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HIV and Aging: 4 Problems To Watch For

Posted on August 10, 2022
Medically reviewed by
Barry S. Zingman, M.D.
Article written by
Jane Chung, PharmD, RPh

  • The life expectancy for people living with HIV is increasing.
  • Like most people, those with HIV have a greater risk of developing health issues as they age.
  • Age-related health issues can be worsened by HIV.
  • Having HIV can also introduce a risk of other medical conditions.

Thanks to the development and widespread use of highly active antiretroviral therapy (ART) since the mid-1990s, the life expectancy of people living with HIV has greatly increased. As a result, there is a growing population of older adults living with HIV.

According to the U.S. Centers for Disease Control and Prevention (CDC), 59 percent of people living with HIV in the U.S. were aged 45 years or older in 2019, 24 percent were 45 to 54 years old, and 34 percent were 55 and older.

As people age, they become more susceptible to age-related comorbidities that may decrease their quality of life.

Comorbidities

Compared with the general population, people who have received an HIV diagnosis are at increased risk of developing certain comorbidities. A comorbidity is when someone has two or more diseases or medical conditions occurring at the same time.

Metabolic Syndrome and Chronic Disease

Metabolic problems occur when the body is unable to break down and use proteins, fats, and carbohydrates. The prevalence of metabolic dysfunction that resembles metabolic syndrome is higher for people with HIV. Metabolic syndrome includes hypertriglyceridemia (high triglycerides, a type of fat, in the blood), low high-density lipoprotein cholesterol, and insulin resistance. These conditions are predictors of the increased risk of cardiovascular disease, which is a term used to describe diseases that affect the heart or blood vessels.

One study looked at whether people living with HIV, aged 18 and older, had higher rates of comorbidities compared to people without HIV. The results showed that people with HIV were more likely to have chronic (long-term) conditions such as diabetes, high blood pressure, high cholesterol, and chronic kidney disease.

Stroke was also seen more often in people with HIV. However, the rates of myocardial infarction (heart attack) and coronary artery disease (buildup of plaque in the arteries supplying blood to the heart) were the same between the two groups.

Another study found similar results. Compared to those without HIV, people with HIV aged 50 or older were more likely to have chronic conditions such as diabetes, high blood pressure, stroke, lung diseases, and dementia, while also noting a higher risk of cardiovascular disease.

Another chronic health condition, liver disease, is one of the leading causes of non-AIDS-related death in people with HIV. Coinfection with hepatitis B and hepatitis C viruses (HBV and HCV) is common in people with HIV. For example, 5 percent to 25 percent of those with HIV may be coinfected with HBV, and 30 percent may have HCV. When a person has both HIV and HBV or HCV, there is a faster progression to scarring and permanent damage of the liver, resulting in long-term liver disease and risk of liver cancer.

Cancers

Lymphomas (cancers of the immune system) and cancers related to human papillomavirus (HPV) were also more likely for people with HIV.

Cancers related to HPV include:

  • Cervical — Cancer of the cervix (the organ connecting the uterus and vagina)
  • Vulvar — Cancer of the vulva (external female genital organs such as the clitoris, vaginal lips, and the opening of the vagina)
  • Penile — Cancer of the shaft or glans of the penis
  • Anal — Cancer of the anus (opening of the rectum, the last part of the large intestine, to the outside of the body)
  • Oropharyngeal — Cancer of the oropharynx (the part of the throat located at the back of the mouth, including the soft palate, base of the tongue, and tonsils)

The incidence (number of new cases) of liver and lung cancers is also higher in people with HIV. Increased liver cancer is related to the high rates of hepatitis B and C leading to cirrhosis of the liver. The increased rate of lung cancers is largely explained by high rates of cigarette smoking.

Age-Related Comorbidities

Not only do age-related comorbid conditions occur more often in people with HIV than in people without HIV, but they also develop at younger ages.

Osteoporosis is commonly seen in older age. This condition occurs when the bones become weak, causing them to break easily. Osteoporosis is also common in people with HIV. Older adults are at a higher risk of falls as well, which is especially dangerous when coupled with the increased risk of osteoporosis and fractures.

