Infectious Disease

HIV sexual activity must be part of talking to older patients, experts say

September 23, 2021

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Disclosure:
Volberding reports as chair of a data and security oversight committee for Merck and as a consultant to Gilead Sciences.

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A case report of an 83-year-old man in Spain newly diagnosed with HIV underscores the importance of screening older adults, experts said.

Enrique Garcia Carus, MD, Doctor at the Central University Hospital of Asturias in Spain, presented the case report during the virtual European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). The patient experienced unexplained weight loss and a fever for about a month before tests showed he was HIV positive. He had a CD4 count of 182 and a high viral load of 180,564 copies / ml.

How the patient contracted HIV remains a mystery, according to a press release distributed by ECCMID. He was put on triple antiretroviral therapy and today, 2 years after his diagnosis, “he is fine,” the statement said.

“This case serves as a reminder that the elderly are not immune to HIV infection,” Garcia Carus said in the press release. “Health care providers need to be aware that age does not automatically equate to low risk, and they should be encouraged to screen patients of all ages for HIV.”

The CDC estimates that 51% of people in the US and dependent areas who were diagnosed with HIV in 2018 were 50 years of age and older. Despite their risk of infection, the authors of a previous HIV risk review wrote that older adults are less likely than younger adults to talk to their doctors about risky sexual behavior and get tested for HIV.

“It is therefore important to educate clinicians about sexual risk behavior in the older age groups,” the authors write.

To this end, Healio interviewed Primary Care Paul A. Volberding, MD, Editor-in-Chief of Infectious Disease News and Professor Emeritus of Medicine at the University of California, San Francisco. Volberding was at the forefront of the so-called AIDS epidemic two weeks after the disease was first discussed in a 1981 edition of the MMWR. He discussed key lessons from the case report in Spain and what clinicians need to know about HIV in elderly patients.

Healio Primary Care: What Should Doctors Take Away From This Case Report?

Volberding: This is an interesting case that should remind everyone that HIV infection is still there, people are still appropriating it, and that sometimes we don’t have a clear sense of how they acquired it.

This case reminds me of a case we had here in San Francisco in the early days of the epidemic with an elderly nun. It is possible that healthcare professionals were embarrassed to ask about and discuss the risks for HIV. It turned out that she had a blood transfusion earlier in her life and when she was diagnosed with HIV she was in a very advanced stage of the disease.

Healio basic care: What misconceptions are there among health professionals about older patients and their risk of HIV?

Volberding: One of the most important things healthcare professionals need to realize is that as people get older, they can and in many cases continue to have sex, and that they do not necessarily become sexually inactive.

Another important aspect is that patients suffer from chronic diseases more and more often as they get older. You are often prescribed many different medications that can have side effects that are worse in the elderly than in younger people. This includes HIV drugs.

Both are intended to remind us that we really need to get to know our patients, especially the elderly.

Healio Primary Care: Why Are Some Healthcare Professionals Reluctant to Offer HIV Testing to Older People?

Volberding: Their hesitation is likely due to the stigma many people still associate with sexual activity and a fear of offending someone by asking him or her a question about sexual activity, especially an elderly person.

Healio Primary Care: What Are Some of the Signs of Late-Stage Infection?

Volberding: We would see weight loss, debilitation, and opportunistic infections frequently in people with very low CD4 counts.

References

CDC.gov. HIV and Older Americans. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed August 4, 2021.

CDC.gov. HIV screening. https://www.cdc.gov/hiv/clinicians/screening/index.html. Accessed August 4, 2021.

European Congress for Clinical Microbiology and Infectious Diseases. Newly diagnosed HIV infection in an 83-year-old man – research shows older populations are still at risk. https://www.eurekalert.org/news-releases/793141. Accessed August 3, 2021.

HIV.gov. HIV and AIDS timeline. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline. Accessed August 3, 2021.

Pilowsky DJ, Wu LT. Subst abuse rehabilitation. 2015; doi: 10.2147 / SAR.S7880.

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