When HIV/AIDS first made news in the early 1980s, mortality rates were high.

Then the first antiretroviral drugs were developed in the late 1980s and early 1990s. While they increased life expectancy in people with HIV by suppressing the virus, they were also very toxic. “The trade-off was that people survived, but with a lot of toxicities,” says Dr. Cécile Tremblay, Principal Scientist and Full Professor, Department of Microbiology, Infectious Disease and Immunology at Université de Montréal.

To avoid these toxicities, some early treatment paradigms delayed antiretroviral therapy in HIV positive patients (with no AIDS defining symptoms) until their T-cell counts dropped below a certain level. However, as these people aged, researchers noticed an earlier onset of age-related comorbidities, such as cardiovascular disease, diabetes, and osteoporosis — believed to be caused by the underlying inflammation from ongoing viral replication and weakened immune system.

Safer and less toxic therapies

Today’s treatments aim to limit these toxicities. “The idea is to hit as soon as you possibly can with the safest, simplest-to-take drugs,” says Linda Robinson, HIV Clinical Pharmacist Specialist at Windsor Regional Hospital

As Dr. Tremblay explains: “The new classes of drugs we’ve developed in the last 10 years are quite safe, tolerable, and don’t have these long-term toxicities. The mode of intake is typically one pill — combining three antiretroviral drugs — once a day. And, from what we know right now, they are even more effective at controlling the virus.”

That’s good news for Canadians living with HIV who are over age 50, which makes up an estimated 50 percent. “This is the first generation to grow into older adulthood living with HIV, and the general public may not be aware of how things have changed since early in the epidemic,” says Kate Murzin, Health Programs Specialist at Realize, a national charitable organization that applies a rehabilitation lens to the challenges facing adults aging with HIV.

With the right treatment regimen and proper adherence, people living with HIV can keep the virus at undetectable levels, avoid ever developing AIDS in their lifetime, and look forward to a life expectancy close to that of the general population.

Social and peer support

In addition to therapies to prevent disease and disability from HIV, there are resources to address the social needs. Peer support groups, community-based exercise and wellness programs, and social activities — all with the unique needs of aging adults with HIV in mind — are popping up in frontline HIV organizations. In addition, these frontline organizations offer access to information and research.

By taking advantage of these resources and information, people living with HIV can empower themselves to have better informed conversations with their clinicians on developing a treatment plan that will help minimize the risk of age-related comorbidities — enabling them to live long, healthy lives.