How aging complicates care of AIDS patients
Like in developed countries, more people living with HIV/AIDS in developing countries are surviving to middle age and beyond.
This sounds like a good new, but it is also a challenge, for there is growing evidence that people who have spend decades battling the virus may be aging prematurely.
At the International AIDS Conference last week, numerous studies examined how heart disease, thinning bones and a list of other health problems typically seen in the senior years seem to hit many people with HIV when they are only in their 50s.
It is estimated that about one-third of 1.2 million people living with HIV in the United States are over 50, and by 2020 half will be.
But even in hard-hit sub-Saharan Africa, home to most of world’s HIV-infected population, studies suggest 3 million people living with HIV are 50-plus, said Dr. Joel Negin of the University of Sydney in Australia. He said by 2040 that could reach 9 million.
Even though the good news is that people with HIV/AIDS are surviving longer into their 50s, experts said new infections are growing, majority of which comes from older people.
“Grandparents still have sex — and that is an age group missed by all those hip safe-sex messages aimed at teens and 20-somethings,” said Dr. Kevin Fenton of the United States Centers for Disease Control and Prevention.
Addressing the conference, Ruth Waryaro of Kenya, 65, and AIDS positive woman, said clinic workers hassle her when she goes to pick up her monthly supply of medication — not believing a grandmother really needs it.
“If you are not strong enough, you just leave the medication and go home,” said Waryaro, who raised four children of her own and now is raising four AIDS orphans. She also has diabetes and high blood pressure.
Although it is said that50 is not old, but for years, world health authorities didn’t even measure HIV in people beyond age 49.
Today, people who are diagnosed and treated early can expect a near-normal life-span, Dr. Anthony Fauci, infectious disease chief at the National Institutes of Health, told The Associated Press.
The new focus is on what survivors like Waryaro can expect as they reach their 50s, 60s and beyond. They’re now getting chronic illnesses such as heart disease, diabetes, kidney disease and osteoporosis — some of the common ailments when anyone gets old. But studies suggest people with HIV may be at higher risk for some of those illnesses, or get them earlier than usual.
Perhaps the strongest evidence links HIV and an increased risk of heart disease. Some AIDS medications raise that risk. But in research published for the AIDS meeting, scientists at Massachusetts General Hospital uncovered another reason.
They scanned the arteries of people with and without HIV, and found the HIV patients had more inflammation inside their arteries, putting them at risk for the kind of clots that trigger heart attacks. That is even though the HIV patients had their virus well-controlled and were not that old — their average age was 52, the researchers reported in the Journal of the American Medical Association.
HIV triggers body-wide inflammation as a person’s immune system tries to fight the virus, a process that persists and can quietly damage organs even with good medications, experts said.
HIV is not acting in a vacuum, said Dr. Amy Justice of Yale University, noting that people’s histories of smoking, for example, also contribute to inflammation.
But she pointed to data from a Veterans Affairs study that said older people with HIV use more medications for other diseases than HIV-free patients the same age.
Fenton noted that the voice of survivor who have aged 50 and above could help other older adults realise they are at risk, when they are getting back onto the dating scene after years of monogamous relationships. Older people don’t use condoms as much as younger people.
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