Although the disease has predominantly been associated with young people since the discovery of the virus, recent epidemiological evidence suggests that there are increases in the numbers of older adults affected by the condition (Mpondo, 2016). Increases in older adults living with HIV/AIDS is attributed to improved treatments, particularly antiretroviral therapy (ART), which increase longevity. Living with the condition is linked with numerous immunological, clinical, and physical challenges with advancing age. Older adults have higher rates of comorbid illnesses that could complicate the clinical care for HIV as the conditions could need significantly more non-ART drugs than in young people. HIV can impact aging biology and potentially lead to early manifestation of clinical conditions typically associated with advancing age. Reduced immunological and mucosal defenses compounded by changes in risk-related behaviors among the elderly could increase the risk of acquiring and transmitting the disease (Budak, 2020). Further, HIV screening remains low among older adults due to the assumption that the population is at lower risks of acquiring the disease. Further, in this research, you will find out more information on HIV disease, nurses and medical department students and students from other departments will find more original essays, unique research papers here on our website, you also can hire an essay writer or any other professional expert.
The number of older adults living with HIV/AIDS continues to increase. Approximately 51% of the individuals diagnosed with HIV in America and dependent areas were aged 50 or more as of 2018 (CDC.gov, 2021). Approximately one in every six new diagnoses encompassed members of this group. The prevalence of HIV testing among older adults continues to be low, approximated to be less than 5%, and decreases as age increases beyond 64 years (Autenrieth et al., 2018). CDC data projects an increase to more than 70% of Americans living with HIV among this population by the end of 2021 (CDC.gov, 2021). Among the population, as mentioned earlier, African Americans accounted for a significant percentage of new HIV diagnoses, followed by whites, Hispanics, and other ethnicities/ races taking the smallest proportion. Older adults belonging to the LGBTQ+ community are overrepresented in new HIV diagnoses statistics. As of 2016, close to 35% of older adults were diagnosed with AIDS (CDC.gov, 2021).
Caring for Older Adults with HIV/AIDS
According to CDC recommendations, all individuals aged 13-64 should routinely undergo HIV screening even more often when ongoing risks for HIV acquisition are suspected (NIH, 2021). Although numerous older adults aged above 65 years continue to be sexually active, CDC’s HIV screening guidelines do not recommend routine testing among the population. The Department of Health and Human Services Panel guidelines recommend the initiation of ART in all individuals above 50 years irrespective of their CD4 cell counts (NIH, 2021). Such recommendations are made because older adults with HIV have increased risks for developing non-AIDS-related complications and have reduced DC4 cell count recovery in response to ART. Risk reduction counseling along with the screening for other STIs may be done in older adults with increased risks of HIV infection. Older adults with increased risks of acquiring are liable to counseling on comprehensive prevention approaches, including having HIV pre-exposure prophylaxis (PrEP) (CDC.gov, 2021).
The recommended ART regimens in older adults with HIV are similar to those in younger patients. Older adults with HIV are encouraged to complete advance healthcare directives and designate durable powers of attorney for their healthcare. Current ERV regimens aim to control viral replication, enhance and maintain immunologic function, decrease mortality and morbidity, and provide longevity to those following their therapy (Treston, 2020). Current standards of care encompass a three-drug oral ARV regimen that contains two NRTIs and an extra drug. Available ARV-based HIV prevention encompasses utilizing three-drug oral PEP regimens or two-drug PrEP, both of which are FDA-approved choices.
Aging and HIV Progression
HIV infections in older adults present special challenges that ART could exacerbate. Chronic infections could result in increased levels of soluble and cellular markers of inflammation and immune activation (Treston, 2020). Although such levels reduce with ART, they contribute to being above normal even under suppressive ART. Aging also results in increases of such markers expected to be exponentially high in individuals with viremia as compared to those under virologic suppression through ART and individuals without HIV. Aging is associated with reduced production of naïve T cells, functional cytotoxic T cells, and reductions in memory T cells populations and T cell functionality. Reduction of cytotoxic Y cells compounded the decreases in CD4 cells results in accelerated progression of the illness in older adults. HIV progression and aging are also associated with negative impacts on B cells. Such impacts mean that older adults have lower immune recovery rates than younger patients because of the thymus reduction.
