HIV Increasing Steadily in Older Adults

The prevalence of human immunodeficiency virus (HIV) rates among people over age 50 has increased steadily in recent years, according to a new study.

New data from UNAIDS indicate that there are 4.2 million people older than 50 years living with HIV infection worldwide-a doubling over the past 20 years. “Care and treatment services need to address the specific needs of older people living with HIV infection. Action is needed to incorporate older age groups into HIV surveillance systems,” state the authors from the UNAIDS Programme Branch in Geneva, Switzerland.

The literature describes an aging HIV-infected population between 50 to 65 years of age with higher rates of comorbid conditions compared with their non–HIV-infected counterparts.

Medical care may be further complicated by neurocognitive decline and high rates of depression, alcohol and substance use, and social isolation.

The goals of caring for older people with HIV infection are to minimize illness and frailty, optimize health and well-being, and prolong life, according to The Quick Reference Guide for HIV Primary Care Clinicians for the Management of HIV in Older Adults, developed by the New York State Department of Health AIDS Institute in 2013.

The key points of the reference guide are:

• People with HIV infection may develop chronic diseases associated with aging earlier in life, resulting in multiple comorbid conditions.
• Aging can compound the immunological impact of HIV and accelerate HIV disease progression.
• Older people with HIV are at particular risk for polypharmacy, which increases the risk of drug-drug interactions and adverse events; it also can negatively affect cognitive function and quality of life.

To prevent or delay disability, the reference guide recommends certain assessments for older adults with HIV/AIDS. These include total HIV and non-HIV disease burden and functional status; medication adherence, adverse effects, drug-drug interactions, and the need for dose adjustments; alcohol and substance use, including prescription drugs; mental and cognitive status; and social support.

Total disease burden and functional status also need to be assessed. Clinicians should take note of disease progression since the last patient visit; consultations, specialty care visits, oral health care, ancillary tests, and any changes in medications; new symptoms and diagnoses; changes in hearing and sight; basic and instrumental activities of daily living; pain, range of motion, and gait; frailty; need for home care, assisted or congregate living, skilled nursing, or hospice services; and hygiene, in particular hair, nails, and feet.

The reference guide also offers several quick screening tools for HIV disease progression and cognitive function. The Veterans Aging Cohort Study Risk Index-a prognostic tool based on a calculation of age and 8 routine laboratory tests-helps monitor HIV disease progression and response to therapy. An online calculator is available.

The International HIV Dementia Scale, a new rapid screening test for HIV dementia, includes simple tests of motor speed, psychomotor speed and memory recall.

In addition, the reference guide suggests clinicians discuss long-term care and hospice plans with their older HIV-infected patients.

“All patients, regardless of CD4 count, should be evaluated for ART. Patients over age 50 years are a high-risk group for whom initiation of ART is particularly urgent,” states the reference guide.

The UNAIDS researchers published their results in the November 2014 issue of AIDS.