HIV infection in older adults

Author:: Meredith Greene, MD
Section Editor:: Rajesh T Gandhi, MD, FIDSA
Deputy Editors:: Milana Bogorodskaya, MD; Jane Givens, MD, MSCE

Literature review current through: Apr 2025. | This topic last updated: May 07, 2025.

INTRODUCTION —

Most of the literature on human immunodeficiency virus (HIV) infection in older adults defines 'older' as ≥50 years of age. Emerging evidence has suggested that this is an appropriate threshold for "older" people living with HIV, as they experience age-related comorbidities and geriatric conditions at relatively younger ages compared with people without HIV [1]. Whether HIV accelerates or accentuates aging remains a source of ongoing debate [2].

With increasing survival resulting from antiretroviral therapy (ART), the proportion of patients with HIV who are in this older age bracket has increased substantially [3]. Additionally, new HIV infections in older adults contribute to the increasing number of older adults living with HIV.

This topic discusses issues specific to the older adult with HIV. Many health concerns in older adults are managed the same in people with HIV as those without HIV, although HIV-associated comorbidities and treatments must be considered. This topic highlights areas where HIV-specific considerations are important. Management of health issues in the general older adult population is discussed separately. (See "Geriatric health maintenance" and "Office-based assessment of the older adult" and "Comprehensive geriatric assessment".)

The diagnosis, antiretroviral management, and general management of HIV infection are discussed in detail elsewhere. (See "Screening and diagnostic testing for HIV infection in adults" and "When to initiate antiretroviral therapy in persons with HIV" and "Selecting antiretroviral regimens for treatment-naïve persons with HIV-1: General approach" and "Initial evaluation of adults with HIV" and "Primary care of adults with HIV".)

EPIDEMIOLOGY

Aging HIV population

●Older adults with HIV infection – By the end of 2016, an estimated 5.7 million individuals aged 50 years or older were living with HIV infection. By the end of 2020, an estimated 21 percent of people with HIV globally were in this older age group [4].

While 80 percent of older adults with HIV live in low- and middle-income countries, the proportion of older adults with HIV is greater in high-income countries, where 33 percent of the adult population with HIV is 50 years and older [4]. In the United States, as of 2022, over 50 percent of people with diagnosed HIV are aged 50 years or older [5]. In low- and middle-income countries, the proportion of HIV infection in older adults is increasing as well (figure 1). One study estimated that over the next 30 years in rural South Africa, the prevalence of HIV infection among persons older than 50 years will double [6].

●Persistent health disparities – As with HIV infection across all age groups in the United States, significant health disparities remain within older adults, with Black/African American and Hispanic/Latino communities disproportionately impacted by HIV [5]. Older people with HIV encompass a heterogeneous group reflecting different lengths of time living with HIV, gender identities, sexual orientations, races, and ethnicities [7].

●New HIV diagnoses in older adults – While those aging with HIV comprise the majority of older adults living with HIV, new infections in older adults also occur. People with potential exposures to HIV should be tested regardless of age. In 2022, approximately 10 percent of new HIV infections occurred in adults aged 55 years or older in the United States [5]. New diagnoses remained stable between 2018 to 2022 in this age group. Global estimates report 110,000 new infections in persons of this age group in 2016, and the majority of them lived in Sub-Saharan Africa [4]. Despite these numbers, prevention in older adults is often not discussed, and delayed diagnoses in older adults routinely occur. (See "Screening and diagnostic testing for HIV infection in adults" and "HIV pre-exposure prophylaxis", section on 'Determining PrEP eligibility'.)

Limited recognition of advanced HIV disease — A greater proportion of adults older than 50 years present with advanced HIV and lower CD4 counts compared with younger adults [8-11]. Since advanced HIV may present with the gradual onset of weight loss, low-grade fever, and fatigue, clinicians may be more likely to evaluate for cancer in older adults but overlook HIV as part of the differential diagnosis [12]. In 2022, people aged 50 years or older presented for care with lower CD4 counts compared with younger patients in nearly every region of the world [11]. People aged 50 to 64 years often comprise the largest percentage of patients who present late to care (defined as having a CD4 count <350 cells/microL) [8-10,13]. (See "Geriatric health maintenance", section on 'Sexually transmitted and bloodborne infections'.)

