HIV-Positive in the Golden Years

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Half of those living with HIV in the United States today are over age 50. Despite the advances in treatment, older adults living with HIV can face unique health challenges related to their long-term use of antiretroviral medications, as well as experiences of HIV-related stigma and discrimination.

The National Center for Innovation in HIV Care at the Fenway Institute recently published "Strategies to Improve the Health of Older Adults Living with HIV," a policy brief for health care and HIV service providers on ways they can help clients and patients address some of these challenges.

Sean Cahill, Ph.D., director of health policy research at the Fenway Institute at Boston's Fenway Health and one of the report's authors, helps us understand it.

What are some of the health challenges faced by older adults living with HIV?
First, their ability to metabolize antiretroviral medications can diminish over time. When this happens, they may be at greater risk for some of the side effects of these medications. Those who are taking medicine for other health conditions might also experience adverse interactions between those drugs, such as liver toxicity.

What should happen if this occurs?
Adjusting medications may be necessary to minimize side effects and unhealthy interactions between drugs being taken for different health conditions. One side effect of some antiretroviral medications is reduced bone density. So providers who are caring for men over age 50 and postmenopausal women with HIV should be monitoring bone density and considering alternative antiretroviral medications in order to minimize the risk of bone fractures.

What can people living with HIV do?
One simple thing we recommend is what's called a "brown bag" review. At each doctor's visit, a patient should put all of the prescription medications, over-the-counter medications, vitamins, and herbal supplements he or she is taking into a brown bag and review these medications with their doctor to identify any potential negative interactions.

Are there any other physical health risks faced by older adults living with HIV?
They might find their cognitive abilities are declining at an earlier age than the general population. Some research suggests anti-retroviral therapy may increase the risk of Alzheimer's disease.

What's the reason for that?
We're not entirely sure, but some hypothesize that people who have been on antiretroviral treatment for a long time might experience chronic inflammation in the brain that is driven by HIV.

What else should providers be aware of when caring for older adults living with HIV?
They need to know that there are much higher rates of depression among older men and women who are living with HIV. They are at a greater risk for substance use ranging from tobacco, alcohol, and marijuana to cocaine, opioids, and other prescription drugs. They're also more likely to be lonely or socially isolated, especially if they are older gay or bisexual men or transgender women. So providers should be screening for these conditions and offering referrals to services.

If you were to pick one thing to be done to improve the health and happiness of older adults living with HIV, what would it be?
That's easy. Increase their opportunities to make new friends and meet others living with HIV. Facilitate discussions around dating and being sexually active while living with HIV, medication adherence, dealing with stigma, and navigating insurance issues. Many people with HIV are getting hit with unfair insurance copayments for their medications. By hosting regular group activities at your health care organization or service site, you can provide helpful information to clients and also create a welcoming space where they can connect with others who are facing similar difficulties. When people connect and become less isolated, it can ease depression and help them stick with their treatment plan. It can lead to a powerful cascade of positive reinforcement for healthy behavior. u

"Strategies to Improve the Health of Older Adults Living with HIV" is a policy brief by the National Center for Innovation in HIV Care at the Fenway Institute. Find it at CareActTarget.org