Antiretroviral Guidelines

US DHHS Guidelines with Australian commentary

HIV and the Older Patient

Last Updated: December 18, 2019; Last Reviewed: December 18, 2019

Key Considerations When Caring for Older Patients With HIV

AU comment: Cardiovascular risk calculators

AU comment: Abacavir and D:A:D

Key Considerations When Caring for Older Patients With HIV

  • Antiretroviral therapy (ART) is recommended for all people with HIV regardless of CD4 T lymphocyte cell count (AI). ART is especially important for older individuals because they have a greater risk of serious non-AIDS complications and potentially a blunted immunologic response to ART.
  • Given that the burden of aging-related diseases is significantly higher among persons with HIV than in the general population, additional medical and social services may be required to effectively manage both HIV and comorbid conditions.
  • Adverse drug events from ART and concomitant drugs may occur more frequently in older persons with HIV than in younger individuals with HIV. Therefore, the bone, kidney, metabolic, cardiovascular, cognitive, and liver health of older individuals with HIV should be monitored closely.
  • Polypharmacy is common in older persons with HIV; therefore, there is a greater risk of drug-drug interactions between antiretroviral drugs and concomitant medications. Potential for drug-drug interactions should be assessed regularly, especially when starting or switching ART and concomitant medications.
  • The decline in neurocognitive function with aging is faster in people with HIV than in people without HIV. HIV-associated neurocognitive disorder (HAND) is associated with reduced adherence to therapy and poorer health outcomes including increased risk of death. For persons with progressively worsening symptoms of HAND, referral to a neurologist for evaluation and management or a neuropsychologist for formal neurocognitive testing may be warranted (BIII).
  • Mental health disorders are a growing concern in aging people with HIV. A heightened risk of mood disorders including anxiety and depression has been observed in this population. Screening for depression and management of mental health issues are critical in caring for persons with HIV.
  • HIV experts, primary care providers, and other specialists should work together to optimize the medical care of older persons with HIV and complex comorbidities.
  • Early diagnosis of HIV and counseling to prevent secondary transmission of HIV remains an important aspect of the care of older people with HIV.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion