The risk for polypathology (the presence of at least two age-associated conditions, such as cardiovascular and kidney disease, hypertension, diabetes, and bone fracture) is similar for an HIV-positive person who is 40 years old and a 55-year-old HIV-negative person.44 As the incidence of AIDS-related malignancies has dropped due to the immunological benefits of antiretroviral therapy, the incidence of non-AIDS-related malignancies has increased among the aging population of PLWHA.46,47,48 As Telzak explains,
One of the most recent and important contributions of HIV medicine is how it has informed all of medicine about the negative outcomes associated with ongoing inflammation, such as diabetes, liver, kidney, and cardiovascular disease. Though still very much in the early stages of study, this might have very broad implications; it could revolutionize how people think about early intervention for diseases, and that there may be unifying risks for many seemingly different kinds of diseases. In many ways, the field of HIV may really be onto something that could have a great impact on medicine.
Researchers are working to determine the contributions of HIV itself, long-term use of antiretroviral therapy, family history, and lifestyle to premature aging. At the same time, clinicians are working with their patients to prevent and manage these conditions. The good news is that ART is effective in suppressing HIV, regardless of a person’s age. However, immune recovery is known to be slower in older people, leaving older patients who are diagnosed with a low CD4 cell count especially vulnerable to a blunted CD4 response.
HIV Treatment Guidelines: Recommendations for Older Patients
The March 2012 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents now includes a section on key considerations when caring for older HIV-infected patients. It recommends initiation of ART in all patients over 50 years of age regardless of CD4 cell count, due to a greater risk for non-AIDS related complications and potentially blunted immunological response to ART.58