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Human Immunodeficiency Virus in an Aging Population, a Complication of Success
Journal of the American Geriatrics Society, 10/01/09

Kirk JB et al. – Despite the increasing prevalence in older patients and cost–effectiveness analyses that favor HIV testing, older patients are less likely to be routinely evaluated for HIV infection. Consequently, when diagnosed, older patients have more–advanced disease than do younger patients and, upon presentation with AIDS–defining conditions, are less likely to receive timely appropriate therapy. The treatment of older HIV–infected patients is complicated by preexisting comorbid conditions, including cardiovascular, hepatic, and metabolic complications, which in turn may be exacerbated by the effects of HIV infection per se, modest immunodeficiency (i.e., at CD4+ counts >350 cells/microL), and the metabolic and other adverse effects of combination antiretroviral therapy. Nevertheless, older patients derive substantial benefit from combination antiretroviral therapy despite having less of an immunological response than expected given their adherence to therapy and excellent virological responses.

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