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WITH HIV AND AGING, IT’S NOT HOW OLD YOU ARE, IT’S HOW YOU ARE OLD!

After spending a week at AIDS 2022, the world’s largest global health conference on HIV and AIDS, I’ve been thinking about the most wonderful trend we’re seeing in the field.

There are fewer new cases of HIV each year, and people living with HIV are living longer. Early in my career, as a practicing infectious diseases pediatrician treating children with HIV, I observed firsthand the steady decrease of pediatric HIV cases as we successfully treated pregnant women to minimize mother-to-child transmission. In parallel, I’ve also witnessed the average age of people living with HIV steadily increase as the HIV epidemic has continued.

Thanks to treatment advances, specifically the introduction of combination antiretroviral (ARV) therapy, people living with HIV are living longer and older adults living with HIV are now living and thriving. The same improvements in care that led to fewer cases of pediatric HIV among my patients have also resulted in higher survival and increased life expectancy in adults. In fact, having a long, healthy life should be achievable for most people living with HIV today.

As part of ViiV’s HIV in View series, we hosted an inspirational panel on HIV and aging at the AIDS 2022 conference. Hosted by advocate and influencer Raif Derrazi, panelists shared their experiences on staying healthy while living with HIV, what it means to grow older and thrive with HIV, and the steps we can yet take as a medical community to meet the needs of people aging with HIV.

Randy Jackson, a professor of social work who has been living with HIV for 32 years, summed up the transformational progress we’ve made since his initial diagnosis in 1990, when few treatment options existed and many of his friends succumbed to AIDS.

“Early in the epidemic, the drugs were highly toxic and caused a lot of damage in my body, including facial wasting and neuropathy in my legs,” Randy said. “Today, the treatments are much less toxic and easier to take than they were in the past, where I would be setting my alarm to wake up at 4 a.m. to take my meds. That’s not what’s happening today, and that’s really a good thing.”

Randy’s story is indicative of an inspiring trend — thanks to innovations in ARV treatment, HIV is now a long-term, manageable, chronic condition – not a death sentence. The proportion of the HIV population over 50 years old is projected to jump from just three in 10 (30%) in 2010, to nearly three in four (75%) by 2030, according to a Dutch model simulation study of more than 10,000 patents.1

This is not to say, however, that older people who are living with HIV don’t have unique challenges. By 2030, more than 80 percent of the 50-and-up population will have at least one additional age-related condition, such as high blood pressure, high cholesterol, or diabetes. More than a third will have three such comorbidities.

Research suggests that as people living with HIV grow older, they’re at higher risk of developing certain conditions, including impaired mobility, sensory and cognitive impairments, bladder and bowel dysfunction, and sarcopenia (low muscle mass).2 That’s why it’s so important to discuss the impact long-term medication can have on the health and emotional wellbeing.

“We’ve gone from a situation early in the epidemic where the most important thing you were trying to do was stay alive to now where it’s about how to live healthy into old age,” my colleague Dr. Nneka Nwokolo, ViiV Healthcare’s Head of Patient Affairs, eloquently stated during the panel. “Providers need to continue listening and understanding what this population needs, so we’re meeting patients where they are, regardless of age, to help people with HIV live long, healthy lives.”

Check out the full HIV in View broadcast to hear more from Dr. Nwokolo, Randy, Raif, and Mercy Shibemba on what on what it means to grow older and thrive with HIV.

References:

  1. Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Inf Dis 2015;15:810-18. 
  2. Green M, et al JAIDS 2015 ; 69(2): 161-167