HIV in seniors
Seniors can be at risk especially those who have come out of a relationship and get involved in a casual relationship.
Seniors can be at risk. Though the prevalence here in Singapore has remained stable, seniors can get HIV especially if they have come out of a relationship and get involved in a casual relationship. Or, women who are no longer concerned about pregnancy and less likely to use a condom during sex, may get HIV.
Ageless Online talks to Dr Julian Hong, a doctor at DTAP Clinic Group and the alternate director of Resilience Collective. He has four years of experience working with HIV/Aids patients:
Can you share the prevalence of HIV in those over 50 in Singapore?
According to the Ministry of Health’s official reports, from 1986 to 2018, for those aged 50 and above, the total number of Singapore citizens and Permanent Residents who are living with HIV are 1,803. This excludes those who may have passed away.
Is the number increasing each year? If so, why is that?
The numbers surrounding new HIV transmissions have remained stable across the years averaging at 450 per year since 2008. This includes both heterosexual and homosexual relationships.
In comparison with let’s say US, the number of older adults living with HIV are increasing over there. This is mainly due to better treatment with HIV medicines and ready access to HIV testing where thousands of older people are newly diagnosed every year in the US.
Are the risk factors for HIV the same for older adults? How is it commonly spread? Age-related factors?
The two main modes of transmission are usually through occupational exposure (needle stick injuries or exposure to blood from HIV carriers) and sexual transmission.
From a medical perspective, most risk factors for HIV are the same for adults of any age. But like all other people, older adults may also not be aware of their risks of HIV transmission.
Other websites out there have also described how some age-related factors can put older adults at risk for HIV infection. For example, age-related thinning and dryness of the vagina may increase the risk of HIV infection in older women as there may be bleeding after intercourse. In addition, women who are no longer concerned about pregnancy may be less likely to use a condom during sex.
Also, older people who have come out of a relationship may get involved in a casual relationship. These casual relationships may have their fair share of sexual health risks, especially if it is a new partner or commercial sex worker.
Should older adults get tested for HIV?
Yes definitely! Without treatment, 100 percent of HIV progresses to AIDS within 10 years (or earlier if they have had the condition for a while). And AIDS is almost always fatal.
Ultimately, finding a trusted medical professional to walk through your concerns with you from start to end is important because early detection will lead to starting treatment early, which ultimately helps one to live a normal life, away from the complications of the HIV disease.
I understand that in older adults, signs of HIV infection may be mistaken for symptoms of ageing or of age-related conditions and hence doctors may not offer HIV testing for older adults. Is this true?
Signs and symptoms of HIV infection can be dormant and insidious. Symptoms include:
- Weight loss.
- Prolonged fever.
- Skin rash.
- Night sweats.
- Persistent diarrhoea.
- Lowered resistance to infections.
There are also many other medical conditions which can also cause the above symptoms. Most people worry often about is cancer, which can occur as people age.
Again, it is important to look for a medical professional who will care for you in a holistic aspect and assess you thoroughly. If you are concerned about HIV, this can be easily checked with a 20-minute rapid test where one can know the results on the spot. I cannot say about other clinics, but my practice group will offer HIV testing even for older adults as such.
Is HIV treatment the same for older adults? I also understand that with liver and kidney functions decline with age, it may make it harder for the body to process HIV medicines and increase the risk of side effects, is this true? Older adults with HIV may have other conditions like diabetes and heart disease, which can also make it difficult to manage HIV infection, and HIV may affect the ageing process and increase the risk of age-related conditions such as dementia, bone loss and some cancers. I also read that taking HIV medicines and medicines for other conditions at the same time may increase the risk of drug-drug interactions and side effects. And also, that the immune system may not recover as well or as quickly in older adults taking HIV medicines as it does in younger people?
There are many antiretroviral medications out there to treat HIV. Most of the time one’s doctor will assess you holistically taking into consideration your overall health, other concomitant health concerns before deciding which medications to start you on. After which, there would be close monitoring of the kidney and liver function, side effects to the medication and response to the treatment.
The ageing process does affect one’s kidney and liver. Ageing also brings about metabolic diseases such as diabetes and heart disease. All these have an overall effect on one’s health and makes the monitoring more difficult, requiring more frequent blood tests and reviews. Age-related conditions such as cancer, bone loss and dementia are also conditions your doctor will keep a close eye on as you undergo antiretroviral treatment.
Most importantly you should speak to a doctor you can trust and someone who will walk with you on this journey and support you as an individual holistically. With the right treatment and right monitoring, one can achieve an undetectable viral count in the body and also have healthy levels of CD4 cells (immune system cells), thereby giving you an immunity and defence against other germs.
Can you share a patient story with HIV who is over 50 and their outcomes?
I will share briefly (because of patient confidentiality) of one person living with HIV (PLHIV). Marcus is in his 50s married and whose wife remains negative. His children have since grown up and his viral count is undetectable, living a normal, happy and productive life. The secret behind his happiness comes from his family support. After a period of conflict emotionally, they were able to overcome the stigma of PLHIV, understand the myths behind the condition and accept their father. A lot of conversations with the family was needed and as a family, they were able to overcome this hurdle together.
Any further advice?
Speak to a doctor you can trust, early testing allows for early treatment. Early testing also allays any concerns you may have over HIV. Most importantly, your doctor should support you holistically and work with you to tailor the treatment plan that suits you best.