HIV in Canada: A primer for service providers

 

HIV and Aging

Key points

  • Knowledge of HIV and uptake of testing among Canadians over 50 is quite low.
  • People with HIV are living longer due to advances in HIV treatment.
  • Managing HIV infection becomes more complex as people age.

Knowledge of HIV and uptake of testing among Canadians over 50 is quite low. This can lead to a late HIV diagnosis. This is problematic because untreated HIV may progress more rapidly in older people and may make it more difficult to treat the HIV infection. However, if HIV is diagnosed early, before the development of advanced HIV disease, HIV treatment works just as well in older people as it does in those who are younger. Older adults are generally more adherent to treatment than younger adults, which leads to better clinical outcomes.

The success of HIV treatment means that people with HIV are living much longer than before. Studies reveal that the life expectancy of Canadians and Americans who are HIV positive is close to that of the general population. People diagnosed with HIV at age 20 years and who begin treatment shortly after can expect to live into their 70s – similar to the general population.

However, treatment can be more complex due to age-related diseases, such as high blood pressure, arthritis and cancers. These diseases may also need treatment, which may cause drug interactions, complicating HIV treatment.

Side effects from HIV treatment do not seem to be any more frequent in older people compared to those who are younger, but they may be more severe in older people.

There is the potential for higher drug toxicity in older adults because of the decreases in kidney and liver function that come naturally with aging. Dosing of HIV drugs may become an issue, because older people sometimes experience weight loss or changes in hormone levels and metabolism, which may mean that drug dosages may need to be changed.

Due to the increased risk of developing certain conditions in people with HIV, especially older adults, standard of care requires screening such as bone density, fasting blood glucose, lipids profile, kidney function, blood pressure, anal and vaginal Pap tests, colorectal cancer screening, prostate screening for men, and mammograms and pelvic exams for women.

Resources

HIV and Aging

Italian and U.S. researchers look to the future and explore aging-related issuesCATIE News

HIV and Aging in Canada – Canadian AIDS Society

HIV and Aging – realize

HIV & Aging: A 2013 Environmental Scan of Programs and Services in Canada – Community Report – realize

Directory of Promising Programs and Services for Older People Living with HIV in Canada – realize

Aging with HIV Resource Center – TheBody.com

Sources

  1. Ghidei L, Simone MJ, Salow MJ, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs & Aging. 2013 Oct;30(10):809–819.
  2. The Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The Lancet HIV. 2017 August;4(8):e349–e356. Available from: http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30066-8/fulltext
  3. Levy L. Growing Older Gracefully. The Positive Side. 2007. Available from: http://www.catie.ca/en/positiveside/summer-2007/growing-old-gracefully
  4. Special Issue on HIV and Ageing. Journal of AIDS. June 2003;33(2).
  5. Special Issue on HIV and Ageing. AIDS. January 2004;18(supplement 1).
  6. The Body. Aging & HIV/AIDS. Available from: http://www.thebody.com/index/whatis/older.html
  7. Atkinson M. A mind of her own. The Positive Side. 2009. Available from: http://www.catie.ca/en/positiveside/winter-2009/mind-her-own