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HIV and Aging

The HIV Population Is Aging1-3

According to the CDC, in 2021, more than 53% of PWH were ≥50 years of age4

Informational icon stating 70% of Americans with HIV will be 50+ years of age in 2030.
  • According to DHHS guidelines, for older PWH, ART is especially important because they potentially have a blunted immunologic response to ART1
  • HIV and advancing age can have combined effects on inflammation and immune activation
  • Levels of immune activation and inflammation associated with chronic HIV can be elevated even with virologic suppression with ART
  • The effect of HIV on immunologic aging and inflammation may contribute to the development of aging related comorbidities. HIV experts and healthcare providers should work together to optimize the medical care of older PWH

Addressing aging-related comorbidities alongside HIV treatment

Generally, as PWH age, they may experience an increased rate of chronic comorbidities—and these may
require additional medications.1

Average non–AIDS-related chronic comorbidities in PWH by age group5

 

Among 10,671 HOPS* participants, 1540 participants met the analysis criteria of receiving continuous care for at least 5 years from January 1, 1997 to June 30, 2015, receiving ART for at least 75% of the observation time, and having a viral load <200 copies/ml for at least 75% of the time while receiving ART. Eleven non–AIDS-related chronic comorbidities (NACMs) were evaluated: cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, HBV or HCV infection, chronic kidney disease, chronic anemia, psychiatric illness, and chronic joint disease/fracture.

*The HIV Outpatient Study (HOPS), an ongoing, open, prospective cohort study of over 10,000 adults with HIV seen in HIV-specialty clinics since 1993.

According
to the DHHS Guidelines

Polypharmacy is common in older people with HIV, and all drugs, supplements, and herbal treatments should be assessed regularly for appropriateness, potential for adverse effects, proper dosing, and drug interactions.

Polypharmacy, drug-drug interaction, and convenient dosing should be considered when making treatment decisions for aging PWH who may have multiple chronic comorbidities. To facilitate ART adherence, it may be useful to discontinue unnecessary non-HIV medications, simplify treatment regimens, and recommend evidence-based behavioral approaches.1

For aging PWH experiencing declining immune systems, maintaining virologic suppression is important.1

How do you identify barriers that may affect your patients’ treatment goals?

Explore some of the key factors that Dr. Joel Gallant and Dr. Calvin Cohen considered to achieve durable viral suppression.

Virologically Suppressed Patients
Adverse Reactions & Discontinuations

Please see full Prescribing Information for BIKTARVY® and DESCOVY®, including BOXED WARNINGS.

ART, antiretroviral therapy; CDC, Centers for Disease Control and Prevention; DDIs, drug-drug interactions; DHHS, US Department of Health and Human Services, PWH, people with HIV.

References:

  1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated September 12, 2024. Accessed September 24, 2024. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
  2. Wing EJ. The aging population with HIV infection. Trans AM Clin Climatol Assoc. 2017;128:131-144.
  3. Nabatanzi R, Cose S, Joloba M, Rowland Jones S, Nakanjako D. Effects of HIV infection and ART on phenotype and function of circulating monocytes, natural killer, and innate lymphoid cells. AIDS Rev Ther. 2018;15(7):1-8.
  4. National Institutes of Health. HIV and Older People. Updated March 12, 2024. Accessed May 14, 2024. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-older-people
  5. Palella FJ, Hart R, Armon C, et al. Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care. AIDS. 2019;33:2327-2335.