HIV often has very mild symptoms or is asymptomatic until it progresses to AIDS. The symptoms of AIDS in its early stages are fatigue, weight loss, night sweats, and decreased appetite (Altschuler, Katz, & Tynan, 2004). Many older adults may attribute these symptoms to normal changes related to aging that become worse as other illnesses and infections compound them and begin to affect the individual. (Lieberman, 2000 & Older People with AIDS need Compassionate Care, 2005) AIDS related dementia may be falsely diagnosed as Alzheimer’s Dementia. (Altschuler et al., 2004 & Lieberman, 2000).Pnuemocystitis carinii pnuemonia, a characteristic pneumonia found in individuals who are immunocompromised may be misdiagnosed as lung disease. (Emlet, 1997) These misdiagnoses can result in increased morbidity and mortality by preventing the older adult patient from receiving the proper care and resources before the HIV disease is able to progress to AIDS. A new North American study shows that starting antiretroviral treatment earlier could reduce the risk of death by up to 94%. The results of a North American study reports that the risk of death in seropositive patients decreases by 69% to 94% if they start treatment earlier than officially recommended.
This study, which was recently published in the New England Journal of Medicine, could have considerable influence on medical practice. (Health Orbit, 2009).

People over the age of fifty, often have other co-morbidities as well, which can compound their HIV symptoms leading them to feel even more ill and may further contribute to a quickly declining health. Early detection and treatment of HIV should be a priority for all patients, especially those over age fifty.

Stereotyping has likely played a role in the untimely diagnosis of HIV in the older adult. Rochel Lieberman, BS, LCCE, FACCE recognized that physicians are less likely to consider HIV infection, calling it a “missed opportunity to prevent progression of disease.” (2000, p. 177) This research report urged health care providers to provide education to the older adult about HIV risk and prevention and to obtain sexual and drug histories, despite the difficulty in discussing these sensitive topics. (Lieberman, 2000) The importance of this cannot be understated. The older adult is a special population because their normal age related changes predispose them to increased risks. HIV appears to progress more rapidly to AIDS and AIDS to death in this population (Older People with AIDS Need Compassionate Care, 2005) When the older adult is evaluated, the health care provider needs to recognize and take advantage of the unique position he or she is in to have a conversation with the older adult patient and to provide education about risky sexual behaviors as well as other choices that may put the older adult at risk for contracting HIV. Health care providers must be able to educate the older adult about HIV and AIDS and the resources available for those with a positive diagnosis.

It is important for healthcare providers to have knowledge about HIV and current treatment options as well as support and assistance programs that are available to patients with a diagnosis of HIV. This knowledge could prove highly beneficial in lessening the anxiety in those patients who may disclose high risk behaviors and in encouraging the older at risk adult to consider HIV testing. There are an array of public and private assistance programs that are available to HIV infected patients to assist financially with the cost of the medication regimens necessary to improve the quantity and quality of life. It is estimated that the cost for one year of commonly prescribed HIV medications it can be as high as $15,000, possibly equal or close to what the older adult might receive from routine retirement benefits. While the cost of care related to the diagnosis of HIV is significant, the cost of not diagnosing or misdiagnosing is also a serious and likely a more costly concern.

In addition to financial implications of late and or missed diagnosis, it is imperative to remember that this disease is not curable, and at best, becomes a chronic illness over one’s life that has serious implications including pain, depression, and significant life style adjustment requirements.

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