Managing HIV in Older Adults: Age-Specific Considerations

New research published in the Journal of the America Geriatrics Society discusses the differences between older and younger adults living with HIV and provides age-specific care recommendations for older adults (2016; doi:10.1111/jgs.14584). 

An increasing number of older adults are living with HIV, however, many existing recommendations regarding the management of HIV is not age-specific. For example, according to authors, current guidelines do not account for age-related changes in “immune response to antiretroviral therapy, multicomorbidity, antiretroviral toxicities, and diagnostic considerations.”

Thus, Jonathan S Appelbaum, MD, University of Florida (Tallahassee, FL) and his coauthor examined findings from recent clinical research in order to provide an adapted management strategy for HIV treatment for older adults. In a statement, Dr Appelbaum remarked, “Our article recommends an overall strategy in which various tools are used to provide information on the likely course of HIV for an individual, which clinicians can then use to guide discussions on personalized, person-centered care.”

In their management strategy, authors stress the unique complexity of each individual, citing the inconsistency of aging rates of older adults and even among individual organs. They also note the importance of each patient’s personal goals and preferences when considering treatment pathways. 

Specific suggestions for older adults with HIV are also given concerning immunizations, blood pressure goals, glycated hemoglobin targets for diabetics, and bone density screenings. HIV-associated neurocognitive disorders (HAND) are also discussed, and details on how to distinguish HAND from Alzheimer’s disease are provided.

Older adults with HIV are particularly prone to polypharmacy as well as alcohol and substance abuse. Routine medication reviews are encouraged for every medical visit in addition to annual medication reconciliation. Authors also suggest routine screenings for alcohol and substance abuse in older adults with HIV, since risk perception is often inaccurate in this population. Medical marijuana use, though summarily, is also mentioned. 

In a statement, authors comment that while the article aims to provide evidence-based approaches to managing HIV in this population, it also “highlights the need for more research on screening, evaluation, and treatment in older adults infected with HIV” as the number of aging adults with HIV grows.—Amanda Del Signore