.

Starting HIV treatment before your CD4 cell count falls to 350 cuts the risk of HIV-related and non-HIV-related illnesses. Recent US treatment guidelines recommend that people start HIV treatment even earlier, when their CD4 cells are between 350 and 500.

Many older people are already taking medications for age-related ailments. It is important to know if HIV drugs can interact with these medications, such as those used for high blood pressure or high cholesterol, and you should speak to your health care provider about possible drug interactions.

Another important step is to get regular medical checkups that look for:

• Heart disease: For good heart health, HIV+ people should talk with their health care providers about monitoring cholesterol levels and blood pressure. Also consider heart-protective habits such as exercising, quitting smoking, and eating a healthy diet.
• Cancers: It is also important to get cancer screening for several non-AIDS conditions that commonly affect HIV+ people (such as cervical and anal cancer) and for common cancers that do not appear to occur more frequently in HIV+ people (including breast, colon, and prostate cancer).
• Bone problems: An easy and painless test called DEXA scanning can help you and your health care provider monitor your bone health and determine if you’re at risk for a serious fracture. Vitamin D and calcium supplements might be recommended and prescription medications to help reverse bone loss are also available.

You should also be monitored for cognitive problems (changes in thinking or memory), liver disease, kidney disease, metabolic and body shape abnormalities, diabetes, and mental health issues, including depression.

The aging process itself lowers energy levels, restricts social encounters, and cause decreased physical and mental capabilities. This means that older HIV+ people may suffer more emotional problems and physical stresses than do others.

Stigma can also make things difficult. There is the stigma of living with HIV disease and the stigma of ageism. This can make it difficult for older people to find support. First of all, they may be ashamed and hesitate to tell anyone that they have HIV. Second, they may not be comfortable in support groups and therefore not join them.

However, it is important for the aging population living with HIV to seek out support. A lack of support can lead to depression. A mental health counselor, health educator, or peer counselor can help. Some peer counselors may have had similar experiences and can share healthy ways to cope.

There is a lot of research and attention focused on aging and HIV. With it may come advances in the care and treatment of older people with HIV. In the meantime, both middle-aged and older HIV+ people need to make sure that their health care providers monitor not only their HIV illness, but also check regularly for signs of diseases associated with aging. This includes testing for cancer, heart problems, bone disorders and other health issues that are growing more common among HIV+ people as they get older.

HIV+ people can take further steps to prevent disease and improve their overall health as they age. These include quitting smoking, eating a healthy diet, getting more exercise, and avoiding or reducing the use of alcohol and recreational drugs.