Symptoms of HIV may be confused with aging or other diseases, leading to delayed diagnosis of HIV. Only one-third of older adults with diabetes or cardiovascular disease—both of which can be worsened by HIV—have been tested.33 Post-menopausal women are less likely to be tested for HIV than their younger counterparts.34 In fact, people over 50 years of age are more likely to have lower CD4 cell counts—and AIDS—when they are diagnosed than younger people.35 According to the CDC, as of 2008 people age 50 and older were most likely to receive an AIDS diagnosis within 12 months of their HIV diagnosis. (See Table 3.)
|Age at Diagnosis||<12 Months to AIDS||>12 Months to AIDS|
Source: CDC. HIV Surveillance Report, vol. 22. Table 10b. March 2012. Available as a PDF here.
“People are aging with HIV disease—we are seeing more chronic conditions, such as heart disease and diabetes. Is this simply part of aging, or is it because of secondary effects of ART that can precipitate some of these diseases, or is it HIV itself?” asks Palow. As Weyer explains, “I’m seeing more primary care issues, such as diabetes, hyperlipidemia, and arthritis. I never used to see these things… how much is due to aging, how much has to do with HIV? I don’t know— ‘why’ doesn’t matter as much, because the person is right there and you are dealing with it.”
Growing Old With HIV
ART has significantly extended life expectancy among HIV-positive people, especially when they are diagnosed and treated before they develop AIDS.36,37 However, older people remain at higher risk for AIDS or death. (See Table 4.)
Avoiding immune deficiency is important, especially for older people who are prone to develop non-AIDS related complications. A low CD4 cell count increases the risk for liver failure (even in people who are not coinfected with viral hepatitis), heart disease, and certain types of cancer.38,39,40
|CD4 cell count||Viral load
|<25cells/μl||19.3% versus 29.4%||23.4% versus 35.1%|
|25–49cells/μl||16.9% versus 25.9%||20.5% versus 31.1%|
|50–99cells/μl||15.7% versus 24.1%||19.1% versus 29%|
|100–199 cells/μl||10.8% versus 16.9%||13.2% versus 20.6%|
|200–349cells/μl||6.7% versus 10.7%||8.3% versus 13.1%|
|≥350cells/μl||5.6% versus 8.9%||6.9% versus 11%|
*Applicable only to HIV-1 positive patients with no previous antiretroviral therapy. No injection drug use (which increases the risk of progression to AIDS or death); CDC disease stage A or B.
Source: University of Bristol. Antiretroviral Therapy Cohort Collaboration (ART-CC). Risk Calculator from Start of ART. Available as a PDF here. Accessed on February 17, 2012.