AIDS and HIV in Older Adults

What is AIDS?

AIDS is a life-threatening illness. It is caused by infection with the human immunodeficiency virus (HIV). This virus destroys part of the immune system. The immune system is the body's natural defense against infection and disease.

You are HIV-positive if you have the virus but your body is still able to fight off infection. When you begin to lose the ability to fight off serious infection, you have AIDS.

How does it occur?

HIV is spread by contact with infected blood, semen, or vaginal fluids. Having sex with an infected person is the most common source of infection in older adults. Sharing needles with an infected person and receiving HIV-infected blood transfusions or organ transplants are rare causes for older adults. These transfusions generally happened before 1985 when there was not a reliable way to test donated blood for the virus. Blood that is donated today is tested and is very safe.

The virus is also found in smaller amounts in tears, saliva, brain/spinal fluid, breast milk, urine, and feces. Contact with these fluids is not likely to spread the virus.

HIV is NOT spread by casual contact such as shaking hands, touching an infected person, touching something that the person has handled, using toilets, using telephones, or swimming in pools.

How does an HIV infection affect older adults?

People may not always consider older adults to be at risk for AIDS. However, about 10% of those with AIDS are over age 55. About 1 in 25 cases of AIDS in the US are people 65 years old and older.

Older adults with HIV often suffer because they are alone and do not have a network of people to support them. They may also have trouble telling their family members.

What are the symptoms of AIDS?

When your body cannot fight off infections you will have symptoms such as:

• fever, sweats, chills
• fatigue
• loss of appetite, weight loss
• nausea, vomiting
• sore throat
• diarrhea
• cough
• shortness of breath
• body rash
• skin problems.

These symptoms are similar to the symptoms of many other illnesses such as cancer, tuberculosis, influenza, mononucleosis, or stomach flu. You may need a physical exam and other tests to rule out other illnesses.

How do you test for HIV infection?

Blood tests are often used to test for HIV. These blood tests can detect HIV antibodies in your blood. Antibodies are proteins made by your body to help fight off viruses. If the test is positive, you have an HIV infection.

If the test is negative, you probably do not have HIV (unless you have been recently infected). The test result can be negative even though you have HIV if you were infected with the virus within the last 6 months. This is because it can take up to 6 months for your body to make antibodies after you have been exposed to the virus. Your healthcare provider may want you to be tested again in a few months.

Other kinds of tests for HIV include urine tests, or an oral fluid sample collected by a healthcare provider, who swabs the inside of your mouth and sends the sample to be tested at lab.

Testing can be done at the local Department of Health clinic or at your doctor's office. It is very important to get counseling before testing to help decide if you should be tested and what tests are to be done. Counseling after the testing helps to explain the results.

Who is at high risk for HIV infection?

People at high risk for HIV include:

• men who have sex with men
• sexual partners of people who are infected
• people who got blood transfusions before 1985
• babies born to mothers who are infected
• people who use IV drugs and share needles
• sexual partners of IV drug users who share needles
• people who have hemophilia (a bleeding disorder)
• prostitutes and their sex partners
• people who have oral, anal, or vaginal sex without a condom and have multiple partners.

Even if they no longer need to use birth control, older adults with more than one sexual partner need to use condoms to help prevent HIV infection.

How is it treated?

Your treatment will depend on if it is known when you became infected with HIV and whether you have symptoms. Your treatment will include:

• lab tests to see how well your immune system is working, to measure the amount of HIV in your blood, and to screen for infections or other medical problems
• antiviral medicines, such as zidovudine (also called ZDV or AZT), didanosine (ddI), lamivudine (3TC), and other protease inhibitors
• regular dental exams, because people who are HIV positive often have mouth problems, including gum disease
• preventive treatment for such diseases as:
  • Pneumocystis carinii pneumonia (PCP)
  • tuberculosis
  • toxoplasmosis (be sure to avoid raw meat and cat litter boxes)
  • tetanus
  • hepatitis B
  • pneumococcal infections
  • influenza (by getting flu shots)
• treatments for other infections and tumors as they develop.

Your healthcare provider will probably recommend starting treatment with anti-virus drugs and anti-pneumonia drugs if you are having symptoms of HIV infection.

While there is no cure for AIDS, newer medicines have been developed to slow the progress of the disease. These medicines can help you live longer and have a better quality of life. Ask your healthcare provider about these medicines.

How can I avoid exposure to HIV?

You are safest if you are in a stable relationship with one partner and both of you are uninfected.

• Use latex condoms with a water-based lubricant and spermicide containing nonoxynol-9 if you engage in male homosexual practices or if you or your partner have more than one sexual partner.
• Do not use IV drugs or share needles with anyone.

At this time, there is no cure or vaccine that will prevent HIV infection. Anyone engaging in at-risk behaviors should have a complete physical exam and blood tests.

All information for HIV testing is confidential. Except for mandatory reporting to health authorities, healthcare providers may not give test results to anyone other than the patient.

The best way to protect yourself is to learn as much as you can about HIV infection, avoid risky behavior, and follow guidelines for protection.

For more information, see Resource List: AIDS.