Growing old with HIV: Challenges and opportunities

In 2015, for example, 50% of people aged 55 years and older who received a diagnosis of HIV had already had the infection for 4.5 years or longer.This matters because, despite the success of antiretroviral therapy, the longer HIV goes untreated, the more irreversible damage the virus does to the body — in particular, the immune and nervous systems.Research suggests that people who receive a diagnosis later tend to respond less well to antiretroviral therapy and have worse outcomes in terms of their overall health and life expectancy. Even when the disease is well-controlled, however, older people living with HIV face a range of challenges to their health, in addition to the usual effects of aging.According to the NIA, they may develop age-related conditions at a younger age than those without the virus and have an increased risk of cardiovascular disease and dementia.Most of the unique physical challenges that older people with HIV face fall into three broad categories:Research suggests that, compared with younger people, the immune system of older adults with HIV recovers less well with antiretroviral treatment.In addition, despite effective antiretroviral treatment, the widespread, chronic inflammation associated with normal aging (called inflammaging or immunosenescence) is more pronounced in people with HIV than in people of the same age without the infection. As one example, research suggests that people with HIV have a higher risk of heart attack.As a result of factors such as inflammaging and late diagnosis, older people with HIV are more likely to experience a phenomenon known as “multimorbidity,” in which several chronic conditions interact to worsen their overall health.Older people may also be more susceptible to the side effects of CART.With age, the kidneys and liver become less efficient at detoxifying drugs.