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Aging with HIV

Reviewed by: HU Medical Review Board | Last reviewed: September 2019

Our understanding of HIV and its treatment has come a long way since the first cases of the virus were reported in the population. Although HIV can be a potentially life-threatening illness, the good news is, advances in treatment have increased life expectancy dramatically and have made the condition manageable.

With these improvements in treatment, individuals with HIV are living longer than ever before. As a result, a new issue has arisen within the HIV population, HIV’s impact on aging. It has been estimated that about half of all individuals with HIV in the United States are above the age of 50, and this number is expected to increase to 70 percent in the next ten years.1,2

While research into HIV’s impact on aging is limited at this time, experts have been able to make some conclusions on HIV and aging as this population of individuals grows larger. Much more research is needed to fully understand the impact of HIV on aging and will continue on as more and more individuals live longer with the virus.

HIV and life expectancy

Life expectancy with HIV has increased significantly with the use of ART medicines (antiretroviral therapy). Some recent studies have suggested that for an individual with HIV who takes their ART as directed, life expectancy is approaching, or even the same as, the general population.3-5 This is especially true for more developed countries, like the United States.7

Individuals with the greatest increase in life expectancy are typically those who start consistent treatment early on, have higher education levels, and those who don’t smoke or who quit smoking,6 however, anyone who is dedicated to treatment and who maintains regular appointments with their healthcare team, regardless of their background, can increase their life expectancy with HIV.

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What kinds of conditions are older individuals with HIV at risk for?

Some older individuals who are living with HIV received their initial diagnosed later in life, while others may have been diagnosed early on and remained adherent to their ART, increasing their life expectancy.1

No matter what an individual’s specific situation is, there are some common conditions that may arise in the aging HIV population. The reasons why an older individual with HIV may get these conditions are not completely understood at this time. Some may be related to increased, long-term inflammation that comes as a result of constantly fighting HIV. Other issues may occur even when an individual is on ART, as some ART medications themselves can have side-effects that lead to long-term conditions. Further, the presence of HIV in general may serve as enough of a risk factor to develop another condition. Finally, although unclear at this time, some experts have suggested that HIV affects the normal aging process to create an “accelerated aging” state.2,7-12

Although AIDS-related conditions are on the decline due to ART, there are some non-AIDS related conditions that are more common in older adults with HIV.7,11 Several of these and common theories as to why they exist include, but are not limited to:

  • Cardiovascular disease:Cardiovascular conditions like coronary artery disease, congestive heart failure, ischemic stroke, and more may occur in the aging HIV population as a result of chronic inflammation and fat dysregulation leading to the development of fatty plaques in the blood vessels. Individuals with HIV may also be more likely to engage in other behaviors that increase the risk of cardiovascular issues, such as smoking or alcohol abuse.
  • Certain cancers: While some cancers are considered AIDS-defining and are on the decline with ART, other non-AIDS defining cancers, like lung, anal, breast, colorectal, and prostate cancers, as well as Hodgkin’s lymphoma may occur more frequently in older individuals with HIV, and at slightly younger ages than what would normally be expected. This could be due to long-term inflammation or problems with the normal functioning of the immune system (including its cancer-fighting abilities).
  • Kidney issues and diabetes:Kidney issues and diabetes may arise due to similar reasons as cardiovascular diseases, and also due to shared risk factors like smoking, high blood pressure, and unstable blood sugar levels. Some ART medications may also increase an individual’s risk of developing kidney problems.
  • HIV-associated neurocognitive disorders: Some older individuals with HIV will experience an increase in neurocognitive issues when compared to those without the virus. These include issues with memory, language, attention, motor skills, or problems walking. These may occur as a result of co-occurring mental health issues, other co-occurring conditions like hepatitis C, or past brain trauma or infection. Mental health conditions like anxiety and depression may also occur more frequently for those with HIV, regardless of age.
  • Liver disease: Liver issues may arise as a result of treatment, as some ART drugs have the potential to affect the liver. Additionally, co-infection with a hepatitis virus, such as hepatitis B or C (both of which occur in the HIV population) may lead to liver damage over time.
  • Osteoporosis or osteopenia: Osteoporosis and osteopenia are both issues related to weakening of the bones. This may occur as the result of medications over time, vitamin D deficiency, substance abuse, smoking history, and low body weight, among other reasons.
  • Other geriatric syndromes: At this time, it seems as though older individuals with HIV may be at a higher risk of having other geriatric-related issues (older age-related issues), such as hearing or vision loss, falls, difficulties with daily activities, slow movements, and urinary incontinence. More research is needed to determine HIV’s role in the development of these issues.2,7-12

What can I do to prevent these issues?

Although many of these conditions may not be completely preventable, there are some strategies that can be used to reduce the risk of developing them. Several of these risk-reducing behaviors include exercising regularly, eating healthy, practicing good infection-reducing techniques like washing hands regularly and thoroughly washing and cooking foods before eating, quitting smoking, reducing alcohol intake, seeing a healthcare provider regularly, taking your ART as prescribed every day, and staying up to date on your regular cancer screenings (colonoscopies, mammograms, prostate exams, and more).9,10

Although ART use may play a role in the development of some of these conditions, it is necessary in order to prevent even worse outcomes, including AIDS and AIDS-defining conditions, which can lead to death. Taking ART every day is the best method of preventing serious HIV-related complications from occurring.