Facing the Challenges of Aging With HIV
Advances in treatment have dramatically improved the life expectancy of people living with HIV, which is welcome progress. However, challenges remain for those aging with HIV.1
Michael Dorosh was first diagnosed with HIV in 1990, and in 1995, when he started to experience a rapid decline in health, he believed he only had a year left to live. However, thanks to advances in treatment, he has now been living with HIV for more than half of his life.
Now a long-term survivor and Director of the Treatment Educat10n Network (TEN) in Denver, Colorado, Michael acknowledges that challenges and uncertainties remain when it comes to getting older with HIV, saying, “People living with HIV may experience age-related health challenges earlier than usual.”
Significant advances have been made in the development of effective HIV treatments that allow individuals to suppress their viral load to undetectable levels, shifting the prognosis from a fatal infection to the management of a chronic illness. As a result of these advances, people living with HIV increasingly live longer and healthier lives and increasingly can expect to live as long as those who do not have HIV.
Despite notable progress in HIV treatment, challenges remain for those aging with HIV. Andrew Clark, Global Medical Lead at ViiV Healthcare, said, “There are medical challenges for those who become resistant to HIV medicines; adherence challenges for those who have difficulty sticking to daily medication; and the additional pressure of having to manage other medical conditions, known as ‘co-morbidities.’ Additionally, these individuals may also face significant social challenges such as a lack of access to care and experiencing stigma.”
“HIV infection in most cases…the vast majority of people [on stable treatment] are suppressed. It’s how do we deal with these complex comorbidities, because that is what kills the patient.”
- Dr. Andrew Clark
An increasing, aging population
There has been a dramatic change in the demographics of the population of people with HIV, with HIV clinics now caring for an increasing number of people aged 50 years or older. According to the medical journal Lancet HIV, it’s estimated the median age of people on treatment will increase from 44 years in 2010 to 57 in 2030, with the proportion of individuals aged 50 years or older increasing from 28% in 2010 to 73% in 2030.1,2
In addition, people living with HIV may have an elevated risk of a variety of chronic illnesses so may require additional care, particularly as the population of people living with HIV who are aging grows.3 These statistics point to a growing need for specialized research and care focused on an aging HIV population, and the chronic conditions associated with HIV.3,4
The changing treatment needs of older patients
Current novel antiretroviral therapies (ARTs) allow many people living with HIV to achieve a near-normal life span; however, as people age, the risk of other health challenges increases.4 These health challenges include cardiovascular disease, cancer, infections, and other diseases and neurocognitive problems associated with aging.4
The general commitment among the scientific community is to design treatment that will have a minimal intrusion on the lives of people living with HIV, including a good safety and tolerability profile, with limited organ-related side effects, or ‘toxicities’ (such as those affecting the liver or kidney), and interactions that occur between different medicines. However, a better understanding of how age affects individuals with HIV, and how ART may influence this, will help address the clinical issues faced by the aging HIV community.4,5
Taking multiple medications creates concerns for people living with HIV, including drug-drug interaction concerns and the impact medications might have on the immune system.1 As we age, so does our immune system, making it more difficult for the body to fight off infection and cancers. The aging immune system is further impaired by HIV-associated complications and chronic inflammation.2,5
Michael Dorosh notes that our immune systems evolved over millions of years by fighting pathogens then going into rest. When our immune system fights, it leads to inflammation. “What we discovered was that even though your virus might be undetectable, your immune system is still fighting something 24/7, and that might be one of the reasons why people living with HIV may experience health challenges earlier than usual.”
Scientists are looking into multiple sources and studies to better understand aging in people living with HIV and are investigating the potential therapeutic treatments or interventions that could be combined with ART to improve health outcomes.
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What about stigma?
While ART and HIV management have continued to improve, social and health consequences of stigma have persisted and, in many countries, increased. As Michael Dorosh notes, “HIV is now a treatable chronic disease, but the disease we have no treatment for is stigma.”
Stigma against the elderly adds to the existing multifaceted HIV stigma, potentially creating an obstacle to older individuals’ access to optimal care and a healthy social environment. The intersection of age-related and HIV-related stigma has been found to have a significant negative effect on the health-related quality of life of older people living with HIV.7 Additionally, older adults living with HIV have been shown to experience higher stress due to social isolation.7 Older adults with HIV need both healthcare support and social support to ensure optimal health outcomes.3,7
Mapping a new future in HIV
ViiV Healthcare is committed to helping people live long, healthy lives with HIV. We run and support multiple studies to build our understanding of how treatments affect older individuals.
“We need to understand the unique contribution that HIV is making to the aging process. To better understand this phenomenon, long-term follow-up from large patient groups who are both HIV positive and HIV negative will provide insights on management and prevention.”
- Frank Spinelli, former Medical Director for US Patient Affairs at ViiV Healthcare
We are working to help understand the clinical, scientific, and societal effects of HIV on aging. Our research programs focus on generating meaningful data for new medicines and treatment strategies, with the aim of reducing the short- and long-term burden of ART on the lives of people living with HIV. This involves close engagement with patient organizations, including educational programs and data generation.
In a recent trial for one of our investigational medicines, at least 25 percent of people living with HIV enrolled were aged 50 years and older. We also actively support and are involved in large observational studies, such as the POPPY (Pharmacokinetic and clinical Observations in People over fifty) cohort and ADHOC (Aging with Dignity, Health, Optimism, & Community) cohort. These are studies that not only look at the clinical challenges faced by older individuals, but also societal factors that may impact their well-being.
By collaborating with the community that is directly impacted by these issues, we are supporting efforts that improve the outcome and control of the HIV epidemic, helping us to map a new future in HIV, leaving no person living with HIV behind.
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. Accessed March 2022. https://clinical info.hiv.gov/en/guidelines/adult-and-adolescent-arv
2. 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.
3. The Gap Report. UNAIDS. Accessed March 2022. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
4. Gebo KA. Epidemiology of HIV and response to antiretroviral therapy in the middle aged and elderly. Aging Health. 2008;4:615-27.
5. Okoli C, de los Rios P, Eremin A, Brough G, Young B, Short D. Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV. Prev Chronic Dis. 2020;17:190359.
6. Aging with HIV. HIV.gov. Accessed March 2022. https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/aging-with-hiv
7. Brown MJ, Adeagbo O. HIV and aging: double stigma. Curr Epidemiol Rep. 2021;8(2):72-78.
HVUWCNT220005 May 2022
