Growing Older with HIV

Today, thanks to improvements in the effectiveness of treatment with HIV medicine (called antiretroviral therapy or ART), people with HIV who are diagnosed early and who get and stay on ART can keep the virus suppressed and live long and healthy lives. For this reason, more than half of people living with diagnosed HIV in the United States and dependent areas are aged 50 and older. Many of them have been living with HIV for many years; others were diagnosed with HIV later in life.

That’s a significant change from the early years of the epidemic when people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after their diagnosis since effective treatments were not yet available. This meant that the issues of aging were not a major focus for people with HIV disease.

According to the latest data from the Centers for Disease Control and Prevention (CDC), in 2021, of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas, over 53% were aged 50 and up. In addition, people aged 50 and older accounted for 16% of the 36,136 new HIV diagnoses in 2021 among people ages 13 and older in the United States and dependent areas. Though new HIV diagnoses are declining among people aged 50 and older, around 1 in 6 HIV diagnoses in 2021 were in this group.

Further, in 2021, people over age 50 with HIV made up 48.3% of the over half a million clients served by the Ryan White HIV/AIDS Program (RWHAP). In addition, in 2021, 93.1% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average (89.7%). (Learn more about the RWHAP and older adults.)

Health Issues and Aging with HIV

People aging with HIV share many of the same health concerns as the general population aged 50 and older: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors. In addition, while effective HIV treatment has decreased the likelihood of AIDS-defining illnesses among people aging with HIV, many HIV-associated non-AIDS conditions occur frequently in older persons with HIV, such as cardiovascular disease, diabetes, renal disease, and cancer. These conditions are likely related to a number of interacting factors, including chronic inflammation caused by HIV. Researchers are working to better understand what causes chronic inflammation, even when people are being treated with ART.

HIV and its treatment can also have effects on the brain. Researchers estimate that between 25 and 50% of people with HIV have HIV-Associated Neurocognitive Disorder (HAND), a spectrum of cognitive, motor, and/or mood disorders categorized into three levels: asymptomatic, mild, and HIV-associated dementia. Researchers are studying how HIV and its treatment affect the brain, including the effects on older people living with HIV.

Late HIV Diagnosis Among Older Adults with HIV

Older Americans are more likely than younger Americans to be diagnosed with HIV late in the course of their disease, meaning they get a late start receiving the benefits of HIV treatment and possibly incur more damage to their immune system. This can lead to poorer prognoses and shorter survival after an HIV diagnosis. Late diagnoses can occur because health care providers may not always test older people for HIV infection, and older people may mistake HIV symptoms for signs of normal aging and don’t consider HIV as a possible cause they should discuss with their provider.

According to a 2023 report from CDC, in 2021, 34% of people aged 55 and older in the United States* already had late-stage HIV infection (AIDS) when they received a diagnosis (i.e., they received a diagnosis later in the course of their disease).

Older Adults, COVID-19, and Other Respiratory Viruses

Older adults and people of any age who have serious underlying medical conditions are at higher risk of getting very sick from respiratory viruses such as COVID-19, flu, and respiratory syncytial virus (RSV). This includes people who have weakened immune systems. The risk for people with HIV getting very sick from respiratory viruses is greatest in people with a low CD4 cell count and people not on effective HIV treatment.

The risk of getting very sick from respiratory viruses also increases with age. For example, people who are 85 years old are at substantially higher risk of getting very sick than people who are 65 years old.

Read CDC’s information about how you can protect yourself from COVID-19, flu, and RSV.

The Importance of Support Services for Older Adults with HIV

Living with HIV presents certain challenges, no matter what your age. But older people with HIV may face different issues than their younger counterparts, including greater social isolation and loneliness. Stigma is also a particular concern among older people with HIV. Stigma negatively affects people’s quality of life, self-image, and behaviors, and may prevent them disclosing their HIV status or seeking the health care or social services that many aging adults my require. HIV care.

Therefore, it is important for older people with HIV to get linked to HIV care and have access to mental health and other support services to help them stay healthy and remain engaged in HIV care. You can find support services through your health care provider, your local community center, or an HIV service organization. Or use the HIV Services Locator to find services near you.

Sources:

CDC. Diagnoses of HIV infection in the United States and dependent areas, 2021. HIV Surveillance Report 2023;34.

CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2021. HIV Surveillance Supplemental Report 2023;28(4).

HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2021. Published December 2022.

*Stage of HIV infection data are from 47 states and the District of Columbia that reported complete CD4 and viral load test results to CDC as of December 31, 2021.