Choosing care is complex

In the late 1980s, Linda Rose Frank began working with HIV-positive individuals at the University of Pittsburgh. At the time, the patients were primarily young men with a frightening prognosis.

“There wasn’t really anything to treat people,” she said. “We saw people dying.”

More than three decades later, Frank is still at the University of Pittsburgh, where he cares for people with HIV. But now, the majority of HIV-positive people are over 50. One of the focuses of Frank’s work is how to best care for people who are aging with human immunodeficiency virus.

Frank is the Executive Director and Principal Investigator of the MidAtlantic AIDS Education and Training Center. In recent years, MAAETC has developed training materials specifically focused on HIV and aging, including a pocket training guide on “Integrating Geriatric Principles into the HIV Clinic.”

“Sometimes it’s hard to tell whether what we’re seeing is something related to HIV or a normal aging condition,” Frank said. “That requires a lot of judgment by experts.”

The Centers for Disease Control estimates that for the most recent year of data, 2022, about 596,000 people over age 50 were living with HIV — about 53% of the total. And while most of those people were diagnosed before age 50, more than 2,600 people over age 55 received a new HIV diagnosis that year.

“I think people assume that older people don’t have sexual relationships, but of course we know that’s not true,” said Frank, who is also a professor in the division of infectious diseases at the University of Pittsburgh and at the nursing and medical schools at Pitt. “Or we assume that only younger people use substances — that’s not true either.”

Frank advocates routine HIV testing by primary care physicians, regardless of age or risk factors. “Just like you need to know your blood pressure and cholesterol, you need to know your HIV status,” she said. “That’s the way to normalize it for everyone.”

Knowing HIV status is so important because medications and treatments are so effective, she said. A study last year in the Lancet HIV found that for many patients who started their HIV drug regimen after 2015, life expectancy is comparable to that of the non-HIV positive population.

According to Frank, ongoing monitoring is one of the keys to the long-term health of HIV-positive individuals, and it may become even more important as the population ages.

“One of our concerns is that people are dropping out of care,” Frank said. “For someone over 50, for example, their husband or wife has died and they’ve become depressed — sometimes they’re leaving care. Our goal is to do more research to find the people who have left care and get them back in.”

Drug interactions also need to be carefully assessed in an aging population, as do concerns about mental health and mobility. These issues will only increase as the population ages. For its most recent demographic report, the CDC added a “75 and older” category to its age tables. And one estimate predicts that by 2030, 70% of people with HIV will be over 50.

“They got the diagnosis and treatment,” Frank said, “and now they’re living into their 50s, 60s, 70s and beyond.”

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