The Aging Face of AIDS in the 21st Century
By 2015 more than half of all people living with HIV in the United States will be older than 50. A fair number of people are simply living much longer with HIV, and that’s a good thing. The Living Affected Coporation (www.livingaffected.org) continues its mission to highlight the various layers in the complicated HIV/AIDS mix. As an organization we've determined that the aging issues juxtaposd to homophobia, stigma and the overarching elements of an individuals social determinants must be apart of an individuals health continuum. It is our premise that those living longer will require additional attention and unique needs that will be added to the HIV/AIDS paradox.
Too many, however, are contracting HIV when they’re older than 50, and their health needs will be different from someone who tested positive at a younger age. What’s more, research increasingly shows that diseases that typically strike HIV-negative people in their 60s and 70s are occurring in people with HIV in their 40s and 50s. These concerns have brought the issue of aging with HIV to center stage.
Right now one of the biggest unanswered questions is why this is occurring. There’s no doubt that many age-related diseases and conditions are popping up at much higher rates—and at younger ages—in people with HIV compared with HIV-negative people. Whether it’s heart attacks, bone fractures, kidney disease or certain cancers, the rates of these conditions in HIV-positive people are alarming. What’s unclear, however, is how much HIV contributes to these conditions, how much is explainable by other factors (such as smoking, HIV drugs and coinfection with other viruses) and what to do about them.
Researchers are working furiously to answer these questions, but in the meantime, lessons are being designed to explain:
Don’t Smoke TobaccoSmoking tobacco is one of the most harmful things that people can do to their bodies—and to their chances of living a long (and healthy) life. Most people know it can cause lung cancer and other lung diseases. Some even know that it can increase the risk for heart attacks and strokes. What many don’t know is that it is also associated with numerous other age-related ailments—including bone mineral loss, muscle wasting, problems with memory and concentration—and age-related cancers, such as anal, breast, cervical and prostate cancer. Click here for some tips on quitting smoking.
Minimize Alcohol and Drug UseConsistent data suggest that moderate alcohol consumption might actually protect the heart and lower blood pressure. However, the American Heart Association recommends that men who drink alcohol should consume no more than two drinks per day and that women should consume no more than one. Studies have found that people who regularly drink more than that are at increased risk of strokes, diabetes, obesity and serious accidents. People with HIV who have liver problems have to take particular care with alcohol.
Data are less clear about how various recreational drugs affect the aging process, though chronic amphetamine (“crystal”) and cocaine use have been implicated in thinking and memory problems, bone mineral loss and heart disease. In addition, excessive use of most drugs is associated with shorter life spans, increased risk of depression and suicide, and other serious health consequences.
ExercisePeople who exercise regularly, on average, are far healthier in numerous respects than people who don’t exercise. As bad as smoking is on just about every part of the body, exercise is good for it. Benefits of regular exercise include reductions in the risk of:
Eat WellAside from exercise, diet also helps determine who will live longest and healthiest. Experts are divided on the ideal diet. Some argue against the consumption of almost any fat. Others say that fats (at least healthy fats from nuts and fish) aren’t the problem, but that sugar is. Some argue for a vegetarian way of life, while others say meats are just fine. Fad diets that come and go just confuse matters further. All of this can make it quite difficult to decide on the best diet.
What most reputable diets have in common is watching caloric intake, along with an emphasis on including lots of fruits, vegetables, whole grains and beans, and then enjoying everything else in moderation. Most also stress the importance of eating the healthiest types of fish and limiting meat consumption to the leanest meats, such as from chicken and turkey, whenever possible. When it comes to fats, there is growing consensus that “healthy” fats—for example, from olive oil, nuts and avocados—are actually good for you.
What the most reputable diets also agree on is that too much sugar and too many processed and fried foods are a primary driver of diabetes, cardiovascular disease and a host of health problems in the United States. Switching from an unhealthy to a healthy way of eating is hard for many people—that’s why diets so often fail. For tips on how to overcome some of those challenges, click here.
Treat HIVCurrent HIV treatment guidelines recommend starting ARV therapy at least as soon as your CD4 count drops below 500 (see our "When Should I Start Treatment, and What Should I Take First?" lesson). The primary rationale for this advice comes from data showing that untreated HIV, and the resulting high level of inflammation, can greatly increase the risk for cardiovascular disease, liver disease and other conditions. Some experts on the DHHS panel that creates U.S. treatment guidelines, and experts who’ve developed guidelines elsewhere now recommend treating at even higher CD4 counts for the same reason, especially in those with a high underlying risk for cardiovascular disease, liver disease or other health problems.
Not everyone has the same underlying risks for the kinds of diseases that the panel was most concerned with, however. For instance, people with no family history of heart disease, who have never smoked and who don’t have hepatitis C or B have a low baseline risk for becoming ill with cardiovascular, liver or kidney disease. For such a person, the decision about when to start treatment might be different from that of a person who does have a family history of heart disease, or who smokes or has HCV. In that regard, the guidelines offer some flexibility.
