HIV in the elderly.

Greater than 10% of persons with AIDS in the United States are over 50 years of age, and the number of elderly persons in their 60s and 70s living with HIV/AIDS is increasing. Contrary to the perceptions of some within the health-care community and the general population, the elderly are at risk for HIV infection and carry a high mortality if diagnosed. Many older persons with AIDS are less likely to practice safe sex; others go undiagnosed and therefore untreated due to perceptions that the elderly are not at high risk for HIV infection, and treatments may be less efficacious. As age increases, the incidence of mortality does as well; 37% of individuals 80 years and older have been reported to die within a month of diagnosis. The history of a 62-year-old HIV-positive woman is presented as a case representative of many of the issues confounding timely diagnosis and treatment. Initial complaints of an undiagnosed elderly person can vary from nonspecific constitutional symptoms to those resembling an AIDS-defining disease. Both normal age-related changes in immune function and poor nutrition may confound the differential diagnosis or contribute to disease progression. Although the perception exists that the elderly are not at great risk for HIV disease, data from the National AIDS Behavior Surveys indicates that 10% of persons over 50 years of age have, at minimum, one risk factor for infection. Further education needs to be directed at physicians and their elderly patients, research on HIV/AIDS pharmacotherapy in the elderly should be extended, and the impact of the HIV/AIDS elderly population on the health-care system needs greater recognition and study.