More than half of the people living with HIV in Philadelphia are 50 and older, and they face greater risk of frailty and impairment than other older Philadelphians, according to the Philadelphia Department of Public Health.
When the first cases of Acquired Immunodeficiency Syndrome were reported by the U.S. Centers for Disease Control and Prevention in 1981 and the cause of it, Human Immunodeficiency Virus, in 1984, a positive diagnosis was considered a death sentence. With the advancements in antireretroviral therapies (ART), however, people with HIV are now living longer, healthier lives.
According to Kathleen A. Brady, M.D., MSCE, director/medical director, Division of HIV Health at the Philadelphia Department of Public Health, people aging with HIV share many of the same health concerns as the general population of people aged 50 and older such as multiple chronic diseases, use of multiple medications, physical and cognitive changes and increased vulnerability. They just face these challenges at a faster rate and have a larger burden of coexisting health conditions.
Brady spoke on the unique challenges this population faces at a recent symposium on aging with HIV. The symposium was hosted by the Philadelphia Department of Public Health, the Health Foundation of Philadelphia and the Mid/Atlantic AIDS Education and Training Center.
Healthy aging with HIV
She explained that rates of new HIV diagnoses have been declining over the last ten years in Philadelphia, but there is still much work to be done.
HIV is still highest among Black Philadelphians. The reasons why are complex and include poverty and lack of access to HIV prevention and treatment like PrEP (pre-exposure prophylaxis) and ART. Health equity continues to be a major focus in the metro area, Brady said.
“We need HIV care and treatment to ensure people aging with HIV can receive whole person care that addresses HIV and age-related issues. This includes improving quality of life, physical, emotional and social wellbeing.”
Amy C. Justice, M.D., Ph.D., CNH, Long Professor of Medicine and Public Health, Yale University, Staff Physician, VA Connecticut Healthcare System, has been active in research on HIV and aging and shared her prescription for healthy aging at the symposium.
Because of chronic inflammation, people with HIV have a greater burden of coexisting health conditions such as cardiovascular disease, diabetes, pulmonary disease, kidney disease, cancer, heart failure, stroke and dementia, she explained.
Other drivers of pathological aging — changes that are caused by diseases or injuries that affect the normal aging process — are weight gain after ART and adverse effects from multiple medications.
In one of her studies published in The Lancet, Justice and her colleagues found that people aging with HIV have more drug-drug interactions than those without HIV, and each non-antiretroviral therapy (ART) medication increased their risk of hospitalization.
Use of alcohol and drugs with ART is also a major driver for serious falls, she said.
Her prescription for health aging with HIV? Start treatment as soon as possible, discuss life experiences and personal preferences with caregivers, and address other health conditions.
She added that more medication is not always the answer. Making lifestyle changes like eating healthier, exercising more and reducing stress are important too. Resources like Patient Priorities Care can help people with HIV identify their health priorities so they communicate them to their healthcare providers.
Justice emphasized that while behavioral change is hard, it is vital and that key factors for success include personal motivation, understanding the need for change, defining a plan with achievable goals, consistent self-monitoring and social support.
She also recommended capitalizing on available resources like the YMCA or Silver Sneakers.
Maintaining a healthy lifestyle
Kristine Mace Erlandson, MS, MS, Professor of Medicine, University of Colorado-Anschutz Medical Campus also talked about the importance of healthy eating and exercising. She shared her research on the positive benefits of exercise for people living with HIV.
In her research, people with HIV experienced similar or greater improvement in function with exercise. There was 10 to 45% improvement in both groups, however, people with HIV had greater gains in 400m walk time, stair climb and endurance. Regular exercise also reduced risk of frailty.
Erlandson and her colleagues also found that exercise reduced chronic inflammation.
“Exercise is the most consistent intervention to successfully improve function and decrease frailty,” she said.
She acknowledged that people with HIV may have unique barriers to exercise. They might not know how to get started, or face barriers in accessing free gym membership. She added that only about 60% of patients had a conversation about exercise with their HIV provider and most HIV providers are not trained in developing exercise prescriptions.
Need for expanded screening
Brady said another challenge older people with HIV face is that many of them are being diagnosed at an older age and later in the course of the disease.
Slightly more than 15% of new HIV diagnoses in 2023 were in people under 50 years of age. Of these, 63% were assigned male at birth, 65.5% Black, 17.2% Hispanic and 17.2% White.
“Providers don’t always test and mistake symptoms for other aging symptoms,” she explained.
Currently the CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of their routine health care.
Justice said that HIV screening needs to be expanded to include those over 64, and self-testing made more accessible to combat stigma. People with certain risk factors are encouraged to get tested on a frequent basis.
She added that healthcare providers need to discuss sexual health and substance use with their older patients.
“It is a fallacy that older people don’t engage in sex or take drugs. Older adults want their providers to ask them these questions. Providers need to be more comfortable bringing it up,” she said.
Resources for older people living with HIV
If you are an older person living with HIV or have questions about your HIV status, there are resources in the region:
- Philadelphia Corporation For Aging offers an Aging well with HIV self-management program.
- The Office of HiV Planning has a service directory of organizations that provide HIV care and prevention services.
- The City of Philadelphia’s Viral Hepatitis Program links those living with hepatitis B, C or D to resources.
- The City also provides resources for HIV/AID testing and prevention.
