Care of the Aging Patient: From Evidence to Action
Clinician's Corner
April 3, 2013

Management of Human Immunodeficiency Virus Infection in Advanced Age

Author Affiliations

Care of the Aging Patient Section Editor: Edward H. Livingston, MD, Deputy Editor, JAMA.

Author Affiliations: Divisions of Geriatric Medicine (Drs Greene and Valcour) and Infectious Diseases (Dr Lampiris), Department of Medicine, and Memory and Aging Center, Department of Neurology (Dr Valcour), University of California, San Francisco; Veterans Affairs Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, Connecticut (Dr Justice); and Department of Veterans Affairs Medical Center, San Francisco, California (Dr Lampiris).

JAMA. 2013;309(13):1397-1405. doi:10.1001/jama.2013.2963

Importance Human immunodeficiency virus (HIV)−positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients.

Objective To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed.

Evidence Acquisition Published guidelines and consensus statements were reviewed. PubMed and PsycINFO were searched between January 2000 and February 2013. Articles not appearing in the search that were referenced by reviewed articles were also evaluated.

Findings The population of older HIV-positive patients is rapidly expanding. It is estimated that by 2015 one-half of the individuals in the United States with HIV will be older than age 50. Older HIV-infected patients are prone to having similar chronic diseases as their HIV-negative counterparts, as well as illnesses associated with co-infections. Medical treatments associated with these conditions, when added to an antiretroviral regimen, increase risk for polypharmacy. Care of aging HIV-infected patients involves a need to balance a number of concurrent comorbid medical conditions.

Conclusions and Relevance HIV is no longer a fatal disease. Management of multiple comorbid diseases is a common feature associated with longer life expectancy in HIV-positive patients. There is a need to better understand how to optimize the care of these patients.