Growing Older with HIV
At the start of the epidemic more than 30 years ago, people who were diagnosed with HIV or AIDS could expect to live only 1-2 years after that diagnosis. This meant that the issues of aging were not a major focus for people with HIV disease.
But today, thanks to improvements in the effectiveness of treatment with HIV medicine (called antiretroviral therapy or ART), people with HIV who are diagnosed early in their infection, and who get and stay on ART can keep the virus suppressed and live long and healthy lives. For this reason, nearly half of people living with diagnosed HIV in the United States are aged 50 and older. Many of them have been living with HIV for years; others are recently infected or diagnosed.
According to the Centers for Disease Control and Prevention (PDF, 3.1 MB) (CDC), of the estimated 1.1 million people with HIV in the U.S. in 2018, approximately 400,000 (36%) were aged 55 and older. In addition, people aged 50 and older accounted for 17% of the 37,968 new HIV diagnoses in 2018 in the United States and 6 dependent areas.
Older adults (those over age 50) with HIV make up 46% of the half a million clients served by the Ryan White HIV/AIDS Program (RWHAP). In 2018, 92% of clients aged 50 and older receiving RWHAP HIV medical care were virally suppressed, which was higher than the national RWHAP average (87%). (Learn more about the RWHAP and older adults (PDF, 445 KB).)
Complications Associated with Aging
With this longer life expectancy, many individuals living with long-term HIV infection exhibit clinical characteristics commonly observed in aging: multiple chronic diseases or conditions, the use of multiple medications, changes in physical and cognitive abilities, and increased vulnerability to stressors.
Complications Associated with Long-term HIV Infection
While effective HIV treatments have decreased the likelihood of AIDS-defining illnesses among people aging with HIV, HIV-associated non-AIDS conditions are more common in individuals with long-standing HIV infection. These conditions include cardiovascular disease, lung disease, certain cancers, HIV-Associated Neurocognitive Disorders (HAND), and liver disease (including hepatitis B and hepatitis C), among others.
In addition, HIV appears to increase the risk for several age-associated diseases, as well as to cause chronic inflammation throughout the body. Chronic inflammation is associated with a number of health conditions, including cardiovascular disease, lymphoma, and type 2 diabetes. Researchers are working to better understand what causes chronic inflammation, even when people are being treated with ART for their HIV disease.
HIV and its treatment can also have profound effects on the brain. Although AIDS-related dementia, once relatively common among people with HIV, is now rare, researchers estimate that more than 50 percent of people with HIV have HAND, which may include deficits in attention, language, motor skills, memory, and other aspects of cognitive function that may significantly affect a person’s quality of life. People who have HAND may also experience depression or psychological distress. Researchers are studying how HIV and its treatment affect the brain, including the effects on older people living with HIV.
For more information, see the National Institute on Aging’s Aging with HIV: Responding to an Emerging Challenge.
Late HIV Diagnosis
Older Americans are more likely than younger Americans to be diagnosed with HIV infection late in the course of their disease, meaning they get a late start to treatment and possibly 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 those of normal aging and don’t consider HIV as a cause.
According to CDC (PDF, 4 MB), in 2018, 35% of people aged 50 and older already had late-stage infection (AIDS) when they received a diagnosis (i.e. they received a diagnosis later in the course of their disease.)
COVID-19 and HIV
Researchers are still learning about COVID-19 and how it affects people with HIV. Based on limited data, scientists believe people with HIV who are on effective HIV treatment have the same risk for COVID-19 as people who do not have HIV.
Older adults and people of any age who have serious underlying medical conditions might be at increased risk for severe illness. This includes people who have weakened immune systems. The risk for people with HIV getting very sick is greatest in people with a low CD4 cell count and people not on effective HIV treatment (antiretroviral therapy or ART).
The Importance of Support Services
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 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.