HIV/AIDS and Aging Awareness Day Sept. 18, 2010

[Guest guest]

NIH statement on National HIV/AIDS and Aging Awareness Day Sept. 18, 2010

from S. Fauci, M.D., Director, National Institute of Allergy and

Infectious Diseases J. Hodes, M.D., Director, National Institute on

Aging Jack Whitescarver, Ph.D., Director, NIH Office of AIDS Research

Older HIV-infected adults face unique health challenges stemming from

age-related changes to the body accelerated by HIV infection, the side effects

of long-term treatment for HIV, the infection itself and often, treatments for

age-associated illnesses.

Sept. 18 marks the third annual National HIV/AIDS and Aging Awareness Day, an

opportunity to highlight these challenges and the research under way to improve

the health and quality of life of older people infected with HIV.

Many HIV-infected individuals are living into their 50s and well beyond as a

result of the powerful combinations of antiretroviral drugs that suppress the

replication of the virus. In 2006, an estimated 25 percent of people living with

HIV in the United States were age 50 years and older.[1]

In those with long-term HIV infection, the persistent activation of immune cells

by the virus likely increases the susceptibility of these individuals to

inflammation-induced diseases and diminishes their capacity to fight certain

diseases. Coupled with the aging process, the extended exposure of these adults

to both HIV and antiretroviral drugs appears to increase their risk of illness

and death from cardiovascular, bone, kidney, liver and lung disease, as well as

many cancers not associated directly with HIV infection.

In addition, a growing number of adults in their 40s and 50s with long-term HIV

infection are experiencing syndromes that resemble premature aging. For

instance, these individuals have a greater risk of impaired kidney function and

end-stage renal disease than their HIV-uninfected counterparts.[2] They also are

three to four times more likely to develop osteoporosis, increasing their risk

for bone fractures.[3] In addition, 55-year-old HIV-infected men are as likely

to be in frail condition as are men ages 65 years or older who do not have

HIV.[4]

In 2008, an estimated 16 percent of all new HIV diagnoses occurred in people

ages 50 years and older in the 37 states with confidential name-based

reporting.[5] HIV disease progresses more quickly in older compared with younger

adults, and antiretroviral therapy restores immune system cells less

effectively, placing this older group at greater risk for illness and death from

HIV infection than younger people who are infected for comparable periods of

time.

Moreover, the higher rate of pre-existing conditions in people of advanced age

often complicates their treatment for HIV infection.

Older people and their health care providers may not consider individuals ages

50 years and over to be at risk for HIV infection, and consequently may not

discuss or act on HIV prevention measures.

To complicate matters, the signs and symptoms of AIDS in older adults can be

mistaken for conditions associated with aging, delaying the diagnosis of HIV

infection and the start of appropriate therapy.

In the United States, nearly one-fifth of the individuals ages 55 years and

older who were living with HIV in 2006 did not know they were infected.[6] As a

consequence of both late HIV diagnosis and greater risk of progressing to AIDS,

adults ages 50 years and older are more likely than any other age group to be

diagnosed with AIDS within a year of their HIV diagnosis, according to data

gathered between 1996 and 2005.[7]

To counteract these trends, health care providers should routinely discuss risk

factors for HIV infection with older patients, educate them about HIV prevention

measures and offer HIV testing. Because early HIV diagnosis is key to optimal

treatment, the Centers for Disease Control and Prevention recommends routine HIV

testing for all adults up to age 64 years.

CDC also recommends HIV testing for adults ages 64 years and over who have risk

factors for HIV infection, such as multiple sexual partners, unprotected sex or

injection drug use.

Medicare covers HIV screening once every 12 months for any Medicare participant

who asks for the test.

NIH is funding a variety of studies to address the challenges posed by HIV,

including aging and the effects of long-term treatment with antiretroviral

drugs. Study topics range from HIV-induced decline of immune system function to

the increased risk of cardiovascular disease, from the effect of

menopause-induced hormonal changes on HIV-infected women to the early detection

of kidney disease, and from the decline of memory and cognition in long-term HIV

infection to the greater risk of osteoporosis and bone fractures.

