Question
Is treatment different for older people?
12 November 2008. Related: All topics, Cure, Living with HIV long-term.
1. What are the problems of HIV treatment in the aging population, i.e older people?
2. Is there a different drug combination for older people?
3. Are treatment guidelines different for older people using HIV drugs?
Answer
Hi,
I’ll answer your questions the way you have numbered them.
1. The problems are numerous and only in the last few years have researchers started to focus on this area. Aging increases the risk of many health problems in the general population and these are just as important – perhaps a little more so – if you are HIV-positive. These include the risk of heart disease and stroke, diabetes, weaker bones and frailty,cognitive function (memory loss, dementia, Alzheimers etc), many cancers – and social issues including lower income, isolation etc.
This means that preventative measures and lifestyle changes to protect your long-term health are even more important if you are HIV-positive – keep active, taking exercise, stop smoking, eat a balanced diet, using alcohol and recreational drugs in moderation etc.
A really good booklet on HIV is older people has been produced by the US group ACRIA and is available at this link.
2. There is generally no difference in choice of HIV drugs, but doctors prescribe on an individual basis, and this should take account of other risk factors that may make some HIV drugs more appropriate than others – for example if you have cardiovascular risk factors (heart disease).
Several studies have reported that older people are better at adherence – they miss fewer doses – and therefore have a better chance of treatment success. This may also be related to achieving higher blood levels of HIV drugs – one study showed that older people metabolise (clear) drugs more slowly.
3. UK treatment guidelines don’t have much to say on age, but the update this year (2008) included a table on risk of serious events from delaying treatment based on CD4 count and viral load based on 3 ages: 25, 35, and 45 years old. This shows that older age is associated with higher risks and that this should be one of the factors to consider for starting treatment earlier. This makes sense for another reason too: CD4 counts generally decline with age, especially over 50-60 – so building and maintain a stronger count earlier wo, in theory, protect you later in life.
The UK (BHIVA) guidelines are online here – and Table 1 referred to above is on page 7 of the PDF version.
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