Human Immunodeficiency Virus (HIV)
HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. Initially, an HIV infection may cause no symptoms or cause non-specific, flu-like symptoms that resolve after a short time period. If the infection is not detected and treated, eventually symptoms of AIDS emerge and begin to progressively worsen. Over time, HIV destroys the immune system and leaves a person's body vulnerable to debilitating infections.
Older adults often consider themselves at low risk for HIV infection. However, adults over age 50 accounted for 22% of estimated new AIDS diagnoses in 2008, according to the most recent statistics from the U.S. Centers for Disease Control and Prevention (CDC). That is in part because older adults often lack up-to-date information about HIV prevention and transmission and may engage in unprotected or high-risk sex. Doctors also may underestimate the risk of HIV among older patients or may attribute common HIV symptoms to the normal aging process, so older adults are less likely to get screening than young people. By 2015, 50% of people living with HIV in the United States will be age 50 or older, according to some estimates. As many as 20% of those with HIV infection are not aware of it and can pass the virus on to others.
HIV is spread in the following ways:
- By having unprotected sex with an infected partner
- By sharing needles or syringes (such as with intravenous injection drug abuse)
- If a pregnant woman is infected with HIV, the virus can be passed to and infect her developing baby.
- In the U.S. today, because of screening blood for transfusion and heat-treating techniques and other treatments of blood derivatives, the risk of getting HIV from transfusions is extremely small. However, before donated blood was screened beginning in 1985 in the U.S. and before treatments were introduced to destroy HIV in some blood products, such as factor 8 and albumin, HIV was transmitted through transfusion of contaminated blood or blood components.
Why Get Screening?
Screening for HIV is an important part of wellness and prevention for older adults because diagnosis early in the course of infection leads to timely, effective treatment that slows progression to AIDS. Early diagnosis also has important benefits for others and society at large. If you learn you are positive for HIV, you can modify your behavior so you don't expose others to your infected blood or body fluids, thus preventing further spread of the disease. If an HIV screening test shows you're not infected, you can take steps to avoid infection. Medicare covers screening once every 12 months for all beneficiaries who ask for the test.
Know Your Risk
People over age 50 often have many of the same risks as younger people. Several situations can put you at high risk of contracting HIV:
- You've had unprotected sex with more than one partner; having a sexually transmitted disease (STD) appears to make people more susceptible to and at higher risk for acquiring HIV infection during sex with infected partners.
- You're a man who has had sexual contact with another man.
- You have exchanged sex for money or drugs or had anonymous sex.
- You use or used injection drugs and are likely to have shared unsterilized needles.
- You have a HIV-positive sexual partner.
- You have had sex with anyone who falls into one of the categories listed above or are uncertain about your sexual partner's risk behaviors.
How often you are tested should depend on your activities and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you've had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.
Different types of antibody tests may be used for HIV screening. Combination tests that detect HIV antibody and the p24 antigen may be performed to increase the likelihood that HIV infection is detected sooner after exposure occurs.
Various options are available for getting tested:
- A blood or oral sample can be collected in a doctor's office or a local clinic and sent to a laboratory for testing. In these same settings, there may be a rapid test available in which results are generated in about 20 minutes.
- A home collection kit approved by the U.S. Food and Drug Administration (FDA) is available for HIV antibody testing. This allows a person to take a sample at home and then mail it to a testing center. Results are available over the phone, along with appropriate counseling.
- In July 2012, the FDA approved for marketing the first HIV test for home use. The testing kit is the same as that used in many doctors' offices and clinics in which an oral sample is collected for testing and results are available in about 20 minutes. Though the home test is convenient, it has limitations. It is less sensitive than a blood test so the home test may miss some cases of HIV that a blood test would detect and it is not as accurate when it is performed at home by a lay person compared to when it is performed by a trained health care professional. Care must be taken to avoid errors when performing the test. (For more, see the article on Home Testing, Avoiding Errors.)
Screening tests have limitations. It is important to remember that:
- Although a healthy person who has no HIV antibodies will get a negative result, a negative screening test means only that there is no evidence of disease at the time of the test. If you have increased risk of HIV infection but negative screening results, it is very important to get screening tests on a regular basis.
- Antibodies can be detected about 2 to 8 weeks after exposure to the virus. If exposure to the virus is more recent, then antibody levels may be too low to detect and repeat testing at a later time with another antibody test or combination HIV antibody/antigen test may be necessary.
- A positive screening test is not a diagnosis. A positive result must be followed by a second antibody test that is different from the first test, sometimes the Western blot test or an antibody test that detects different antigens and differentiates between HIV-1 and HIV-2, to establish a diagnosis.