Older adults have been shown to produce less significant CD4 count responses to ART as compared to younger patients (Capeau, 2021). Renal elimination and hepatic metabolism are essential to drug clearance routes. However, aging decreases kidney and liver functions and could produce elevated drug exposure and drug elimination challenges. Age-related body changes such as a reduction in body weight can also impact drug pharmacokinetics among older adults leading to increased levels of drugs in tissues. Studies indicate that older adults indicate poor virological and immunological responses resulting in poor ART clinical outcomes. Poor ART outcomes relate to the declines in creatinine clearance that accompanies increasing age. Drugs with especially NRTIs, which are eliminated through glomerular filtration and tubular secretion in the kidneys, produce the most significant adverse impacts on their metabolism. Drugs with NNRTIs and PIs could enhance hepatic insufficiencies in particularly individuals with preexisting liver illnesses.
In elderly patients with hepatic or renal dysfunctions, medication hoses need to be appropriately adjusted for the patient’s benefit (Capeau, 2021). The provision of comprehensive multidisciplinary psychological and medical support to older adults with HIV and their families should be considered. With some older adults having higher risks of developing comorbid conditions, it is advisable to closely monitor drug toxicity, side effects of ART, and adverse reactions with other medications. Such solutions may significantly be impactful since there are no special guidelines for initial ART regimens or monitory in elderly patients with HIV. In older adults with risks for or with renal dysfunctions, clinicians should consider avoiding regimens with atazanavir and TDF (Collins & Armstrong, 2020). In situations where ART has negative impacts on qualities of life, decisions on continuing therapy should proactively be made with the patient and their families after they are informed of the benefits and risks of withdrawing or continuing treatment.
The population of older adults with HIV continues to increase globally, attributed to effective ART, which has significantly extended life expectancies. Older adults tend to present with HIV-induced immune-phenotypic alterations that are similar to accelerated aging and expose such a population to unique challenges. The unique challenges that older adults with HIV may experience include greater incidences of comorbidities and health complications sometimes accelerated or exacerbated by ART. HIV screening remains low among older adults due to the assumption that the population is at lower risks of acquiring the disease. Comprehensive psychosocial and medical support is needed to assist older adults with HIV and their families in addressing the challenges associated with the disease.
Autenrieth, C., Beck, E., Stelzle, D., Mallouris, C., Mahy, M., & Ghys, P. (2018). Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020. PLOS ONE, 13(11). https://doi.org/10.1371/journal.pone.0207005
Budak, J. (2020). Core Concepts – HIV in Older Adults – Key Populations – National HIV Curriculum. Hiv.uw.edu. Retrieved 8 December 2021, from https://www.hiv.uw.edu/go/key-populations/hiv-older-patients/core-concept/all#antiretroviral-therapy-older-patient-hiv.
Capeau, J. (2021). Ageing with HIV: is the virus or the treatment guilty?. The Lancet HIV, 8(4), e182-e183. https://doi.org/10.1016/s2352-3018(20)30337-4
CDC.gov. (2021). HIV and Older Americans. Centers for Disease Control and Prevention. Retrieved 8 December 2021, from https://www.cdc.gov/hiv/group/age/olderamericans/index.html.
Collins, L., & Armstrong, W. (2020). What It Means to Age With HIV Infection. JAMA Network Open, 3(6), e208023. https://doi.org/10.1001/jamanetworkopen.2020.8023
Mpondo, B. (2016). HIV Infection in the Elderly: Arising Challenges. Journal Of Aging Research, 2016, 1-10. https://doi.org/10.1155/2016/2404857
NIH. (2021). HIV and the Older Person | NIH. Clinicalinfo.hiv.gov. Retrieved 8 December 2021, from https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/hiv-and-older-person.
Treston, C. (2020). Older Adults Aging With HIV: A Growing Population Experiencing Comorbidities and Social Isolation. Innovation In Aging, 4(Supplement_1), 221-222. https://doi.org/10.1093/geroni/igaa057.715