APPROACH TO ROUTINE HEALTH MAINTENANCE —

As adults with HIV live longer, it is important for clinicians to keep in mind the routine age-appropriate health maintenance that should be offered to the older patient.

Routine laboratory testing and immunizations should follow the same schedules as outlined for all adults with HIV (table 1 and figure 2). Routine age-appropriate screening examinations are generally the same as in patients without HIV. Exceptions to this include:

●Cervical cancer (see 'Malignancy' below and "Screening for cervical cancer in patients with HIV infection and other immunocompromised states")

●Anal cancer (see 'Malignancy' below and "Anal squamous intraepithelial lesions: Epidemiology, clinical presentation, diagnosis, screening, prevention, and treatment", section on 'Screening for anal SIL')

●Osteoporosis (see 'Bone health' below and "Bone and calcium disorders in patients with HIV", section on 'Bone mineral density screening')

●Statin use for prevention of cardiovascular disease (see "Management of cardiovascular risk (including dyslipidemia) in patients with HIV", section on 'Indications for statins')

●Screening decisions should be based on life expectancy and not on age cut-offs alone. These issues are discussed in detail elsewhere. (See "Primary care of adults with HIV" and "Immunizations in persons with HIV" and "Geriatric health maintenance" and "Overview of preventive care in adults".)

ANTIRETROVIRAL THERAPY —

The timing of initiation, selection, and dosing of antiretroviral therapy (ART) in older adults are the same as in younger adults with HIV. Comorbidities and drug-drug interactions should be taken into consideration when starting and/or changing an ART regimen [3,14-20]. (See "When to initiate antiretroviral therapy in persons with HIV" and "Selecting antiretroviral regimens for treatment-naïve persons with HIV-1: General approach".)

Polypharmacy and drug-drug interactions — We periodically (at least annually and after transitions in care, such as a hospitalization) perform a thorough review of all prescription and over-the-counter medications and supplements in older patients with HIV to reduce polypharmacy and the potential for drug-drug interactions (table 2) [21]. Details on how to approach deprescribing are discussed separately (see "Deprescribing"). Studies have documented high rates of potentially inappropriate medication use in older patients with HIV [22-24] and polypharmacy is associated with falls, frailty, and hospitalizations [25-28].

Older age also increases the risk of having potential drug-drug interactions among a patient's medication list [29,30]. Although drug-drug interactions are more common with protease inhibitors, they can still occur with integrase inhibitors. Multivalent cations (such as calcium, magnesium, iron, and zinc) that are present in some multivitamins or supplements can alter the absorption of integrase inhibitor drugs, leading to subtherapeutic levels in the bloodstream. In one study of adults with HIV, 51 percent of participants aged 50 years or older had a potential drug-drug interaction on their medication list [29]. In a study of over 9000 adults with HIV (median age 51 years), 43 percent had potential harm or minimal risk drug-drug interactions identified, 14 percent were deemed to have polypharmacy, and 2 percent had a contraindicated drug-drug interaction [30]. Antidepressants, anxiolytics/sedatives, and statins were the most prevalent nonART drug classes associated with drug-drug interactions in the study. Similarly, in another study of 89 patients older than 60 years of age with HIV, the median number of medications per patient was 13, and 70 percent of patients had at least one potential category D drug-drug interaction (consider modification) compared with 39 percent of age- and sex-matched patients without HIV [22].

Specific drug interactions can be reviewed in the drug interactions program included with UpToDate or the University of Liverpool HIV Drug Interactions program. A general discussion of drug prescribing for older adults and deprescribing in general is found elsewhere. (See "Drug prescribing for older adults" and "Deprescribing".)

Safety and tolerability — There are few studies that have examined the tolerability and safety of ART in older patients with HIV, who may have decreased renal and hepatic function and may have other comorbidities, placing them at greater risk of adverse effects [31]. Many studies were done with older HIV medications, which are less well tolerated than more contemporary antiretroviral agents such as integrase inhibitors [32,33].