What is clear, however, is that the longer people wait after their CD4s drop below 500, the greater their risk for developing age-related illnesses will likely be. In fact, one of the most potent predictors of a higher risk for the majority of age-related diseases is a CD4 count under 200.
Treat Other InfectionsCurrent HBV and HIV guidelines recommend that people with both infections should begin HIV therapy (with a backbone of treatments that also fight HBV) as soon as possible. This is because treating HBV early significantly reduces the risk of liver cancer and other liver problems, without significantly increasing the risk of side effects from the medication.
Deciding when to treat HCV is a little harder. Though many new medications are in development, the cure rate for HCV therapy in the majority of people infected with both HIV and HCV in the United States is still relatively low and the side effects of the treatment can be serious and unpleasant. When HCV therapy does work, however, it significantly reduces the risk of developing not only liver disease, but also other related conditions.
Follow Disease Prevention and Screening GuidelinesResearchers have begun to question whether certain age-related screening guidelines might need to start at a younger age in people with HIV. For instance, some have questioned whether the most popular screening tool to assess heart attack risk, based on data from the long-running Framingham study, should be modified for people with HIV.
Experts have questions whether others tools, such as the FRAX score for assessing bone mineral loss, might also need to be adjusted for HIV-positive people. In fact, some now recommend that HIV infection alone counts enough as a risk factor that bone screening ought to begin at a younger age, particularly for HIV-positive men, than is typically recommended. There are, however, no consistent guidelines yet in this area.
Studies are being conducted to help identify whether current disease screening guidelines for people older than 50 are sufficient for people with HIV. While we wait for the results of those studies, however, it is important to ask your doctor what types of disease prevention and screening guidelines are in place for a person of your age and medical background and to insist on following those guidelines in your own care. The U.S. Preventive Services Task Force produces disease screening and management guidelines and may be found here.
Stay Socially and Mentally ConnectedNumerous studies have found that people who maintain social connections with their family, friends and colleagues and who engage in activities that they feel add meaning to their lives not only live longer, but also remain healthier than people who are socially isolated and who do not engage in meaningful activities. There are a variety of ways to get connected socially if you aren’t close to family and don’t have many friends. Many local AIDS service organizations (ASOs) have support groups for people with HIV to connect with one another. Volunteering with a charity that works on causes you believe in, or with a political campaign, can also help you connect socially. Finding local groups of people to exercise with would accomplish two goals: social connection and fitness. The website meetup.com can be a way to find others who share your interests and hobbies.
If you are unable to get out of your house easily, or if you live in a rural area without many opportunities meet like-minded folks, it is possible to connect with others online in forums. Check the AIDSmeds Forums for topics that interest you, and begin connecting with others today. Consider volunteer opportunties at the Living Affected Corporation, contact us at info@livingaffected.org
By 2015 more than half of all people living with HIV in the United States will be older than 50. A fair number of people are simply living much longer with HIV, and that’s a good thing. The Living Affected Coporation (www.livingaffected.org) continues its mission to highlight the various layers in the complicated HIV/AIDS mix. As an organization we've determined that the aging issues juxtaposd to homophobia, stigma and the overarching elements of an individuals social determinants must be apart of an individuals health continuum. It is our premise that those living longer will require additional attention and unique needs that will be added to the HIV/AIDS paradox.
Too many, however, are contracting HIV when they’re older than 50, and their health needs will be different from someone who tested positive at a younger age. What’s more, research increasingly shows that diseases that typically strike HIV-negative people in their 60s and 70s are occurring in people with HIV in their 40s and 50s. These concerns have brought the issue of aging with HIV to center stage. Right now one of the biggest unanswered questions is why this is occurring. There’s no doubt that many age-related diseases and conditions are popping up at much higher rates—and at younger ages—in people with HIV compared with HIV-negative people. Whether it’s heart attacks, bone fractures, kidney disease or certain cancers, the rates of these conditions in HIV-positive people are alarming. What’s unclear, however, is how much HIV contributes to these conditions, how much is explainable by other factors (such as smoking, HIV drugs and coinfection with other viruses) and what to do about them.
Researchers are working furiously to answer these questions, but in the meantime, lessons are being designed to explain:
- How aging works in a general sense
- What we know about HIV and the aging process
- What steps can be taken to reduce the risk of aging-related diseases, and
- What kinds of experimental treatments are on the horizon
Don’t Smoke TobaccoSmoking tobacco is one of the most harmful things that people can do to their bodies—and to their chances of living a long (and healthy) life. Most people know it can cause lung cancer and other lung diseases. Some even know that it can increase the risk for heart attacks and strokes. What many don’t know is that it is also associated with numerous other age-related ailments—including bone mineral loss, muscle wasting, problems with memory and concentration—and age-related cancers, such as anal, breast, cervical and prostate cancer. Click here for some tips on quitting smoking.
