How does the Centers for Disease Control and Prevention (CDC) define older adults in the context of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)?

CDC Definition of "Older Adults" in HIV/AIDS Context

The Centers for Disease Control and Prevention (CDC) defines "older adults" in the context of HIV/AIDS as individuals aged 50 years and older. 1

Evidence and Rationale

The CDC's definition of older adults as those 50 years and older in the HIV/AIDS context differs from the traditional geriatric definition (typically 65+) for several important reasons:

• This age threshold is specifically used for HIV surveillance, prevention, and treatment planning
• The definition recognizes the unique challenges faced by people aging with HIV infection
• At age 50 and above, HIV-infected individuals begin to experience:
  • More pronounced immunologic changes
  • Higher rates of comorbidities
  • Different responses to antiretroviral therapy
  • Increased risk of frailty at earlier ages than the general population 2

Clinical Implications

This age definition has significant implications for clinical management:

1. Frailty Assessment: The International Antiviral Society-USA panel recommends assessment of mobility and frailty beginning at age 50 for all persons with HIV 2

2. Screening Frequency:

   • For frail or prefrail patients: Every 1-2 years
   • For robust patients: Up to every 5 years 2

3. Cognitive Function Monitoring: Routine cognitive function assessment using validated instruments is recommended every other year for people with HIV who are older than 60 years 2

4. Polypharmacy Management: Close attention to medication interactions and side effects is particularly important in this population 2

Epidemiological Context

The definition is also important from a public health perspective:

• Approximately 17% of new HIV diagnoses occur in individuals aged 50 and older 3
• More than 50% of individuals living with HIV in the United States are now aged 50 and older 3
• The proportion of HIV-infected people aged 50+ is projected to increase from 28% to 73% by 2030 4

Clinical Management Considerations

For HIV-infected adults aged 50 and older:

• Medication Management: Higher risk of drug-drug interactions due to polypharmacy and age-related changes in metabolism 2
• Comorbidity Screening: More aggressive screening for age-related conditions that may appear earlier in HIV-infected individuals
• Immune Response: Potentially different immune recovery patterns after initiating antiretroviral therapy 5
• Social Support: Assessment of social isolation, which is particularly common in older adults with HIV 2

This age-specific definition helps clinicians recognize the need for specialized care approaches for this growing population of older adults living with HIV/AIDS.