Drug toxicity in the older age group may be related to age-associated physiologic changes that alter pharmacokinetics, such as increased adiposity (which affects the distribution of fat-soluble drugs), increased gastric pH, decreased albumin levels, and changes in the cytochrome p450 enzyme system [31]. Changes in drug elimination in aging may lead to increased vulnerability to short- and long-term drug toxicities in this patient population.

Reduced immunologic recovery with ART — Most studies have demonstrated that, despite successful ART and viral suppression, immune recovery is less robust with increasing age, highlighting the importance of diagnosis and treatment of HIV earlier [34-41]. However, several studies have suggested that patients older than 50 years of age with HIV tend to be more adherent with antiretroviral medications than younger individuals, and rates of viral suppression are often higher accordingly [36,42-46]. Less is known about adherence to nonantiretroviral medications used to treat HIV-associated morbidities, although some studies have suggested that older adults may be more adherent to antiretroviral medications than to medications for other comorbidities [47].

Despite delayed immune recovery in older patients, data demonstrate that ART still has a substantial impact on decreasing HIV-related mortality among older adults with HIV. As an example, in one observational study of over 3500 individuals with HIV in the United States, the mortality risk reduction associated with initiation of ART at a CD4 cell count threshold of 500 cells/microL rather than 250 to 300 cells/microL was greatest among patients aged 45 to 65 years [48]. Similarly, in a retrospective study from the United Kingdom, ART initiation at CD4 cell counts <200 cells/microL was associated with a greater reduction in mortality among adults ≥50 years old compared with younger adults (42 versus 12 percent fewer deaths) [49].

GERIATRIC SYNDROMES AND FUNCTIONAL IMPAIRMENT —

In addition to facing multimorbidity and polypharmacy, older adults with HIV may also be at risk for geriatric syndromes, such as falls, frailty, functional impairment, and disability. As with certain comorbidities, these geriatric syndromes may also occur at relatively younger ages in adults with HIV compared with the general population [50,51]. For people with HIV and frailty or other geriatric syndromes, geriatric consultation can be helpful when available.

Falls — Falls are a particularly important consideration in older adults with HIV given their increased risk of osteoporosis and fracture [52-54]. Risk factors for falls, such as polypharmacy and peripheral neuropathy, are also common in adults with HIV. Observational cohorts have not clearly demonstrated increased risk of falls in older adults living with HIV; although in one study of males, balance problems were more prevalent [55,56]. Nevertheless, many studies report a high rate of falls in this population, at 25 percent or higher [50,57]. Prevention and management of falls are discussed elsewhere. (See "Falls in older persons: Risk factors and patient evaluation" and "Falls: Prevention in community-dwelling older persons".)

Frailty — Frailty is often defined as a state of decline and vulnerability in older adults, characterized by weakness and decreased physiologic reserve, which results in increased risk for multiple adverse outcomes. There is no standard definition or criteria for diagnosis, although the two primary models are the phenotypic model and the cumulative deficits model. The majority of studies evaluating frailty among patients with HIV have generally used the phenotypic model to identify frailty (weight loss, exhaustion, low activity, slowness, weak grip strength) but have defined these deficits differently [58,59]. Although in some studies, frailty appears to affect patients with HIV at a younger age than individuals without HIV [60,61]. The risk of frailty among individuals with well-controlled HIV is similar to that in controls without HIV [62-64]. Factors associated with frailty in adults with HIV include increased age, low nadir and lower current CD4 cell count, detectable viremia, non-normal body mass index, loneliness/depression, cognitive impairment, and less than a high school education [50,58,64,65].

A more detailed discussion of frailty in the general population is found elsewhere. (See "Frailty" and "Comprehensive geriatric assessment".)

