HIV/AIDS began its deadly course in the United States mostly as a disease of young men, but today the epidemic touches people of all ages, including adults aged 50 and older. On September 18, the first National HIV/AIDS and Aging Awareness Day, we pause to recognize the importance of preventing HIV infection in this age group and understanding and addressing the unique health effects of the virus on older Americans.
Thanks to the advent of potent, multi-drug therapy against HIV in the mid-1990s, many HIV-infected Americans are living into their 50s and well beyond. Also, while the majority of new HIV infections are in younger Americans, individuals 50 years of age and older accounted for approximately 10 percent of all new HIV infections in the United States in 2006. As a consequence of these trends, approximately one quarter of HIV-infected adults in the United States in 2007 were at least 50 years old.
Older adults with long-term or new HIV infection experience complex interactions among HIV, antiretroviral therapy, age-related changes to the body, and, often, treatment for illnesses associated with aging. These interactions affect the health care needs and quality of life of older adults. It is imperative that we in the research community decipher the medical implications of aging with HIV and continue developing more sophisticated treatment approaches so these older adults can live longer, healthier lives.
It also is critical to prevent new HIV infections in older Americans by educating them about the importance of routine HIV testing and early diagnosis; how the virus is transmitted; behaviors that place them at risk for acquiring or transmitting the virus; and strategies, such as condom use and needle exchange, that can reduce their risk. Since early diagnosis of HIV is key to optimal treatment, the Centers for Disease Control and Prevention recommends routine HIV testing for all adults up to age 64. CDC also recommends HIV testing at least annually for adults aged 64 and over who have risk factors for HIV infection, such as injection drug use.
The U.S. Department of Health and Human Services this month proposed that Medicare cover HIV screening tests for beneficiaries at increased risk for acquiring the virus, including women who are pregnant, and Medicare beneficiaries of any age who voluntarily request the service. Medicare provides health insurance coverage to people who are aged 65 and over or who meet other special criteria.
Aging is an important and expanding focus of HIV/AIDS research at the National Institutes of Health and the NIH-sponsored Centers for AIDS Research. The National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, funds a range of studies to understand the biology of HIV infection in older adults with the goal of improving their medical care. Scientists are studying the interaction between HIV and aging in areas as diverse as diseases of the liver, kidney, brain, heart and lung; cancer; bone density; physical activity; mental health; balance; hearing; response to antiretroviral therapy; immune function; and adherence to medical care.
For example, researchers with the Multicenter AIDS Cohort Study have shown that HIV infection accelerates the development of frailty, a condition of the elderly that makes people more vulnerable to illness, injury and death. Scientists now want to determine which HIV-infected individuals are at highest risk for developing HIV-associated frailty with the hope of identifying factors to mitigate or prevent its development. NIAID and the National Institute on Aging (NIA), also part of NIH, are planning a workshop for late 2009 to identify current knowledge and research gaps in the areas of HIV and frailty, bone health, muscle health and vitamin D production.
Still, many gaps remain in scientific knowledge about the effects of HIV and antiretroviral therapy on aging. To that end, NIAID, NIA, the National Institute of Mental Health and the National Institute of Nursing Research, all part of NIH, are soliciting research proposals to explain and prevent a spectrum of biomedical problems faced by older adults with HIV infection. More information about these funding opportunities is available at http://grants.nih.gov/grants/guide/pa-files/PA-09-018.html, http://grants.nih.gov/grants/guide/pa-files/PA-09-019.html, and http://grants.nih.gov/grants/guide/pa-files/PA-09-017.html.
When AIDS and then its cause — HIV — were recognized in the early 1980s, no one imagined that individuals with HIV infection would eventually survive for decades. Now, with a quarter of the HIV-infected U.S. population age 50 years and older, the biomedical and public health communities face new challenges at the intersection of HIV and aging. In the absence of a cure for HIV, this first annual National HIV/AIDS and Aging Awareness Day marks an opportunity to rededicate ourselves to research aimed at preventing HIV infection in older adults and improving the health and quality of life of those who are infected.
1. HI Hall et al. 2008. Estimation of HIV incidence in the United States. JAMA 300:520–529.
2. CDC. 2008. HIV prevalence estimates — United States, 2006. MMWR 57:1073–1076.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases;, Dr. Hodes is director of the National Institute on Aging; and Dr. Whitescarver is director of the Office of AIDS Research, all at the National Institutes of Health in Bethesda, Maryland.
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov.
The NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people. For more information on research and aging, go to www.nia.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.