HIV infection and older Americans: the public health perspective

Abstract

HIV disease is often perceived as a condition affecting young adults. However, approximately 11% of new infections occur in adults aged 50 years or older. Among persons living with HIV disease, it is estimated that more than half will be aged 50 years or older in the near future. In this review, we highlight issues related to HIV prevention and treatment for HIV-uninfected and HIV-infected older Americans, and outline unique considerations and emerging challenges for public health and patient management in these 2 populations.

FIGURE 1—

Examples from 3 public health campaigns to increase awareness of HIV risk among older adults, including (a, b) a current campaign developed by the US Administration on Aging, (c, d) a campaign created by the AIDS Community Research Initiative of America with funding from the New York City Department of Health and Mental Hygiene conducted in New York City during 2010, and (e, f) a Brazilian public health campaign to promote HIV awareness and condom use among older persons used during Carnaval 2009 and the World Cup soccer championship in 2010. Note. The Brazilian images read (e) “Mature Woman's Club [in circle]. Use Condoms. The Safe Woman's Choice.” and (f) “Condoms after 50: Try It.” Both feature the statement “Sex doesn't depend on age. Neither does protection.”

FIGURE 2—

Estimated numbers of persons living with HIV, by year and selected characteristics in (a) 2007 and (b) 2009: 46 states with confidential name-based reporting of HIV infections to the Centers for Disease Control and Prevention. Note. In 2007, the median age was 40-44 years, and 28.6% were aged ≥ 50 years. In 2009, the median age was 45–49 years, and 32.7% were aged ≥ 50 years.

FIGURE 3—

Median CD4 cell count, and the proportion of individuals who have a CD4 cell count greater than or equal to 350 cells/mm, at first presentation for HIV clinical care in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Source. Reproduced with permission from Althoff et al.

FIGURE 4—

Percentage of persons diagnosed with AIDS less than 12 months after HIV diagnosis: 46 states with confidential name-based HIV infection reporting, 2009.

FIGURE 5—

Percentage of persons alive at 36 months by type of diagnosis: 46 states with confidential name-based HIV infection reporting, 2009.

FIGURE 6—

Factors contributing to the phenomenon often termed “premature aging.” Source. Reproduced and adapted with permission from Deeks and Phillips.