HIV (Human Immunodeficiency Virus) is usually contracted through unprotected sex or sharing needles. When left untreated, it can badly damage the immune system, preventing the body from fighting the infections a normal immune system can handle. People with HIV who have severe immune damage are diagnosed with AIDS or Acquired Immune Deficiency Syndrome.
New HIV medications have transformed HIV from an often-fatal disease into a chronic disease, like diabetes, that many people live with. Some people have lived with HIV for decades, and are proof that HIV treatment can help people lead long, healthy lives. But we are just beginning to learn what this means for their long-term health.
Even in people whose HIV is well controlled with treatment, the virus can still cause long-term damage. This is because HIV not only suppresses the immune system, it also activates it. This leads to inflammation, and chronic inflammation can damage organs such as the heart, kidneys, and liver and may cause other problems. People with HIV also tend to have a higher rate of other illnesses (comorbidities) than people who are HIV-negative. This section discusses some of the health issues people with HIV may face as they age, and how they can manage them.
BACKGROUND
Improved medications and medical care have had a profound effect on the long-term survival and quality of life for older adults with HIV. One of the results of this is that the percent of people with HIV ages 50 and older is now over 50% in most large cities and even higher in New York City. This is true even in the face of increases in new HIV infections in younger people in the Southern part of the country. By 2030, people ages 50 years and older are projected to account for over 70% of the people living with HIV.
Another effect of HIV treatment is that the life expectancy of people living with HIV is now closer to the life expectancy of people without HIV. This is reflected by fewer deaths from HIV. Consequently, HIV is now classified as a chronic disease like diabetes – needing care, but treatable.
HIV infections in people ages 50 years and older has persistently been about 17% of new cases. Efforts to encourage condom use during sex have not been successful, either because of denial of risk, desire to please partners, or refusal to take PrEP (Pre-exposure Prophylaxis) that can help prevent HIV. Some cities such as Washington, DC, have increased efforts to address HIV infection rates among all ages, including people ages 50 years and older, with prevention campaigns.
Another issue is the effect that the COVID-19 pandemic has had on the lives of people with HIV. Some are concerned about having an increased risk of the virus despite the lack of evidence demonstrating higher risk. HIV.gov states: “Based on limited evidence we believe that people with HIV who are on effective treatment have the same risk for COVID-19 as people who do not have HIV”.
TREATMENT
Many HIV medications are available, and immediate treatment is now recommended for everyone with HIV. Your healthcare team will monitor your HIV viral load, CD4 count, and check for any side effects. If there is a problem, changes can be made. Most HIV meds must be taken daily, but an injectable treatment given every 4 or 8 weeks was recently approved.
A major challenge facing older adults with HIV is the management of other illnesses (comorbidities). Treatments are available for many of these problems, and their impact can be managed.
WHAT CAN BE DONE
Research on a cure for HIV has been ongoing for decades. While progress has been made, a cure remains elusive. While we wait, it’s important to know that staying healthy with HIV as you age is about more than just taking medications. It requires a healthy lifestyle including the adequate nutrition, exercise, and sleep. Supportive mental health activities such as stress reduction and other activities are an important part of a holistic approach to health. With the right choices, your future can be very positive.