Functional impairment and disability — Functional impairment is common among older adults with HIV. In an acquired immunodeficiency syndrome (AIDS) Clinical Trial Group cohort of over 1000 adults with HIV on antiretroviral therapy (ART) with a median age of 51 years, self-reported impairment in at least one instrumental activity of daily living occurred in 18 percent [66]. Similarly, difficulty with one or more instrumental activities of daily living was seen in almost 50 percent of a San Francisco-based HIV cohort, with housework and shopping the most common deficits [50]. Assessment of functional impairment is discussed separately. (See "Office-based assessment of the older adult", section on 'Instrumental activities of daily living'.)

Social isolation and loneliness — In the general population, social isolation (an objective measure of social networks) and loneliness (a subjective measure) are associated with mortality [67,68]. Although there are few direct comparisons, older adults with HIV may have higher rates of social isolation and loneliness than the general population [69]. While older adults with HIV are more likely to live alone than younger adults with HIV, reports vary, and they may have similarly sized social networks [70]. As in the general population, social isolation has been associated with hospitalization and mortality in older adults with HIV [71]. Loneliness and lack of social support are also associated with mood disorders and sexual behaviors associated with sexually transmitted infection exposure [72,73]. Social isolation in the general older adult population is discussed separately. (See "Geriatric health maintenance", section on 'Social isolation and loneliness'.)

NON-AIDS MORBIDITY

Overall burden — Successful antiretroviral therapy (ART) has lengthened survival in individuals with HIV and has led to changing patterns of morbidities and mortality. As deaths from AIDS and opportunistic infections have declined, age-related medical conditions have become more prevalent [74]. (See 'Life expectancy and prognosis' below.)

People with HIV appear to have a higher risk of certain comorbid conditions compared with the general population. This is due, in part, to chronic inflammation and immune activation from HIV, side effects of ART, and traditional risk factors such as alcohol and tobacco use, which are more common in older adults with HIV compared with the general population [3,75] (see 'Role of immune activation' below). As an example, in a study of 540 individuals with HIV and 524 controls without HIV ≥45 years old, HIV infection was independently associated with a higher burden of age-associated comorbidities, including cardiovascular, metabolic, pulmonary, renal, bone, and malignant disease [76]. Multimorbidity, or having two or more comorbidities, was also more common among adults with HIV. Similarly, a case-control study demonstrated that among patients with HIV aged 41 to 50 years, the prevalence of multimorbidity was comparable to that among controls without HIV aged 51 to 60 years, suggesting an earlier age of onset [77]. (See "Multiple chronic conditions".)

Role of immune activation — HIV infection causes immune activation with inflammation that is most intense in the early stages of infection and persists despite ART. People with low nadir CD4 cell counts are more likely to experience higher levels of chronic inflammation than those diagnosed and treated early (before a decline in their CD4 cell counts), emphasizing the importance of early diagnosis. Causes of this persistent inflammatory state are poorly understood, but viral persistence and microbial translocation from the gastrointestinal tract (ie, "leaky gut") are thought to play important roles [78]. Laboratory markers of inflammation that are elevated during this chronic inflammatory state include interleukin-6, D-dimer, high-sensitivity C-reactive protein, and soluble CD14 [79,80]. As demonstrated in several trials, ART that successfully controls HIV infection reduces these inflammatory markers but does not return them to normal levels [80,81].

Studies have also emphasized the role of untreated HIV infection on aging and have concluded that immune activation results in "immunosenescence" (eg, accelerated aging of T cells) [82,83]. The implication of this observation is that a person with HIV infection is physiologically older than indicated by birth date; however, it is not clear that these changes are reversed by ART [84].

Cardiovascular disease — There is a higher risk of cardiovascular disease among individuals with versus without HIV within the same age group, even among those who are virally suppressed [85,86]. Many experts consider HIV to be a risk-enhancing factor when considering an individual's predicted cardiovascular risk [87]. Due to this increased and earlier onset risk for cardiovascular disease, the general threshold at which to start statin therapy is lower in people with HIV compared with those without HIV. (See "Management of cardiovascular risk (including dyslipidemia) in patients with HIV", section on 'Indications for statins'.)

