Ageing with HIV: faster, lonelier, poorer?

Growing old is associated with social, financial and health problems. But if a lifelong HIV infection is added to this, ageing can often become a challenge.

The challenges of HIV in old age

It was not until the first antiretroviral drugs became available in the mid-1990s that there was a faint hope that life could at least be extended a little. By then, however, a good 10% of MSM in the USA alone had died of HIV and the immunodeficiency disease AIDS. Social connections were severed, careers ended - developments in the lives of survivors that continue to have an impact to this day and also have a lasting effect on the ageing of people with HIV.

• People who contracted HIV between the ages of 20 and 40 in the 1990s are now partly in retirement age thanks to available antiretroviral therapies (ART). And we now also see 80-year-old people with HIV.
• Despite ART, HIV infection causes a lifelong weakened immune system and systemic inflammation, which accelerates the ageing process. Age-associated diseases therefore occur years earlier in people with HIV.
• People with HIV have a higher risk of cuts in their social and financial environment. Many had to give up their jobs for a while due to their illness, or were unable to take out private supplementary health insurance for many years. Even worse, many lost important social anchors in friends, loved ones and family, especially in the early days of HIV. These strong ties can rarely be re-established later in life, so that there is a high risk of loneliness in old age.

Interview with social gerontologist Dr. Dana Rosenfeld

HIV is a chronic infection

Thanks to modern ART, it has been possible to transform HIV infection from a fatal disease into a chronic infection. In most cases today, therapy succeeds in repressing the virus below the detection limit so that no further transmission can take place.

This enables these people to age with their HIV infection and achieve a statistical lifespan comparable to people without HIV. Nevertheless, despite lifelong therapy, people with HIV have a weakened immune system and suffer from a systemic inflammatory reaction against the virus, which can accelerate the ageing process. Age-associated diseases therefore tend to occur somewhat earlier in people with HIV, increasing the comorbidity burden in old age.

We have a general care problem in old age

Closely related to care in old age is the question of whether we really need a difference in care in old age between HIV+ and HIV- populations. With age, psychological burdens due to comorbidities, social isolation and loneliness increase. Although people with HIV are at greater risk of this, these stresses can of course also occur in old age in people without HIV.

Therefore, the goal should be to make elderly care structures sustainable for all. Is a serostatus distinction still necessary? This is an important question because people with HIV would in this way be met with the same appreciation and empathy as every person in elderly care.

However, this idea already shows that today not even the requirements for dignified ageing are met for people without HIV infection. What will be needed above all is an inclusive, empathic and appreciative approach to people requiring support in old age, regardless of their serostatus, gender or sexual identity. It is a long way to go, but it was also a long way to go in the field of HIV therapy - and it is only because of the successes that people are now talking about ageing with HIV.

A short biography of Dr. Dana Rosenfeld

Dana Rosenfeld is a social gerenterologist currently working as a Visiting Scientist in the College of Liberal Arts and Sciences at the University of Westminster. Her main area of interest is ageing with HIV and the associated challenges for those affected.

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