HIV Treatment: The Challenges for Older Adults
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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 human immunodeficiency virus (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, ranging from high blood pressure to osteoporosis.

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, who works with elderly HIV patients at the University of Miami.

HIV drugs also increase the risk of heart disease, high cholesterol, hypoglycemia, bone loss, and fracture, all of which are already concerns for older adults. Plus, the sheer volume and range of medications elders often take increases the risk of drug interaction "tremendously," according to Dr. Goodkin.

"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're in a quandary right now. As a result, we're entering a whole new area of research to define what's appropriate to do."

Remembering to Take Medication

There's also the issue of getting patients to remember to take all their medicine.

"The most common reason HIV patients don't take their meds is 'I forgot,'" says Lori Fantry, MD, PhD, medical director of Baltimore's Evelyn Jordan Center at the Infectious Disease Clinic for the University of Maryland and the Institute of Human Virology. "Think of that with a 20- to 30- year-old and think about it with a 70-year-old. They probably forget to do more things than a younger person."

But forgetting to take medications can be life-threatening for someone with HIV.

"Antiretroviral therapies are extremely sensitive to lack of adherence," Dr. Goodkin explains. "You need 95% compliance. There are typically three drugs two to three times a day and different drugs at different times a day. With every 5% degradation in adherence, there's an increase in the amount of HIV in the blood."

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 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're 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 can't do that with everyone. One regimen is seven pills a day, but it's 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 medicine."

RESOURCES:

HIV/AIDS Treatment Information Service
http://www.hivatis.org

National Institute of Allergy and Infectious Diseases
http://www3.niaid.nih.gov/

CANADIAN RESOURCES:

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

Canadian HIV/AIDS Information Centre
http://www.aidssida.cpha.ca/

References:

Ship JA, Wolff A, Selik RM. Epidemiology of AIDS in Older Persons. Journal of Acquired Immune Deficiency Syndromes. 1991;4;84-88.

Silverberg MJ, Leyden W, Horberg MA, DeLorenze GN, Klein D, Quesenberry CP Jr. Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med. 2007;167:684-691.

Walker AS, Doerholt K, Sharland M, Gibb DM. 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.



Last reviewed October 2007 by Rosalyn Carson-DeWitt, 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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