WASHINGTON, DC—VA not only has the largest HIV care program in the country, but the largest HIV geriatric care program in the country. VA cares for over 24,000 HIV-positive patients, 120 of whom are older than 80. This gives VA physicians and researchers a front-row seat to the newest discoveries on how the physical effects of aging impact HIV symptoms and how they present.

The Intersection of HIV, Aging

“The mean age for HIV patients in VA is 52-to-53 years old. The result is that the vast majority of HIV clinics in VA provide primary care as well as HIV care, explained David Ross, MD, PhD, director of VA’s Office of Clinical Public Health Programs. “As they get older, we think not just about HIV drugs, but about cholesterol and drugs and so on. We put out a handbook for VA providers last year dealing with primary care of veterans with HIV. It dealt not with HIV, but with diseases related to aging—heart disease, osteoarthritis, cancer screening, and others. A lot of diseases associated with aging present differently in patients with HIV. They may come on differently, and some may be exacerbated by some HIV treatments.”

This includes smoking-related diseases, which occur at an accelerated pace and at higher frequency in HIV-patients. As a result, VA places a strong emphasis on smoking cessation in its HIV clinics. Ross, who runs an HIV clinic at the Washington, DC VA Medical Center, explained that there is a dedicated smoking cessation clinic attached to his HIV program.

Another disease that presents more quickly is heart disease. “We’re much more aggressive in managing things like cholesterol,” Ross said.

VA researchers presented findings from the Veterans Aging Cohort Study at a White House conference on HIV and aging last month. The research noted that older HIV-positive patients will also be in danger of reduced T cell numbers over time, which can lead to low-level immune activation and inflammation. This chronic inflammation could increase the patient’s chances to develop liver disease, lung disease, bone marrow suppression, renal disease, and cancer.

The researchers recommended universal HIV screening and early treatment and further research into the joint effects of HIV, aging, and substance use. They also advocated training for those who work with the aging on special issues surrounding HIV, and training for those working with HIV on the special issues surrounding aging.

Removing Barriers to Universal Screening

Getting VA patients screened for HIV and into treatment early has become easier in recent months, Ross noted.

Up until 2009, VA physicians had to get written permission from patients to perform an HIV test. “This has been [required] since the late ’80s,” Ross noted. “It made sense then, because there wasn’t anything we could do for patients with HIV. And there were a lot of concerns about discrimination.”

The landscape of HIV has changed significantly with the development of effective treatments and a social climate that, while far from perfect, is much less discriminatory than the 1980s. Consequently, the law requiring written consent was repealed in 2009—something that VA has taken advantage of. “We’ve run large-scale promotional campaigns to promote HIV testing—we had HIV testing week at the end of June.”

VA has also distributed clinical reminder programs to its medical centers, so that physicians will have electronic reminders pop up when viewing a patient’s electronic medical record. “We’ve seen terrific results,” Ross declared. “We have preliminary reports that there are many VA facilities where the testing rates have gone up from 400% to 1200%.

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