By Frank Spinelli, M D

Originally published on Advocate.com November 23 2009 11:00 AM ET

This year I attended the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy. More than 10,000 physicians, researchers and other health care professionals from around the globe gather each year at ICAAC to exchange the latest information and present research on topics related to HIV and other infectious diseases.

There was some interesting data presented on HIV and aging. Currently 15%-20% of HIV-positive individuals in the United States are over the age of 50. It's estimated that by 2015 this number will reach 50%.

What does this sharp rise in older HIV-positive individuals mean?

As the HIV population ages, we will begin to see more issues with brain disorders — specifically Alzheimer’s disease and dementia — bone diseases like osteoporosis, and diabetes, kidney disease, and non-AIDS-related cancers.

A greater demand will be placed on services for older people with HIV, and this will likely burden the health care system, which is currently not equipped to handle these patients. Also, toxicities associated with long-term antiretroviral therapy will impose greater risks for comorbid conditions and premature death. Some HIV treatment advocates consider aging and HIV the number 1 issue and believe this topic deserves greater attention. Other health care providers, like myself, argued that the good news is that people with HIV are living longer.

There was a considerable amount of discussion regarding the expansion of HIV testing. In 2006 the Centers for Disease Control and Prevention recommended routine optional HIV testing for all adults who sought medical care, including those who visited emergency rooms. The majority of people who opted out of testing stated they did not believe they had any risk factors for acquiring HIV.

Researchers at George Washington University in Washington, D.C., tested discarded blood samples of emergency room patients who opted out of testing to calculate their HIV rate. Washington has the highest HIV prevalence in the United States — at least 3% among people over 12 years old — and the HIV-positive population is predominantly African-American.
Their results concluded that those individuals who declined HIV testing had an HIV rate more than two times higher than those who agreed to the testing.

The researchers believe that "it is critical for public health issues to determine whether the opt-out population is truly HIV-negative or whether their personal risk is being underestimated."