1. Healthy Aging for People Living with HIV: Achieving the 4th 90 AIDS 2018 25 July 2018
Tiffany G. Harris, PhD, MS
Director of Strategic Information
Associate Professor of Epidemiology at CUMC

2. Introduction
Availability of potent antiretroviral therapy (ART) has transformed the HIV epidemic
In higher-income countries, life expectancy for people living with HIV (PLWH) has increased substantially with similar gains seen in some parts of sub-Saharan Africa
Need to understand
Effect of aging on PLWH
Effect of HIV infection on the aging process
Optimal approaches to HIV prevention among older individuals
Aim for healthy aging among PLWH: “the 4th 90”

3. Older Adults with HIV
Number of older PLWH (age 50 years) predicted to increase by 47% to 6.9 million by 2020
Sub-Saharan Africa will bear a large burden
15% of PLWH are currently aged ≥50
Predict that by 2040 will increase to 27% or 9.1 million PLWH
UNAIDS. Get on the Fast-Track, The life-cycle approach to HIV 2016
Hontelez et al. AIDS 2012

4. HIV Prevalence among Older Adults
Until recently most population-based HIV prevalence surveys in sub-Saharan Africa have not included older adults
Population HIV Impact Assessments (PHIAs) results from the surveys conducted in Malawi, Zambia, and Zimbabwe have found a high HIV prevalence among older adults
HIV prevalence among persons 0-64 years by sex and age, Zimbabwe
Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) : First Report
Age 50-64

5. HIV Incidence among Older Adults
Little published data from the last five years on HIV incidence among older adults in sub-Saharan Africa
Nationally representative survey from Rwanda conducted in (Nsanzimana et al. Lancet HIV 2017)

6. HIV Testing and Prevention among Older Adults
Older adults continue to be at risk for HIV acquisition but often lack awareness about risk, leading to unrecognized infection
Behavioral interventions to reduce risk among older adults are lacking and there are challenges to providing HIV education for older adults (Milaszewski et al., J Evid Based Soc Work 2012)
Ageism among health professionals
Reluctance to discuss sexuality
Misconceptions about HIV risk

7. HIV Prevention and Care Continuum: Challenges for Older Individuals in LMIC
SOCIAL/BEHAVIORAL
STRUCTURAL
BIOLOGICAL/PHYSIOLOGICAL
Perception of low risk
Providers unaware of HIV risk among older individuals
Suboptimal immunological response to antiretroviral drugs
Low rates of HIV testing
Limited availability of tailored HIV prevention and treatment services
Some antiretroviral drugs may increase risk of some non-communicable conditions
Low rates of condom use
Lack of access to services for non-HIV conditions
Increased risk of co-morbid conditions (e.g. hypertension, cancer)
Adherence challenges
Limited mobility hinders access to services
Increased risk of polypharmacy with risk of non-adherence, adverse events and drug-drug interactions
Continued engagement in risky behaviors
Increased risk of poverty
Lack of social support
LMIC=low and middle-income countries
Harris et al., AIDS 2018;32:

8. Summary
With ART scale-up, there has been an increase in older adults living HIV
Small, growing body of work focused on HIV and aging
Limited amount from LMIC, which have the highest burden of HIV
Need more focus on healthy aging among PLWH especially in LMIC