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HIV Treatment: The Challenges for Older Adults


Improved medications have helped many people with HIV live longer, but treating older adults with HIV presents some unique challenges.

The challenges related to diagnosing HIV in older adults have been well documented. In many instances, both doctors and patients are uncomfortable discussing risk factors, such as unprotected sex and injection drug use, and the symptoms of HIV can mimic symptoms of other conditions common in older adults.

Once a diagnosis is made, however, there are additional challenges for older adults with HIV and the doctors who treat them. The most effective combination of drugs can interact with medications these adults frequently take for a host of other conditions, such as high blood pressure .

Drug Interactions

The protease inhibitors that are a critical part of treating HIV inhibit an enzyme in the liver that metabolizes medications, raising the risk of drug interactions, says Karl Goodkin, MD, PhD.

"Usually, you just avoid prescribing the drugs that interact," says Dr. Goodkin. "You don't have that option here. You have to prescribe the drugs. Substance abuse and diet can also interact with these antiretroviral medications. We are in a quandary right now. As a result, we're entering a whole new area of research to define what's appropriate to do."

HIV drugs may also increase the risk of certain conditions, such as high cholesterol , high triglyceride levels , kidney stones , inflammation of pancreas, and liver damage. Plus, the volume and range of medications that elders take also increase the risk of drug interaction.

Remembering to Take Medications

There is also the issue of getting patients to remember to take all of their medications.

One of the most common reasons HIV patients do not take their medications is because they forget. Forgetting to take medications can be very serious for someone with HIV. Taking medications on a regular basis helps decrease the amount of the virus in the body, called viral load.

The decrease in viral load improves overall health and quality of life. Evidence from one study found that people who took their medications 95% or more of the time spent less time in the hospital, and had fewer infections, and deaths.

Some Good News

There is good news, however, on two fronts. Patients who take their medication "have a very good chance of getting a good response," says Dr. Fantry. And older adults may experience the same benefits from treatment as do younger patients. "Seniors generally have a better acceptance about taking their HIV medication than do younger people," Dr. Fantry explains, "because they are already used to a daily routine of taking pills."

"The elderly people in our clinic clearly have a responsible attitude toward their disease," she says. "They may need more support to do it, but once you put the supports in place with the social worker, pill boxes and reminders, they seem to do well."

There have also been significant advances in reducing the number of pills that need to be taken to control the illness. "We've come a long way from 20 pills a day," says Dr. Fantry. "We have a regimen where we can get good control with just one pill in the morning and one in the evening. You cannot do that with everyone. One regimen is seven pills a day, but it is much better than we had just a few years back. The news is clearly not all negative. Every year, it gets a little easier to take medication."

RESOURCES:

National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov

US Department of Health and Human Services
http://www.aids.gov

CANADIAN RESOURCES:

Canadian AIDS Society
http://www.cdnaids.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Antiretroviral therapy for HIV infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 29, 2013. Accessed June 21, 2013.

Gebo KA, Justice A. HIV Infection in the Elderly. Curr Infect Dis Rep . 2009;11(3):246-54.

Gebo KA, Moore RD. Treatment of HIV infection in the older patient. Expert Rev Anti Infect Ther . 2004;2(5):733-43.

Mills EJ, Nachega JB, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med . 2006;3(11):e438.

Paterson DL, Swindells S, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med . 2000;133(1):21-30.

Ship JA, Wolff A, et al. Epidemiology of acquired immune deficiency syndrome in persons aged 50 years or older. Journal of Acquired Immune Deficiency Syndromes . 1991;4;84-88.

Silverberg MJ, Leyden W, et al. Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med . 2007;167:684-691.

Walker AS, Doerholt K, et al. Collaborative HIV Paediatric Study (CHIPS) Steering Committee. Response to highly active antiretroviral therapy varies with age: the UK and Ireland Collaborative HIV Paediatric Study. AIDS . 2004;18:1915-1924.

Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR . 2010;59(No. RR-12):1-110.



Last reviewed June 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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