Frailty, which is generally seen in the geriatric population, commonly occurs at an earlier age in people with HIV. Symptoms include weakness, exhaustion, decreased physical activity, and weight loss. This condition is associated with negative health outcomes and multimorbidity (the presence of two or more chronic conditions at the same time). Frail older adults are more likely to be admitted to the hospital and require long-term care.

Decreased mental function can also occur in the aging population, as well as in those with HIV. Individuals living with HIV-associated dementia, a severe form of dementia, present with decreased attention and concentration, as well as slowed thinking and slow body movements. About one-third of people with HIV have at least a mild form of neurocognitive impairment.

COVID-19 and HIV

Research is still ongoing regarding COVID-19 and its effects on people living with HIV. So far, scientists believe that people on effective HIV treatment are at the same risk level for COVID-19 as those who are not HIV-positive.

However, older adults and people with other serious medical conditions, including those with weakened immune systems, might be at increased risk for severe illness from COVID-19. People with a low CD4 cell count (white blood cells that are attacked and destroyed by HIV) and those not on effective HIV treatment are at a higher risk of becoming very ill from COVID-19.

Why Are People With HIV at Higher Risk?

People living with HIV are at a higher risk of developing comorbidities due to a variety of factors, including:

  • Damaging effects of chronic HIV infection, especially if uncontrolled for many years
  • Chronic suppression of the immune system
  • Toxicity related to ART regimens, especially prolonged exposure to the older therapies, which were associated with more side effects
  • Potential coinfection (simultaneous infections by different viruses) due to overlapping risk factors, such as intravenous drug use
  • Alcohol use, smoking, and drug use
  • Obesity, low levels of physical activity, and unhealthy diets
  • Ethnicity and gender (for example, Black men have the highest rate of cardiovascular disease in the U.S.)
  • Lower socioeconomic status

Communicate With Your Health Care Team

Talk with your HIV care provider about preventing future comorbidities as you age with HIV. Continue taking your antiretroviral treatment, and keep your HIV controlled by having regular follow-up visits with your HIV care team.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, more than 35,000 people come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Are you an older adult living with HIV? Share your experience in the comments below or start a conversation by posting on your Activities page.

References
  1. Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care — Journal of Acquired Immune Deficiency Syndrome
  2. HIV in the United States by Age — Centers for Disease Control and Prevention
  3. Defining Comorbidity: Implications for Understanding Health and Health Services — The Annals of Family Medicine
  4. HIV Therapy, Metabolic Syndrome, and Cardiovascular Risk — Current Atherosclerosis Reports
  5. Excess Clinical Comorbidity Among HIV-infected Patients Accessing Primary Care in U.S. Community Health Centers — Public Health Reports
  6. Chronic Disease Onset Among People Living With HIV and Aids in a Large Private Insurance Claims Dataset — Scientific Reports
  7. Mechanisms of Liver Disease in Patients Infected With HIV — BMJ Open Gastroenterology
  8. Managing HIV Infection in Patients Older Than 50 Years — Canadian Medical Association Journal
  9. Premature Age-Related Comorbidities Among HIV-infected Persons Compared With the General Population — Clinical Infectious Diseases
  10. Osteoporosis Overview — National Institute of Arthritis and Musculoskeletal and Skin Diseases
  11. Bone Loss in the HIV-infected Patient: Evidence, Clinical Implications, and Treatment Strategies — The Journal of Infectious Diseases
  12. Facts About Falls — Centers for Disease Control and Prevention
  13. Frailty — UpToDate
  14. Impact of Aging on Neurocognitive Performance in Previously Antiretroviral-naive HIV-Infected Individuals on Their First Suppressive Regimen — AIDS
  15. Aging With HIV — HIV.gov
  16. Issues in HIV/AIDS in Adults in Palliative Care — UpToDate
  17. The Prevalence of Comorbidities Among People Living With HIV in Brent: A Diverse London Borough — London Journal of Primary Care
  18. Cover Story | One Size Does Not Fit All: The Role of Sex, Gender, Race and Ethnicity in Cardiovascular Medicine — American College of Cardiology

All updates must be accompanied by text or a picture.
Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jane Chung, PharmD, RPh earned a Bachelor of Science in Pharmacy Studies and a Doctor of Pharmacy from Northeastern University in Boston, MA. Learn more about her here.

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