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Growing Older and Ageing with HIV

More people with HIV are living into old ageBefore the introduction of antiretroviral therapy in the mid-1990s, very few people living with HIV would survive to old age.

Highly-active antiretroviral therapy (HAART), a combination of very effective antiretroviral drugs, marked a turning point in the global HIV epidemic. HAART block all stages of HIV replication, transforming HIV into a manageable long-term condition. This enabled people living with HIV to control their infection and so live longer with HIV.

What it means to grow old with HIV

Today, the global commitment to provide HAART to all people living with HIV, has resulted in a significant reduction in mortality rates among HIV-positive people. This is most evident in high-income countries where access to antiretroviral therapy is almost universal. Recent studies show there are increasing numbers of older adults with HIV in sub-Saharan Africa, especially South Africa where more than 80 percent of people living with HIV are on HARRT treatment.

Ageing with HIV presents a number of unexpected challenges for the person living with the virus as well as those who provide care. Multiple research reports confirm that many adults are developing multiple chronic illnesses typically seen in the very old, age 75+. This population evidences high rates of cardiovascular disease, cancer, chronic kidney disease, diabetes, osteoporosis, frailty, and neurocognitive deficits. This phenomenon is often described as premature ageing or accelerated ageing.

Why are people with HIV more at risk of developing health conditions?

Research is underway to determine why this is happening. Suggested causes include:

  • The effects of long-term antiretroviral therapy. Although antiretrovirals are much less toxic today than previously, it is becoming evident that long-term antiretroviral treatment may increase the risk of a person developing certain health conditions.
  • The effects of long-term HIV infection. Even with antiretroviral treatment, HIV can make some individuals more susceptible to certain health conditions; particularly as they live longer.
  • The physical effects of ageing. As with HIV-negative people, people with HIV are developing age-related health conditions, which previously many would not have lived long enough to experience. 
  • The effects of long-term behaviours. Certain behaviours can place people at risk of developing some health conditions. These include smoking, drinking and a lack of exercise. People with HIV are now living long enough for behaviour-related health conditions to develop.

In many cases the risk of developing certain health conditions is due to a collection of the factors above. 1 For example, the damaging effect of smoking may be amplified due to the effect HIV has on the body. Therefore an HIV-positive person who smokes may be more at risk, than HIV-negative smokers, of developing certain health conditions. This is explored further in our page on ' HIV, ageing and comorbidities'.

If you are living with HIV take a look at our page on ' Growing older with HIV and drug interactions'. 

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