Signs and Symptoms of HIV in Older Adults

So! what happens when one is infected with HIV?  Is it the same for everyone?  Hmmm . . .

Well, signs and symptoms of HIV in older adults can, in fact, be similar to that of younger adults in the early stages of infection.  However, when we add in common complications that occur with aging as well as a variety of chronic illnesses that can come with age, it’s not always so easy to distinguish between HIV and other problems.  Unfortunately, HIV is usually the last thing that is addressed in older adults or, in many cases, missed completely.

Many people have no symptoms when they first become infected with HIV. It can take as little as a few weeks for minor, flu-like symptoms to show up, or more than 10 years for more serious symptoms to appear. Signs of HIV can include headache, cough, diarrhea, swollen glands, lack of energy, loss of appetite, weight loss, fevers and sweats, repeated yeast infections, skin rashes, pelvic and abdominal cramps, sores in the mouth or on certain parts of the body, and short-term memory loss.  In the table below from Smith et al., you can see the frequency that one might see of the most common signs and symptoms.

Many HIV symptoms in older adults can resemble symptoms associated with a number of other illnesses that are commonly seen in the population.  Most commonly, these include fatigue, flu-like symptoms, respiratory problems, weight loss, chronic pain, night sweats, skin rashes, swollen lymph nodes, and neurological problems.

In addition, as the disease progresses, the effects of HIV may have a much greater impact on the aging adult.  According to Stoff et al. as found on the UNC website listed below, “Compelling evidence exists that natural history and symptom manifestations of HIV infection in the elderly substantially differ from those seen in younger cohorts. Relative to their younger counterparts, older adults living with HIV/AIDS have a more severe HIV disease course and a shorter survival rate; have less desirable health indices at diagnosis (e.g., lower CD4+ cell counts); have shorter AIDS-free intervals; have a higher number of opportunistic infections; and have earlier development of tumors and lesions.”

I think the take home message here is: while it may appear on the surface that everyone's response to HIV infection is the same, there may actually be much more we aren't seeing.  Of course, everyone is different and reacts differently but, with older adults, there can be many other things going on that can steer us away from HIV infection.  All in all:  remember to look outside the box! :D

Fitzpatrick, L. K. (2011). Routine HIV testing in older adults. American Medical Association Journal of Ethics, 13(2), 109-12. Retrieved from http://virtualmentor.ama-assn.org/2011/02/cprl1-1102.html

Smith, D. K., Grohskopf, L. A., Black, R. J., Auerbach, J. D., Veronese, F., Struble, K. A., Cheever, L., & Onorato, I. M. (2005, January 21). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to hiv in the united states. Retrieved from http://www.thebody.com/content/art17171.html

The citation below is a great resource for medical matters!  They cover issues related to HIV in older adults in a variety of systems and disease states including the immune system, heart and blood vessels, high cholesterol and triglycerides, body weight, diabetes, the senses, the nervous system and mental health, bones, urinary system, liver, kidneys, skin, and cancer.

Ernst, J., Hufnagle, J., Karpiak, S., & Shippy, A. (2008). HIV and older adults. AIDS Community Research Initiative of America (ACRIA). [booklet]. Retrieved from http://www.acria.org/files/hiv-older-adults.pdf

Very cool website from the University of North Carolina.  The learning module walks you through aging and HIV; worth taking the time to work your way through. http://www.med.unc.edu/aging/elderhiv/welcome.htm