Aging with HIV
While AIDS-defining illnesses are increasingly rare in those who are on effective antiretroviral therapy, there is concern about the growing number of HIV-associated, non-AIDS (HANA) conditions requiring medical attention. To understand the true differences between older individuals with and without HIV infection, studies require careful design to manage how these populations differ in a number of behavioral and biological factors known to affect the aging process.
The prevalence of HIV infection in people aged 50 years or older is rapidly increasing. Age-associated inflammation and chronic inflammation are risk factors for morbidity and mortality in older adults given its impact on the functioning of the immune system. Other common issues in older people with HIV infection include multi-morbidity, poly-pharmacy, HIV-associated neurocognitive impairment, and lifestyle behaviors that impact health. Further, the complexity of assessing HIV vs. treatment effects vs. aging vs. concurrent disease, and the interrelated mechanisms of immune senescence, inflammation and hypercoagulability give rise to the critical need for research in HIV and aging.
Biomedical Challenges, Psychosocial Resilience
As the medical science community works to address the biomedical challenges associated with HIV and aging, behavioral health scientists can contribute in another important way. In addition to neurocognitive assessment, examining factors that contribute to successful psychosocial aging is important. While self-rated successful aging has been found to be lower in those with HIV when compared to their HIV- counterparts, people aging with HIV have reported optimism, personal mastery, and social support as contributing to successful aging (Moore et al., 2014). It is essential that an individual's resilience and ability to access supportive resources are understood in the context of managing HIV-associated impairments exacerbated by aging.
A Review of the Literature
Charles A. Emlet of the University of Washington discusses research on the subject of HIV in older adults in his 2014 article, "Current Knowledge and Future Directions on Aging and HIV Research." The article brings attention to the biopsychosocial challenges present when caring for older adults living with HIV infection. In addition, it will be time to review and assess our approach to determine what changes, if any, are needed in the future or HIV treatment for an aging HIV-positive population. Recently, Negredo and colleagues published their review article, "Aging in HIV-Infected Subjects: A New Scenario and a New View." This article is available in the open access journal "BioMed Research International."