National HIV/AIDS and Aging Awareness Day

Over the past 17 years, the proportion of people living with HIV (PLWH) over the age of 50 has more than doubled—from 29 percent in 2005 to nearly 70 percent in 2022.1 The increase in PLWH ages 50 and older is due to both advances in treatment and new HIV infections among those 50 and older.  September 18, 2022, marked National HIV/AIDS and Aging Awareness Day (NHAAD), a day to raise awareness about the specific needs of adults 50 years and older when it comes to HIV prevention, care, and treatment. The day also highlights the need for additional data in this population to increase knowledge about the impact of aging on PLWH.²

Key Highlights

• The proportion of people living with HIV who are over the age of 50 has increased dramatically in recent years due to both advances in treatment for HIV and new infections in older adults.
• Ongoing and future research focused on the relationship between aging and HIV is crucial to supporting older adults living with HIV to have a long, healthy life.

HIV treatment advances

Advances in treatment for HIV over the last 35 years have resulted in PLWH living long, healthy lives. The first antiretroviral therapy (ART) for the treatment of HIV was approved by the U.S. Food and Drug Administration (FDA) in 1987.³ Today, there are over 30 therapies available.⁴ Because of HIV treatment advances, the most common morbidities and causes of death among PLWH, such as cardiovascular disease and declining physical function, match those seen in adults without HIV. The difference is that PLWH first experience these morbidities about 5-10 years earlier than noninfected adults.⁵ This highlights the importance of better understanding the relationship between HIV and aging.

New HIV infections among adults 50 and older

Another concern associated with HIV in aging adults is new diagnoses. In 2017, over 15 percent of new diagnoses for HIV were among individuals 50 and older.⁶ While many of the risk factors for HIV are the same among older and younger individuals, age-related factors such as thinning and dryness of the vagina may increase the risk of HIV in older women. Older individuals may not use condoms during sex as often due to a lower concern about pregnancy.⁷ Those in older age groups may view symptoms of HIV as the consequences of normal aging⁸ and are less likely to be tested as some healthcare providers may not view older adults as being at risk for HIV.⁹ This results in older individuals getting diagnosed with HIV at later stages and increasing the likelihood of progression to AIDS.¹⁰

Given the rising numbers of PLWH in older age groups, ongoing and future research focused on the relationship between aging and HIV continues to be crucial to help PLWH live longer.

About the author

Margaret Dunne, MSc, is a Lead Research Associate with experience in the design and implementation of research projects to address public health challenges. She currently serves as the project manager of the VISION Vaccine Effectiveness (VE) project that estimates the effectiveness of the COVID-19 vaccines in the U.S. Through her previous work facilitating HIV-prevention programs in Botswana, the Philippines, and Washington, DC, she has contributed to the positive impact that the collection and use of quality data, strategic planning, and strong community collaboration can have on controlling infectious diseases, and thereby, improving health.

References

¹Pallikkuth, S., and Pahwa, S. (2022). HIV and aging in the era of ART and COVID-19. Journal of Acquired Immune Deficiency Syndromes, 89(Suppl 1), S1-S2. doi: 10.1097/ QAI.0000000000002835. PMID: 35015738; PMCID: PMC8751282.

²U.S. Department of Health and Human Services. (n.d.). National HIV/AIDS and Aging Awareness Day. Bethesda, MD: National Institutes of Health. Available at: https://hivinfo.nih.gov/ understanding-hiv/hiv-aids-awareness-days/national-hiv-aids- and-aging-awareness-day. Retrieved on: August 26, 2022.

³Tseng, A., Seet, J., and Phillips, E.J. (2015). The evolution of three decades of antiretroviral therapy: Challenges, triumphs and the promise of the future. British Journal of Clinical Pharmacology, 79(2), 182-194. doi: 10.1111/bcp.12403. PMID: 24730660; PMCID: PMC4309625.

⁴National Institute of Allergy and Infectious Diseases. (2018). Antiretroviral drug discovery and development. Rockville, MD: Author. Available at: https://www.niaid.nih.gov/diseases- conditions/antiretroviral-drug-development#:~:text=In%20 March%201987%2C%20AZT%20became,reverse%20 transcriptase%20inhibitors%2C%20or%20NRTIs. Retrieved on: August 26, 2022.

⁵Montano, M., Landay, A., Perkins, M., Holstad, M., Pallikkuth, S., Pahwa, S., and HIV and Aging in the Era of ART and COVID-19 Inter-CFAR Symposium. (2022). HIV and aging in the era of ART and COVID-19: Symposium overview. Journal of Acquired Immune Deficiency Syndromes, 89(Suppl 1),S3-S9. doi: 10.1097/ QAI.0000000000002837. PMID: 35015739; PMCID: PMC8751291.

⁶U.S. Department of Health and Human Services. (n.d.). National HIV/AIDS and Aging Awareness Day. Bethesda, MD: National Institutes of Health. Available at: https://hivinfo.nih.gov/ understanding-hiv/hiv-aids-awareness-days/national-hiv-aids- and-aging-awareness-day. Retrieved on: August 26, 2022.

⁷U.S. Department of Health and Human Services. (2021). HIV and older people. Bethesda, MD: National Institutes of Health. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-older-people#:~:text=Does%20HIV%20affect%20 older%20people,were%20aged%2050%20and%20older. Retrieved on: August 26, 2022.

⁸National Institute on Aging (2021). HIV, AIDS, and older adults. Gaithersburg, MD: Author. Available at: https://www.nia.nih.gov/ health/hiv-aids-and-older-adults. Retrieved on: August 26, 2022.

⁹Fitzpatrick, L.K. (2011). Routine HIV testing in older adults. The Virtual Mentor, 13(2), 109-112. Available at: https://journalofethics. ama-assn.org/article/routine-hiv-testing-older-adults/2011-02.  doi: 10.1001/virtualmentor.2011.13.2.cprl1-1102.

¹⁰National Institute on Aging (2021). HIV, AIDS, and older adults. Gaithersburg, MD: Author. Available at: https://www.nia.nih.gov/ health/hiv-aids-and-older-adults. Retrieved on: August 26, 2022.