- The U.S. Centers for Disease Control and Prevention (CDC) recommends HIV screening at least once for older adults until age 64. Annual screening at any age is recommended if you are at increased risk of contracting an HIV infection.
- The American College of Physicians agrees with the CDC that everyone up to age 64 be offered an HIV screening test in health care settings. It also recommends that the frequency of repeat screening be determined by doctors on an individual basis.
- The U.S. Preventive Services Task Force (USPSTF) recommends that all people ages 15 to 64 undergo screening for HIV and sees no age limit for screening those at increased risk for HIV. As for how often, the Task Force says a reasonable approach is one-time testing for all people ages 15 to 64 and at least annual screenings for those at very high risk of HIV, such as males who have sex with males, IV drug users and in settings with high HIV-positive prevalence, such as STD clinics, drug treatment centers, correctional facilities, and clinics that serve the homeless. Adults at increased but not very high risk may be screened less frequently than every year, such as every three to five years. The Task Force points out that risk is "on a continuum" and health professionals should use their own discretion in deciding how frequently to test people for HIV.
Aside from these recommendations, certain individuals should get tested and learn their status. These include:
- People diagnosed with hepatitis, tuberculosis (TB) or an STD
- People who received a blood transfusion prior to 1985, or had a sexual partner who received a transfusion and later tested positive for HIV.
- A health care worker with direct exposure to blood on the job
- Any individual who thinks he or she may have been exposed
Talk to your health care provider
Don't be surprised if a health care provider asks you or your partner to consent to an HIV screening test, in keeping with CDC recommendations. Routine HIV testing (which you can decline or "opt out" of) prevents feelings of embarrassment or shame from becoming obstacles to crucial health care. Infected individuals can then get treatment when it works best and take steps to protect the health of sex partners. If your health care provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.
As an older adult, you may have to ask your doctor for screening. Some don't offer HIV screening to older people because they underestimate older people's risk. Catching an infection before it progresses to AIDS is especially important for older people because certain AIDS symptoms – such as fatigue, weight loss, and mental confusion – may be seen as normal signs of aging.
Resources & Links
For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-232-4636.
To find a testing site near you, visit National HIV and STD Testing Resources
MedlinePlus Interactive Health Tutorial: HIV and AIDS
Mayo Clinic: HIV/AIDS - Preparing for your appointment
CDC: HIV Among Persons Age 50 and Older
Sources Used in Current Review
Deborah Parham Hopson. Observing National HIV/AIDS and Aging Awareness Day in an Aging Epidemic. Health Resources and Services Administration. PDF available for download at http://hab.hrsa.gov/abouthab/populations/olderadultsfacts.pdf through http://hab.hrsa.gov. Published April 4, 2011. Accessed May 2012.
National Association on HIV Over 50. HIV FAQs for life: Are more adults over 50 now living with HIV and Aids? Available online at http://hivoverfifty.org/en/about/neahof/mission.html through http://hivoverfifty.org. Accessed May 2012.
Health Resources and Services Administration. Population Fact Sheet. Older Adults. PDF available for download at http://hab.hrsa.gov/abouthab/populations/olderadultsfacts.pdf through http://hab.hrsa.gov. Published August 2010. Accessed May 2012.
U.S. Centers for Disease Control and Prevention. Fact Sheet. HIV Among Persons Age 50 and Older. PDF available online at http://www.cdc.gov/hiv/topics/over50/resources/factsheets/pdf/over50.pdf through http://www.cdc.gov. Published February 2008. Accessed May 2012.
U.S. Preventive Services Task Force. Summary of Recommendations, Screening for HIV. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm through http://www.uspreventiveservicestaskforce.org. Amended version issued April 2007. Accessed April 2012
U.S .Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Available online at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Last modified 22 Jan 2007. Accessed April 2012.
Presidential Advisory Council on HIV/AIDS. Resolution on HIV Testing. PDF available for download at http://www.aids.gov/federal-resources/policies/pacha/meetings/january-2011/jan-2011-resolution-hiv-screening.pdf through http://www.aids.gov. Issued January 28, 2011. Accessed May 21, 2012.
U.S. Department of Health and Human Services. HIV Screening. Available online at http://www.medicare.gov/navigation/manage-your-health/preventive-services/hiv-screening.aspx through http://www.medicare.gov. No posting date given.
Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement, DRAFT. Available online at http://www.uspreventiveservicestaskforce.org/draftrec.htm#consider through http://www.uspreventiveservicestaskforce.org. Accessed January 4, 2013.