Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
United Press International - March 19, 2002
Koren Capozza, UPI Science News
Presentations at the American Foundation for AIDS Research meeting shed new light on the unique issues facing HIV patients over age 50.
"When I was speaking to a high school class, a teenage girl said: 'Look, we all know we're going to die someday and you're already old so what's the big deal?'" said Jane Fowler, 66, who is HIV-positive and the national coordinator of the National Association on HIV Over Fifty. "We face a double stigma."
Today between 11 percent and 15 percent of Americans infected with the human immunodeficiency virus are over age 50.
One of the biggest challenges for care providers working with elderly patients who may be at risk for HIV infection is distinguishing between symptoms which are hallmarks of aging -- like fatigue, memory loss and digestive problems -- and those which are indicative of HIV.
Moreover, many care providers do not even look for sexually transmitted diseases in older patients because of the prevailing myth they are no longer sexually active.
In fact, increasing evidence indicates older women are particularly susceptible to HIV-infection because the vaginal wall thins with age, increasing the risk of transmission through sexual intercourse. And post-menopausal women may not see the need for condom use when they are no longer at risk for pregnancy.
Once older patients have been diagnosed, they face new challenges with the drug treatment, called anti-retroviral therapy, prescribed to keep HIV levels at very low -- sometimes undetectable -- levels.
"A lot of the anti-retroviral drugs have side effects that are similar to the kind of conditions you see in an aging population anyway: Type 2 diabetes, osteoporosis and high cholesterol," said Donna Gallagher, director of the New England AIDS Education and Training Center in Boston. "But they're getting these things 20 years before they're supposed to."
Few studies have compared survival rates between younger and older HIV-infected patients but preliminary research suggests the elderly may die sooner.
"Studies have shown that olders (patients)were more likely to have decreased survival after diagnosis of HIV but those studies were confounded by a bias against making a diagnosis in olders. They were only diagnosed after an AIDS-defining illness," said Dr. Karl Goodkin, a psychiatrist at the University of Miami who studies survival rates in younger and older HIV-infected patients.
He said he hopes to determine if late diagnoses are driving lower survival in elderly patients or if HIV affects older people differently.
"People over 50, have an immune system that's on the down-swing," Gallagher said. The side effects of the anti-retroviral drugs tend to compound conditions associated with aging, causing HIV-positive people over 50 to die of complications linked to conditions like high cholesterol.
"If you already had a little bit of high cholesterol and then the medication tripled it, that may be what pushes people over the edge," she said.
Health providers face a another challenge in treating elderly HIV-positive patients. Very little research has been done on how drugs for common conditions like high blood pressure and hormone replacement therapy interact with anti-retroviral drugs.
"As people that are HIV-positive and young today continue to live, we'll learn more and more about these problems," Fowler said.
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