As a doctor, I’m well aware that the estimated life expectancy of people who are first diagnosed with HIV at age 30 is now 75 years old — a huge leap from the 1980s, when those with the virus were given as little as a few weeks to a few years to live.
Fortunately, a lot of people outlived those dire projections, and many of them are now long-term survivors who continue to thrive as they age. The development of highly active antiretroviral therapy in the 1990s is credited with the miraculous extension in life expectancy that people with HIV enjoy today.
But it also means that HIV-positive people can expect to be on antiretroviral medications for 40 years or more. According to Sage, the country’s largest organization dedicated to improving the lives of older LGBT adults, “By 2020, more than 70 percent of Americans with HIV will be 50 or older.”
Does HIV accelerate the aging process?
Many researchers believe that aging is accelerated in HIV-positive people due to the presence of the latent virus, which is not completely eradicated by antiretrovirals. The good news is that people living with HIV are living longer, healthier lives if their viral loads are suppressed with these drugs. However, they may still develop age-related comorbidities. And, for some people living with HIV, certain age-related health conditions might arise at a younger age.
Are there support issues I need to be concerned with?
Older people living with HIV face more social isolation and loneliness than others their age. HIV stigma is still prevalent, even among older men and women living with the virus. By and large, older HIV-positive people feel disenfranchised not only from their families but also from younger men and women within the LGBT community. Stigma may negatively impact a person’s quality of life and self-image, and may prevent them from seeking counseling. It is important for older people with HIV to connect with HIV support groups specifically geared toward other poz people their age. You can find support groups through your provider or by contacting a local HIV service organization.
As a person living with HIV, when should I get screened for cancer?
The United States Preventive Services Task Force recommends the following:
• Men and women at average risk should be screened for colorectal carcinoma starting at age 50, using fecal occult blood testing (FOBT), flexible sigmoidoscopy with or without FOBT, or a colonoscopy. Office-based digital rectal examination plus FOBT should not be used.
• Women 50 and above at average risk should be screened every one to two years for breast cancer using mammography.
• Sexually active women should be screened every three years for cervical cancer using the Papanicolaou (“Pap”) smear. (The same applies to transgender men who still have a cervix.)
• There is not adequate evidence to recommend for or against screening men or transgender women for prostate cancer.
These recommendations may be applied to HIV-positive patients with CD4 counts of >350 cells/µL or completely suppressed HIV RNA. For patients with lower CD4 counts, screening should be discussed in the context of the patient’s prognosis, preferences, and health goals.
What are the considerations for treating older people with HIV using antiretrovirals?
Antiretroviral therapy is recommended for all people with HIV regardless of CD4 count. Treatment is important for older individuals because they have a greater risk of developing serious non-AIDS-related complications. Older individuals may experience more adverse drug reactions than younger individuals with HIV. Healthcare providers should closely monitor bone, kidney, metabolic, cardiovascular, and liver function. Older people living with HIV are more likely to be on multiple medications for comorbid conditions. The potential for drug-on-drug interactions should be assessed routinely by your healthcare provider. It’s a good idea to keep a list of all your medications, including prescription drugs, over the counter medicines, and herbal and vitamin supplements. Keep your doctor up to date on any changes and have them reconcile your list with the list in your electronic medical record.
Does aging with HIV put me at greater risk of geriatric syndromes?
According to several studies, frailty is a syndrome of decreased physiological reserve associated with an increased susceptibility to falls, worsening mobility, and loss of independence. Aging and frailty are complex. There are numerous confounding factors in people living with HIV — including sex, race, education, and employment. Bone fragility in older people living with HIV can lead to fractures, which increase frailty and muscle wasting and can reduce an individual’s functional capacity. These frailty-associated conditions may pose a threat to an individual’s day-to-day living, making it difficult for them to run errands, socialize, or attend medical appointments. Some clinicians believe that targeted exercise programs to increase physical activity and improve endurance and strength should be evaluated to improve the lives of people living with HIV.
Dr. Frank Spinelli, MD, is a physician living in NYC. He is the author of The Advocate Guide to Health and Wellness and the host of Dueling Doctors (@SpinelliMD)