The epidemiology, pathogenesis, and management of cardiovascular risk in patients with HIV are discussed elsewhere. (See "Epidemiology of cardiovascular disease and risk factors in patients with HIV" and "Pathogenesis and biomarkers of cardiovascular disease in patients with HIV" and "Management of cardiovascular risk (including dyslipidemia) in patients with HIV" and "Overview of cardiac and vascular diseases in patients with HIV", section on 'Coronary artery disease'.)

Neurologic complications

●Neurocognitive disorders – Older adults with HIV are at risk for neurocognitive disorders, whether associated with HIV infection itself or other factors. The most severe form of HIV-associated neurocognitive disorders is HIV-associated dementia, classically manifested as a subacute onset of impairments in subcortical function, such as decreased attention/concentration and psychomotor slowing. Although the overall prevalence of HIV-associated neurocognitive disorders has not changed since the early days of the HIV/AIDS epidemic, milder forms, including asymptomatic neurocognitive impairment and mild neurocognitive disease, have become more frequent manifestations.

Unsurprisingly, several studies have suggested that increasing age is a risk factor for HIV-associated neurocognitive disorders [88-90]. In one study of patients with HIV, the adjusted odds of having HIV-associated dementia were threefold higher among 106 patients older than 50 years than among 96 patients aged 20 to 39 years [88].

HIV-associated neurocognitive disorders are discussed in detail elsewhere. (See "HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis" and "HIV-associated neurocognitive disorders: Management".)

●Peripheral neuropathy – Increased age is a risk factor for peripheral neuropathy in individuals with HIV. In an observational study of 2141 antiretroviral-naïve patients with HIV who were seen annually between 2000 and 2007, aging was associated with peripheral neuropathy despite virologic and immunologic control of HIV [91]. Aging was also associated with lower odds of recovery after neurotoxic antiretroviral drugs were discontinued. (See "HIV-associated distal symmetric polyneuropathy (HIV-DSPN)", section on 'Risk factors'.)

Malignancy — Separate from the risk of AIDS-defining cancers (eg, Kaposi's sarcoma, non-Hodgkin lymphoma, invasive cervical cancer), HIV infection is associated with an increased risk of certain non-AIDS malignancies, especially those related to infectious etiologies (eg, anal cancer, liver cancer) and smoking (eg, lung cancer) [92].

Long-term viral suppression decreases cancer risk, but the risk remains higher than in those without HIV [92,93]. Some of the increased incidence seen is related to longstanding inflammation and changes to the immune system, behavioral factors, as well as increasing age [94]. Data are mixed on actual cancer screening rates in people with HIV compared with the general population, with some studies suggesting lower screening rates despite increased risk. A systematic review of nine studies identified social determinants of health (eg, insurance status, access to health care, education, income level) as the most likely indicator of whether a person with HIV received cancer screening [95].

Screening recommendations for cervical and anal cancer in people with HIV differ from those for people without HIV. (See "Screening for cervical cancer in patients with HIV infection and other immunocompromised states" and "Anal squamous intraepithelial lesions: Epidemiology, clinical presentation, diagnosis, screening, prevention, and treatment", section on 'Screening for anal SIL'.)

The epidemiology and management considerations of malignant diseases in patients with HIV are discussed elsewhere. (See "HIV infection and malignancy: Epidemiology and pathogenesis", section on 'Epidemiology' and "HIV infection and malignancy: Management considerations".)

Bone health — Adults with HIV are at increased risk of disordered bone metabolism, decreased bone density, and fragility fractures due to increased prevalence of lifestyle risk factors (eg, smoking, alcohol use), higher prevalence of lower testosterone in males, and tenofovir disoproxil fumarate toxicity [52-54]. Guidelines recommend starting osteoporosis screening at postmenopause for females and at age 50 years for males with HIV [96]. Screening and other issues related to bone disorders in patients with HIV are discussed separately. (See "Bone and calcium disorders in patients with HIV".)

