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Patients aged 50 and older should be tested for HIV

The risk of contracting HIV is often underestimated in this patient population.

Issue: February 2007

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Clinicians should lower HIV testing thresholds to account for heterosexual sex transmission in patients aged 50 years and older. The risk of HIV transmission in patients in this age group is often underestimated by both doctors and patients, according to a new study.

Kathleen K. Casey, MD, an infectious disease specialist at Jersey Shore Medical Center and co-author of the study, said doctors often falsely assume patients are not sexually active because of their age; older patients assume they are not at risk because of misperceptions about sexually transmitted disease and blood testing. “Young people may think that sexual activity goes away in middle age but – especially these days, with Viagra, divorce and retirement communities where people meet other people – older patients are acquiring HIV through sexual contact,” Casey told Infectious Disease News.

In the early 1990s, almost 10% of patients with HIV/AIDS in the U.S. were older than 50 years of age. The number increased to 12% by the end of 2000, according to the study.

Data collection

Casey and her colleagues collected data from a suburban HIV clinic in Neptune, N.J. Any patient living with HIV or AIDS who was 55 years of age or older, regardless of age at diagnosis, and who had visited the clinic at least twice from 1996 to 2005, was included in the study.

One hundred sixty-three patients fit the criteria for the study. Of these, 66% were male, 52% were black and 7% were Hispanic. Fifty percent of the patients (n=81) were diagnosed after age 50. The most common risk factors were heterosexual sex (49%), intravenous drug use (33%), men who had sex with men (11%) and blood product transfusions (5%).

Eighty-seven percent of the patients reported at least one comorbidity, including hepatitis C (40%), hypertension (40%), diabetes (15%), cancer (12%), coronary artery disease (9%) and end-stage renal disease (9%).

CD4 counts were less than 200/mm³ upon presentation in about one third of the patients (n=61). At eight months, undetectable viral loads of less than 400 copies/mL were seen in 34% of patients diagnosed before age 50 and in 62% of patients diagnosed after age 50. Patients were taking an average of nine daily prescription medications each.

Of the 81 patients diagnosed after 50 years of age, 17% were diagnosed at least 10 years prior to the start of the study and 13 are still living.

“I was surprised at how well these people did on therapy and their compliance with these very difficult regimens was very good,” Casey said.

The most common side effects of HAART were: neuropathy (31%), hyperlipidemia (17%), anemia (12%), lipodystrophy (7%) and lactic acidosis (6%).

Consider HIV first

Physicians should consider HIV in the 50 and older age group and should counsel them on risk, according to researchers. The researchers cited patients wrongly diagnosed with dementia and depression when later testing revealed HIV infection.

Some patients aged 50 or older believe that all blood work is tested for HIV, which compounds risk and further transmission. “We in health care know that there is consent involved in HIV testing, but the average patient does not,” Casey said. Casey added that patients divorced or widowed after many years of marriage may be uninformed about safe sex. Furthermore, when menopause removes fear of pregnancy, women may put themselves at greater risk.

“HIV is not at the top of the list in the thought process when older patients present with a particular disease,” said Ajay N. Mathur, MD, physician at Robert Wood Johnson Medical School and co-author. “We should probably be thinking about HIV up front because it is simple enough to rule out in tests.” – by Kirsten H. Ellis

For more information:

• Mathur AN, Hart D, Spooner, LM. HIV in the elderly: a suburban community clinic’s experience. Poster presented at: The 44th Annual Meeting of the Infectious Disease Society of America; Oct. 12-15, 2006; Toronto.