In Puerto Rico, statistics from the Department of Health as of August 31, 2024 show that more than 30% of patients with HIV/AIDS belong to the group between the ages of 45 and 65.
By: Jorge L Santana Bagur, MD, FIDSA Director of the ACTU Project University of Puerto Rico School of Medicine, Medical Sciences Campus MCS Collaborator
The human immunodeficiency virus (HIV) remains a major public health problem, particularly among the elderly population. Historically associated with younger demographics, the incidence and prevalence of HIV among the elderly has been increasing, validating the need for awareness and the design of interventions that specifically target this population.
Today, more than half of HIV-positive individuals in the U.S. are age 50 or older, creating the phenomenon known as the “silver tsunami.” In Puerto Rico, statistics from the Department of Health as of August 31, 2024 show that more than 30% of patients with HIV/AIDS belong to the group between the ages of 45 and 65. One of the many reasons to focus on HIV incidence in the elderly is the changing demographics and behavioral dynamics in this population. Life expectancy is increasing, with more seniors engaging in sexual activity, and often without adequate knowledge of the risks.
Healthcare professionals often avoid discussing sexual activity with those in this population, either due to a lack of time, a fear of offending the person, and from embarrassment and/or limited training on the skills and abilities required to address this issue. This lack of awareness can lead to delayed diagnoses, including the omission of sexually transmitted diseases such as syphilis and gonorrhea, which results in an additional health burden and morbidity of the complications expected with the natural aging process. In addition, seniors may experience age-related changes that can complicate HIV treatment, amplify comorbidities, and lead to problems such as polypharmacy, intersectionality and frailty. All of this can have a negative impact on wellness and health care, extending far beyond one’s physical health and well-being..
Social stigma and other health determinants play a vital role leading to isolation of the elderly, along with mental health problems, depression, fear, lack of confidence, a reluctance to get tested for HIV and other sexually transmitted diseases, and treatment. In fact, it’s known that depressed seniors may turn to using opioids and other illegal drugs as a way to cope or forget the situation, while even isolating themselves from friends and family. One of the many factors contributing to loneliness is the lack of family, social support, and peer networks, as well as the inaccessibility or non-existence of government programs for the elderly, resulting in greater isolation from the social environment. This leads to many other challenges, and sometimes makes these people victims of unscrupulous individuals who take advantage of the elderly person’s vulnerability.
Data collected from 2019 to 2021 by the Centers for Disease Control and Prevention (CDC) on more than 2,391 HIV-positive people age 55 or older, assessed the need for ancillary services and showed that between 17% and 28 % of these people had an unmet need for HIV support services (mental health, dental care, counseling services on the use of illicit substances and alcohol, lack of transportation, food assistance or housing). In addition, the economic implications of the disease in the elderly can overburden healthcare systems, highlighting the need to develop comprehensive care strategies.
Strategies for long-term survivors must be aimed at addressing health issues holistically, which can include:
Cardiovascular Risk (statin use)
Hypertension
Dyslipidemia
Chronic Kidney Disease
Aging Bones (osteopenia, osteoporosis)
Cancer (prostate, colorectal, lung, bladder)
Drug-to-Drug Interactions and Polypharmacy with Antiretroviral Drugs
Oro Dental Care
Psychosocial Aspects (mental health, housing, food insecurity, companions and caregivers)
Considering the comprehensive aspects described above, we can put antiretroviral therapy (ART) for the elderly in a healthy and beneficial context. Fortunately, pharmacological paraphernalia has evolved in a favorable way for this population, as the therapy recommended by the Department of Health and Human Services (DHHS) involves the use of 2-3 combination drugs in a single tablet regimen (STR) that includes one or two nucleoside analogues and an integrase transfer inhibitor (INSTI). These drugs are extremely convenient, given their intake of one (1) time daily, their potency, tolerability, and few or limited drug interactions. Moreover, the outlook for the near future contemplates oral drug preparations of one tablet once a week, as well as long-acting antivirals in injectables every two (2) months, and possibly even one injection every six (6) months.
The increasing incidence and expectations of aging underscore the importance of education, prevention and healthcare services designed and targeted at this population. Addressing these issues and conducting coordinated planning will not only improve individual health outcomes, but also enhance the public health efforts being undertaken to combat the epidemic. By raising awareness and promoting proactive programs and measures aimed at improving health-related services, we can mitigate the impact of HIV on the elderly, ensuring a better quality of life for this vulnerable population.