Some of these studies are being funded through an ongoing grant program called

Medical Management of Older Patients with HIV/AIDS, established by the National

Institute of Allergy and Infectious Diseases, the National Institute on Aging,

the National Institute of Mental Health and the National Institute of Nursing

Research, all part of NIH. This program continues to solicit research proposals

to study a range of biomedical issues relevant to older adults with HIV

infection.

More information is available at

http://grants.nih.gov/grants/guide/pa-files/PA-09-018.html,

http://grants.nih.gov/grants/guide/pa-files/PA-09-019.html, and

http://grants.nih.gov/grants/guide/pa-files/PA-09-017.html.

HIV clearly poses a risk to individuals 50 years and older and presents complex

treatment challenges. Therefore, older adults at risk need to get tested for the

virus and take steps to protect themselves and their loved ones from becoming

infected.

In addition, NIH-funded research is under way to help health care providers

tackle the often complicated treatment of HIV infection and related illnesses in

older individuals, as well as the phenomenon of accelerated aging due to

long-term HIV infection.

While NIH continues to seek a cure for HIV infection and to develop more varied

and powerful HIV prevention tools, we remain committed to helping HIV-infected

adults live longer, healthier lives.

Dr. Fauci is director of the National Institute of Allergy and Infectious

Diseases; Dr. Hodes is director of the National Institute on Aging; and Dr.

Whitescarver is director of the Office of AIDS Research, all at the National

Institutes of Health in Bethesda, land.

More information on HIV and aging is available at AIDS.gov

(http://www.aids.gov/hiv-aids-basics/diagnosed-with-hiv-aids/overview/aging-popu\

lation/).

NIAID conducts and supports research — at NIH, throughout the United States, and

worldwide — to study the causes of infectious and immune-mediated diseases, and

to develop better means of preventing, diagnosing and treating these illnesses.

News releases, fact sheets and other NIAID-related materials are available on

the NIAID Web site at http://www.niaid.nih.gov.

The Office of AIDS Research (OAR), a part of the Office of the Director of NIH,

plans and coordinates the scientific, budgetary and policy elements of the NIH

AIDS program. Information about the OAR and NIH AIDS research can be found at

http://www.oar.nih.gov/.

The NIA leads the federal effort supporting and conducting research on aging and

the medical, social and behavioral issues of older people. For more information

on research and the aging, go to www.nia.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency —

includes 27 Institutes and Centers and is a component of the U.S. Department of

Health and Human Services. It is the primary federal agency for conducting and

supporting basic, clinical and translational medical research, and it

investigates the causes, treatments, and cures for both common and rare

diseases. For more information about NIH and its programs, visit www.nih.gov.

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References:

1. Centers for Disease Control and Prevention (CDC). 2008. HIV prevalence

estimates—United States, 2006. MMWR 57(39):1074. Available at

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a2.htm.

2. Eggers PW et al. 2004. Is there an epidemic of HIV infection in the US ESRD

program? Journal of the American Society of Nephrology 15(9):2477-2485. 3. Brown

TT et al. 2006 Antiretroviral therapy and the prevalence of osteopenia and

osteoporosis: a meta-analytic review. AIDS 20(17):2165-2174.

4. Desquilbet L et al. 2007 HIV-1 infection is associated with an earlier

occurrence of a phenotype related to frailty. Journal of Gerontology: Biological

Sciences 62(11):1279-1286.

5. CDC. 2010. HIV Surveillance Report, 2008. Table 1a. Accessed August 10, 2010.

Available at

http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/table1a.htm.

6. Campsmith ML et al. 2010. Undiagnosed HIV prevalence among adults and

adolescents in the United States at the end of 2006. Journal of Acquired Immune

Deficiency Syndrome 53(5):621.

7. CDC. 2009. Late HIV testing — 34 states, 1996-2005. MMWR 58(24):664.

Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a2.htm.