Liver disease — Chronic liver disease is a frequent finding in older adults with HIV. The prevalence of metabolic dysfunction-associated steatotic liver disease is rising in adults with HIV [97-99]. Coinfection with hepatitis B and C viruses is also common in patients with HIV because of shared routes of transmission. HIV adversely impacts the natural history of each of these hepatitis viruses, with a higher likelihood of chronic infection and a faster rate of liver fibrosis progression. (See "Approach to the patient with HIV and hepatobiliary complaints" and "Epidemiology, clinical manifestations, and diagnosis of hepatitis B in patients living with HIV" and "Epidemiology and transmission of hepatitis C virus infection", section on 'People with HIV'.)

Pulmonary disease — Pulmonary diseases represent a substantial burden of non-AIDS morbidity among older adults with HIV due to a variety of factors (eg, smoking, HIV-associated immunosuppression, and HIV-associated immune activation). In the Veterans Aging Cohort Study (VACS), consisting of 33,420 veterans with HIV and 66,840 veterans without HIV matched by age, sex, race, and ethnicity, the incidence of chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, pulmonary fibrosis, and pulmonary infections was significantly more common among veterans with HIV [100]. (See "Evaluation of pulmonary symptoms in persons with HIV".)

Sex-specific issues

Menopause — Menopause may occur earlier in females with HIV, and they may be more likely to experience menopausal symptoms, which can contribute to depression and anxiety [101]. Limited data are available about menopause and the use of hormonal replacement therapy in older females with HIV. This topic is discussed elsewhere. (See "HIV and women", section on 'Menstrual abnormalities and menopause'.)

Hypogonadism — Hypogonadism is common in males with HIV and has been associated with advanced disease and, in the ART era, persistent viremia [102]. In one study of the Multicenter AIDS Cohort Study cohort, the rate of decline in testosterone level over 10 years appeared similar between males with and without HIV, although HIV may be associated with greater loss of diurnal variation [103]. This topic is discussed elsewhere. (See "Pituitary and adrenal gland dysfunction in patients with HIV".)

UNIQUE POPULATIONS —

Individuals who have lived with HIV for many decades (which also includes individuals infected with HIV perinatally) warrant special consideration.

Long-term survivors — "Long-term survivors" are a specific group included among older adults with HIV, and often defined as those diagnosed before the availability of combination antiretroviral therapy (ART) in 1996 [104]. Higher rates of comorbidities and multimorbidity are associated with longer duration of HIV infection [105-107]. Long-term survivors of HIV often experience additional psychosocial challenges. Many of these survivors were not expecting to age when diagnosed with HIV in the 1980s or early 1990s and did not prepare for retirement. Many are also on long-term disability from the time of their AIDS diagnosis or given their multiple comorbidities. Additionally, for many, isolation and loneliness may also be intertwined with traumatic loss and complicated grief [108]. (See "Major depression, mania, and schizophrenia in patients with HIV", section on 'Major depression'.)

Lifetime survivors — "Lifetime survivors" of HIV are another specific group that includes those who acquired HIV through perinatal transmission or in early childhood. The oldest of these individuals have been living with HIV for 30 or more years and are approaching their fourth decade. In a North American cohort, by age 30 years, participants with perinatally acquired HIV had a 40 percent or higher cumulative incidence of hypercholesterolemia and hypertriglyceridemia, a 25 percent cumulative incidence of chronic kidney disease, and a 22 percent incidence of hypertension [109]. It is thought that much of this is driven by persistent inflammation and suggests the need to screen for chronic conditions earlier in this population [110]. (See "Epidemiology of cardiovascular disease and risk factors in patients with HIV" and "Management of cardiovascular risk (including dyslipidemia) in patients with HIV".)

LIFE EXPECTANCY AND PROGNOSIS —

Overall, life expectancy for adults with HIV is improving and approaching that of the general population, especially with early treatment [81,111]. As in the general population, estimating prognosis is important to guide screening and treatment decisions in older adults with HIV, multimorbidity, and polypharmacy. An online Veterans Aging Cohort Study (VACS) calculator can generate a five-year mortality risk [112].

