It has been almost 40 years since the world was first introduced to the HIV/AIDs epidemic. Since those early days of confusion and fear, HIV has transformed from a death sentence to a manageable condition. Thanks to treatment advances, people with living with HIV can and do lead long and healthy lives. And that has led to a scenario that doctors and patients in the 1980s and early 1990s could not have imagined: the aging HIV patient.
In fact, according to the U.S. Centers for Disease Control and Prevention (CDC), almost half of people living with HIV in the United States are age 50 or older and by 2020 more than 70 percent of people living with HIV will be older than 50.
“These numbers really show that there has been a lot of headway in terms of both preventing new infections and getting people living with HIV on effective treatment,” said Helen Koenig, MD, an associate professor of Infectious Diseases in the Perelman School of Medicine.
When combination drug therapy first became available in 1996, it was a game-changer for many people living with HIV. Previously, patients had to take several pills many times throughout the day with challenging side effects and many people weren’t put on medication until their disease had progressed from HIV to AIDS. Today, HIV-positive patients are generally treated with a single, once-a-day, fixed-dose tablet that combines multiple drugs. It is much easier to manage and has fewer side effects. This more effective medication coupled with the now standard practice of putting people on ART as early as possible to suppress the virus has revolutionized what it means to be living with HIV.
“The majority of my patients have been living with HIV for 10 years or more, and a large proportion, about 10 to 20 percent, have been HIV-positive for 20 or even 30 years,” Koenig said.
But this progress comes with new challenges for care providers. Even with effective treatment, HIV can be a risk factor for cardiovascular disease, cancer, kidney disease, and neurodegenerative diseases, just to name a few. Though the exact reasons why this happens are unknown, it appears a combination of factors are at play, the most important of which is increased inflammation from the infection itself.
“These other co-morbidities can mean that people living with HIV may need to take more medications to manage these other conditions, which can be complicated for patients,” Koenig said.
Lifestyle can also be a contributing factor to other chronic diseases, especially conditions related to tobacco use and substance abuse which can cause diabetes, heart disease, and cancer.
And living with HIV for many years also means living with the fear, stigma, discrimination that is often a reality for people who are HIV-positive. HIV stigma refers to the unfair and unjust treatment of someone based on their real or perceived HIV status and can lead to many people living with the virus to not seek out treatment or disclose their status to close family and friends, including sexual partners.
“Many older people living with HIV have learned to live with stigma, and have learned where it is safe or not safe to disclose their status, and potentially have found long-term partners who have accepted their status,” Koenig said. “But in many ways I believe they still face the same degree of stigma that younger people living with HIV and even people who were living with the virus in the 1980s and early 1990s faced.”
With older populations, this stigma and fear of discrimination could also lead to isolation, loneliness, and depression or other mental health challenges. By ensuring that all people living with HIV, including those who are older, are linked to care, they can access mental health and other services to help them cope with stigma and discrimination and stay engaged in their treatment regimen.
However, Koenig points out that, “stigma is not their problem, it’s our problem, a problem within our society that we need to continue to confront at every level.”
“All people, regardless of their age, gender, where they live or who they love, have the right to health,” said Michel Sidibé, executive director of UNAIDS in a recent statement on World AIDS Day 2017. “No matter what their health needs are, everyone requires health solutions that are available and accessible, free from discrimination and of good quality.”
As World AIDS Day 2017 approaches on Friday, Dec. 1, the conversation around treating and preventing HIV will continue to shift towards viewing the virus as a chronic, manageable condition and how to ensure the people who are living with HIV long-term do not slip through the cracks as this group of people will be essential in global fight to end the epidemic.
Follow the World AIDS Day 2017 conversation on social media using #WAD2017 and #EndAIDS.