Due to the effectiveness of antiretroviral therapy, human immunodeficiency virus (HIV) has become a controllable chronic illness and no longer a death sentence as it was prior to the mid-1990s. Many people living with HIV are expected to live well into their older years. Currently, there are roughly 1.2 million people in the United States diagnosed with HIV and half of them are 55 years of age and older. Almost 20% of all newly diagnosed cases of HIV are among people over age 50.
Many older adults diagnosed with HIV will enter senior care centers such as assisted living and skilled nursing. Managing polypharmacy and comorbidities will be a challenge for the medical and nursing staff. Individuals will age with common age-related illnesses including neurodegenerative disorders, cardiovascular problems, and metabolic and endocrine disorders as well as HIV. Providers will need to understand how to care for older adults with HIV. They will also need to learn how to manage medications and the complications associated with polypharmacy.
(NOTE: Interested in learning more about Neurodegenerative Disorders? Checkout my Neurodegenerative Disorders on CEU Academy and try a FREE CEU today!)
Healthcare professionals will also need to learn how to better manage the many comorbidities that are associated with HIV and the aging process as well as complex psychosocial issues among this population. Many experts agree that as individuals with HIV who are on antiretroviral therapies grow older, the burden of this comorbid medical disease will continue to increase. Since there is an increased life expectancy anticipated due to the effectiveness of therapies, there too is expected an increase in age-related conditions like dementia.
Accelerated Aging with HIV?
There is a debate in research about the relationship between HIV and aging. Some believe that HIV itself accelerates the aging process and people with HIV will experience age-related health problems younger than those who don’t have HIV. Others believe that the antiretroviral drugs themselves are behind advanced aging. And there are those who don’t believe either of these.
There is some evidence that many age-related disorders including diabetes, cardiovascular and liver disease, cancer and dementia occur at earlier ages among people who have HIV compared to HIV-negative persons. What’s the difference? What is it that makes people age faster with HIV than those who don’t have it? It may be associated partially with the side effects of antiretroviral medications. It may also be due to the persistent impairment of the immune system and chronic inflammation. Add HIV, comorbidities and the aging process up and we have an increased risk of frailty among older adults.
Older adults living with HIV may also be more vulnerable to developing dementia. Dementia, in particular, is an important contributor to the decline of physical functioning among older adults and may lead to decreased quality of life.
The Role of Immunosenescence
Immunosenescence refers to the physiological aging of the immune system. It is associated with a dysfunction in innate and adaptive immunity which diminishes the ability to respond to infections. It is also known as “immune senescence”. These changes also take place among those diagnosed with HIV, except that changes in the immune function occur at a much younger age. Some of these changes have been detected in studies as early as age 20 or 30 years before people not infected with HIV. Special medical concerns among older adults diagnosed with HIV include metabolic changes, diabetes, coronary heart disease, renal complications, bone mineral density problems leading to fractures, osteoporosis, HIV-associated neurocognitive disorder (HAND) and frailty syndrome.
Final Words on Aging with HIV
The relationship between aging and HIV is quite complex. Some believe that HIV accelerates the aging process itself, while others think that the medications used to treat HIV are negatively affecting the body and causing advanced age. While there is some clinical evidence available, it remains unclear if either line of thinking is accurate.
(NOTE: Interested in learning more about Neurodegenerative Disorders? Checkout my Neurodegenerative Disorders on CEU Academy and try a FREE CEU today!)
More Neurodegenerative Disorder Articles
- What is Creutzfeldt-Jakob Disease?
- Engaging Older Adults Diagnosed with Neurodegenerative Disorders
- Neurodegenerative Disorders and End of Life Care
- Amyotrophic Lateral Sclerosis (ALS) and End of Life Care
- Parkinson’s Disease and End of Life Care
- Managing Huntington’s Disease in Senior Care
- Managing Multiple Sclerosis in Senior Care