Peter Selwyn, one of today’s guests, has been caring for people living with HIV for over 40 years. In that time, care of people with HIV has changed dramatically. Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions. The average age at death was in the 30s.

Now, more people in the US die with HIV rather than from HIV. Treatment regimens are simplified, and the anti-viral drugs are well tolerated. People are living with HIV into advanced ages. The average age at death is likely in the 60s. Nearly half of people living with HIV are over age 55. One in 10 people with newly diagnosed HIV is an older adult. Our second guest, Meredith Greene, is a geriatrician and researcher who focuses on care of older adults living with HIV, in the US and Africa.

On today’s podcast we discuss:

Implications of aging with HIV for clinical care
Loneliness and social isolation among older adults living with HIV
Persistence of stigma
Need to consider HIV in the differential diagnosis for older adults
Screening for HIV
Screening for osteoporosis in people living with HIV
Dementia and cognitive impairment risk in people living with HIV
When to stop anti-virals near the end of life

Toward the end we speak to the moment. More older adults live with HIV in SubSaharan Africa and the global South than anywhere else in the world. Funding for research and clinical care is at risk, as USAID and PEPFAR (which is under USAID), are shuttered. Millions of lives are at stake. Meredith wore a shirt that said Silence=death.

Eric gave me the hook during my live cover of One, by U2, a song released in 1992 whose proceeds went entirely to AIDS research. I couldn’t help it, forgive me dear listeners, I had to do a longer than usual cut at the start!

-Alex Smith

Useful links:

Peter's article on the evolution of HIV: https://link.springer.com/article/10.1007/s11524-011-9552-y

Peter’s book Surviving the Fall: Personal Journey of an AIDS Doctor

PEPFAR: Global Health Policy | KFF

Articles:

Geriatric Syndromes in Older HIV-Infected Adults - PMC

Loneliness in Older Adults Living with HIV

Management of Human Immunodeficiency Virus Infection in Advanced Age
https://pmc.ncbi.nlm.nih.gov/articles/PMC3684249/

About Act-up for those who might know the Silence=Death t-shirt reference:
https://www.npr.org/2021/06/16/1007361916/act-up-a-history-of-aids-hiv-activism

https://www.newyorker.com/magazine/2021/06/14/how-act-up-changed-america

HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene

GeriPal - A Geriatrics and Palliative Medicine Podcast