The Lancet HIVAging with The Lancet Healthy Longevity HIV (Ageing with HIV) album. A comprehensive look at geriatrics behind the high burden of multiple complications in older HIV-infected individuals; the intersection of stigma and health-related quality of life; delayed diagnosis of HIV; and how health systems are adapting to an ageing population of HIV infection and complications.
The efficacy of antiretroviral therapy (ART) and the success of treatment regimens worldwide mean that HIV is no longer a life-threatening infectious disease as long as individuals have access to care. Along with this success, however, came an unintended consequence: The increasing number of older HIV-infected individuals (usually defined as 50 years or older). This population is increasing as younger HIV-infected people live longer and get older, and as more and more older people are living with HIV. As a result, the prevalence and incidence of persons aged 50 years and older are growing faster than the general population. For example, in the United States, the overall prevalence of HIV infection increased by 8% between 2015 and 2019, Incidence decreased by 4%; among people aged 50 and older, prevalence increased by 40% and incidence increased by 15%. UNAIDS estimates that the global number of people living with HIV aged 50 or older will increase from 5.4 million in 2015 to 8.1 million in 2020.
The Lancet-Health on Aging and The Lancet-AIDS recently released a joint album exploring the trends and challenges of aging among people living with HIV. The album discusses four important topics: geriatrics behind the high burden of multiple complications in older HIV-infected individuals; the intersection of stigma and health-related quality of life; delayed diagnosis of HIV; and how health systems can adapt to populations with HIV infection and complications Ageing. We hope this album ties in with The Lancet Summit: HIV and Healthy Longevity on March 17-18, 2022 Together, foster communication among geriatricians, geriatric scientists, infectious disease specialists, and people living with HIV who are experiencing aging.
Older people living with HIV face unique challenges. There is a general consensus among society, including health care professionals, that older adults are less at risk for new HIV infections. Barriers exist for older adults to access protective health information and early HIV testing due to society’s perception that older adults are not sexually active and do not use drugs. As a result, nearly half of older AIDS patients are diagnosed late in the disease course (defined as CD4 counts
Older adults are more likely than younger adults to have multiple complications. However, HIV-infected older adults have more severe complications than uninfected HIV-infected people of similar age. There is a considerable research gap in understanding how HIV affects the aging process.
Monty Montano and colleagues examine biological aging in HIV-infected individuals from a geriatrics perspective to investigate whether key markers of aging may act synergistically with HIV infection to become older in HIV-infected individuals driving factors. In addition to more complications, older people living with HIV also face discrimination-related issues.
Evelyn Hsieh and colleagues discuss how older people living with HIV cope with ageism and HIV discrimination, which can have a huge impact on their health-related quality of life. The authors review the interplay of these discriminations in China, Europe, and Latin America, which have different epidemiological and cultural trends in ageing and HIV incidence, finding insufficient research data and inconsistent use in some regions, Especially in Latin America, this may hinder the delivery of care services and the development of appropriate policies and research.
Finally, healthcare systems around the world are not equipped to meet the growing needs of older people living with HIV. The health care system provides fragmented care to older people living with HIV, a situation compounded by the lack of comprehensive aging and HIV-related services and support systems. Jepchirchir Kiplagat and colleagues suggest how to improve health care through a responsive universal health coverage approach.
Even an ideal world that achieves the UNAIDS 95-95-95 goals would continue to have an increasing number of older people in need of appropriate care. Thus, arguably a new area of research is needed to understand how long-term but antiretroviral therapy-controlled HIV infection interacts with the aging process, and whether this understanding can inform our understanding of the underlying mechanisms of aging . Further research is needed as a result of the success of antiretroviral therapy: we must build on this success to ensure that the aging of people living with HIV is something to celebrate, not mourn.
*The Chinese translation is for reference only, and the original English version shall prevail.