Editor’s note: This is the final in our series of blog posts sharing highlights from the National Minority AIDS Council’s 2012 U.S. Conference on AIDS.
HIV and aging was the issue in the spotlight at the third day of the annual U.S. Conference on AIDS (USCA). Thanks to effective treatment, the population of people living with HIV in the United States is getting older. In fact, by 2015, it is projected that one-half of the people living with HIV (PLWH) will be over 50 years old. In some places, including San Francisco, more than half of the PLWH population is already over 50; and the Department of Veterans Affairs also reports that the median age of its patients living with HIV is 53.
In a plenary session on HIV and aging, Dr. Tony Mills, a physician and Assistant Professor of Clinical Medicine at UCLA, observed that though the advent of highly active antiretroviral therapy (HAART) has resulted in a significant increase in the life expectancy of PLWH who are on treatment, research shows that the their life expectancy is still shorter by approximately 10 years compared to the general population. However, it is not HIV/AIDS that is claiming the lives of many of these PLWH. In fact, he reported, in the decade after the introduction of HAART (1996-2006) approximately 50 percent of deaths of PLWH were the result non-AIDS-related causes such as cardiovascular disease; liver-related diseases, particularly hepatitis B and C; violence and substance abuse; and respiratory and renal diseases. Many of these diseases and conditions are associated with aging, rather than HIV/AIDS.
Dr. Mills explained that HIV appears to increase the risk for several age-associated diseases as well as to cause persistent inflammation. Inflammation, he noted, is linked with a number of conditions, including cardiovascular disease, lymphoma, type 2 diabetes, cognitive dysfunction, and frailty. So researchers are working to better understand what causes persistent inflammation, even when persons are being treated with ART for their HIV disease. Some studies suggest that earlier initiation of ART appears to prevent persistent inflammation. The findings offer additional powerful data in favor of starting treatment earlier, he noted.
Moving toward a more multidisciplinary approach to care for PLWH is the clear implication of these findings, Dr. Mills observed. Given the evidence of increases in chronic diseases and other conditions associated with aging among PLWH on HAART, HIV care is no longer just about treating the HIV, he concluded, urging PLWH to be active participants in their care by asking their health care providers lots of questions and candidly discussing all conditions they are experiencing.
In two subsequent workshops on the topic of HIV and aging, presenters and participants discussed related prevention, treatment and care challenges as well as shared examples of outreach activities. Among the highlights from these workshops were:
- “Age Is Not a Condom,” a public awareness campaign conducted in the New York City transit system with support from the City Council to raise awareness of HIV risk among older adults.
- Highlights from “Research on Older Adults with HIV,” a study of more than 1,000 adults by the AIDS Community Research Initiative of America (ACRIA) examining a comprehensive array of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.
- A partnership between The AIDS Institute, located in Tampa, Florida, and the nearby James Haley Veteran's Hospital that recently resulted in a co-hosted HIV/AIDS awareness event in observance of the 2012 National HIV/AIDS and Aging Awareness Day. The VA system is the largest single provider of HIV care in the United States.
- The American Academy for HIV Medicine (AAHIVM) shared its recently released Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV, which they developed in partnerships with the American Geriatrics Society and ACRIA. The recommendations were developed by an expert panel of 14 leaders in HIV treatment, research, and geriatric care and cover a range of topics that people living with HIV often face as they age including monitoring ART in HIV and aging, cardiovascular risk reduction, diabetes in HIV and aging, viral hepatitis screening in HIV and aging, sexual health in HIV and aging, and drug-drug interactions and polypharmacy in HIV and aging. AAHIVM has also recently launched a discussion forum on HIV and aging to help engage a broader cross-section of participants in advancing the knowledge and communication in this area of medical uncertainty. Input from the forum will help inform subsequent updates to the recommendations, according to AAHIVM.
- Mr. Ken South of AAHIVM observed that smoking—as well as other substance use disorders—are significant issues among the population of people aging with HIV. In fact, the new AAHIVM treatment recommendations for older patients with HIV note that “While about 20% of the general population in the U.S. smokes, between 40% to 70% of HIV-infected people smoke.” Recent studies show that there has been a growing incidence of lung cancer among patients with HIV/AIDS. Thus, smoking cessation is critical to the management of HIV/AIDS, according to the recommendations, which note that “in the HAART-era HIV-infected persons who smoke have a lower quality of life and a doubling of their mortality, even when factors such as age, CD4 cell count, HIV RNA level are controlled.”
- The emerging need to better address caregiving challenges being faced by a growing number of aging people living with HIV was another issue identified during the workshop discussions. Some suggested that the HIV and healthcare communities need to work with the national network of senior services organizations to enhance their capacity to serve PLWH, some of whom may be experiencing aging conditions years ahead of their peers and many of who are single and childless and thus, may find these community systems of care particularly important as they age.
The several sessions illuminated a range of research, clinical care, public awareness and partner engagement activities necessary as ever-greater numbers of people living with HIV on ART live longer, fuller lives.