The VACS 2.0 Index is a prognostic index used to identify multisystem deterioration and susceptibility to adverse outcomes among patients with HIV [113,114]. This index was found to estimate the probability of all-cause mortality within a North American cohort. Its highest predictive ability was for AIDS and non-AIDS events and lowest (c-statistic 0.65) for accidental deaths in a European cohort [115].

In the United States, in part because of the improved survival of patients older than 50 years with HIV, the median age at death from HIV infection has accordingly risen (figure 3) [116]. Nevertheless, other studies continue to suggest that patients diagnosed with HIV at an older age have greater HIV-associated mortality than younger patients [34,38,117,118]. In a multinational study of 16,534 patients with known duration of HIV infection, there was an association between increasing age at seroconversion and excess mortality [117]. In the United States, according to surveillance data, the proportion of persons surviving 12 to 36 months following a diagnosis of HIV or AIDS decreases as the age of diagnosis increases [119].

SOCIETY GUIDELINE LINKS —

Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: HIV treatment in nonpregnant adults" and "Society guideline links: Primary care of adults with HIV".)

INFORMATION FOR PATIENTS —

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5^th to 6^th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10^th to 12^th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)

●Basics topic (see "Patient education: Starting treatment for HIV (The Basics)")

●Beyond the Basics topic (see "Patient education: Initial treatment of HIV (Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

●Epidemiology

•Most of the literature on HIV infection in older adults defines older as ≥50 years of age. An estimated 20 percent of people living with HIV worldwide are over the age of 50 years. (See 'Aging HIV population' above.)

•Delayed diagnosis of HIV infection among older patients is a major problem. Older adults are frequently not perceived as being at risk for HIV and are less likely to be tested. Even when testing for HIV is undertaken in the older patient, the diagnosis is often made later in the natural history of their disease, which increases the risk of opportunistic infections and transmission to others. (See 'Limited recognition of advanced HIV disease' above and "Geriatric health maintenance", section on 'Sexually transmitted and bloodborne infections'.)

●Approach to routine health maintenance – Routine laboratory testing and immunizations should follow the same schedules as outlined for all adults with HIV (table 1 and figure 2). Routine age-appropriate screening examinations are generally the same as in patients without HIV. Exceptions to this include:

•Cervical cancer screening

•Anal cancer screening

•Osteoporosis screening

•Indications for statins for the prevention of cardiovascular disease (see 'Approach to routine health maintenance' above)

●Antiretroviral therapy (ART)

•Polypharmacy is common in older adults, and potential drug-drug interactions and other prescribing issues are critical considerations when selecting and managing ART regimens in older adults. (See 'Antiretroviral therapy' above and "When to initiate antiretroviral therapy in persons with HIV", section on 'Introduction' and "Selecting antiretroviral regimens for treatment-naïve persons with HIV-1: General approach".)

•The beneficial impact of ART on HIV-related mortality has been especially substantial among older patients, despite evidence of delayed immune recovery in this population. (See 'Reduced immunologic recovery with ART' above.)

●Non-AIDS morbidity – As deaths from AIDS and opportunistic infections have declined, however, age-associated medical comorbidities, such as cardiovascular, metabolic, liver, bone, and malignant disease, as well as geriatric conditions, have become more prevalent. These are particularly prevalent in individuals with HIV, in part because of chronic inflammation, immune activation, and immunosenescence associated with HIV.

Clinical care of older patients with HIV focuses on identifying and modifying risk for such conditions. (See 'Non-AIDS morbidity' above and 'Life expectancy and prognosis' above and "Primary care of adults with HIV".)

ACKNOWLEDGMENTS —

The UpToDate editorial staff acknowledges Nathalie Casau-Schulhof, MD, and Charulata Jain Sabharwal, MD, MPH, who contributed to earlier versions of this topic review.

UpToDate gratefully acknowledges John G Bartlett, MD (deceased), who contributed as Section Editor on earlier versions of this topic and was a founding Editor-in-Chief for UpToDate in Infectious Diseases.

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Topic 3735 Version 54.0

خرید پکیج

HIV infection in older adults

References