Minimize Alcohol and Drug UseConsistent data suggest that moderate alcohol consumption might actually protect the heart and lower blood pressure. However, the American Heart Association recommends that men who drink alcohol should consume no more than two drinks per day and that women should consume no more than one. Studies have found that people who regularly drink more than that are at increased risk of strokes, diabetes, obesity and serious accidents. People with HIV who have liver problems have to take particular care with alcohol.
Data are less clear about how various recreational drugs affect the aging process, though chronic amphetamine (“crystal”) and cocaine use have been implicated in thinking and memory problems, bone mineral loss and heart disease. In addition, excessive use of most drugs is associated with shorter life spans, increased risk of depression and suicide, and other serious health consequences.
ExercisePeople who exercise regularly, on average, are far healthier in numerous respects than people who don’t exercise. As bad as smoking is on just about every part of the body, exercise is good for it. Benefits of regular exercise include reductions in the risk of:
- cardiovascular disease, diabetes and metabolic syndrome
- age-related cognitive decline
- bone-mineral and muscle loss
Eat WellAside from exercise, diet also helps determine who will live longest and healthiest. Experts are divided on the ideal diet. Some argue against the consumption of almost any fat. Others say that fats (at least healthy fats from nuts and fish) aren’t the problem, but that sugar is. Some argue for a vegetarian way of life, while others say meats are just fine. Fad diets that come and go just confuse matters further. All of this can make it quite difficult to decide on the best diet.
What most reputable diets have in common is watching caloric intake, along with an emphasis on including lots of fruits, vegetables, whole grains and beans, and then enjoying everything else in moderation. Most also stress the importance of eating the healthiest types of fish and limiting meat consumption to the leanest meats, such as from chicken and turkey, whenever possible. When it comes to fats, there is growing consensus that “healthy” fats—for example, from olive oil, nuts and avocados—are actually good for you.
What the most reputable diets also agree on is that too much sugar and too many processed and fried foods are a primary driver of diabetes, cardiovascular disease and a host of health problems in the United States. Switching from an unhealthy to a healthy way of eating is hard for many people—that’s why diets so often fail. For tips on how to overcome some of those challenges, click here.
Treat HIVCurrent HIV treatment guidelines recommend starting ARV therapy at least as soon as your CD4 count drops below 500 (see our "When Should I Start Treatment, and What Should I Take First?" lesson). The primary rationale for this advice comes from data showing that untreated HIV, and the resulting high level of inflammation, can greatly increase the risk for cardiovascular disease, liver disease and other conditions. Some experts on the DHHS panel that creates U.S. treatment guidelines, and experts who’ve developed guidelines elsewhere now recommend treating at even higher CD4 counts for the same reason, especially in those with a high underlying risk for cardiovascular disease, liver disease or other health problems.
Not everyone has the same underlying risks for the kinds of diseases that the panel was most concerned with, however. For instance, people with no family history of heart disease, who have never smoked and who don’t have hepatitis C or B have a low baseline risk for becoming ill with cardiovascular, liver or kidney disease. For such a person, the decision about when to start treatment might be different from that of a person who does have a family history of heart disease, or who smokes or has HCV. In that regard, the guidelines offer some flexibility.
What is clear, however, is that the longer people wait after their CD4s drop below 500, the greater their risk for developing age-related illnesses will likely be. In fact, one of the most potent predictors of a higher risk for the majority of age-related diseases is a CD4 count under 200.
Treat Other InfectionsCurrent HBV and HIV guidelines recommend that people with both infections should begin HIV therapy (with a backbone of treatments that also fight HBV) as soon as possible. This is because treating HBV early significantly reduces the risk of liver cancer and other liver problems, without significantly increasing the risk of side effects from the medication.
Deciding when to treat HCV is a little harder. Though many new medications are in development, the cure rate for HCV therapy in the majority of people infected with both HIV and HCV in the United States is still relatively low and the side effects of the treatment can be serious and unpleasant. When HCV therapy does work, however, it significantly reduces the risk of developing not only liver disease, but also other related conditions.
Follow Disease Prevention and Screening GuidelinesResearchers have begun to question whether certain age-related screening guidelines might need to start at a younger age in people with HIV. For instance, some have questioned whether the most popular screening tool to assess heart attack risk, based on data from the long-running Framingham study, should be modified for people with HIV.
Experts have questions whether others tools, such as the FRAX score for assessing bone mineral loss, might also need to be adjusted for HIV-positive people. In fact, some now recommend that HIV infection alone counts enough as a risk factor that bone screening ought to begin at a younger age, particularly for HIV-positive men, than is typically recommended. There are, however, no consistent guidelines yet in this area.
Studies are being conducted to help identify whether current disease screening guidelines for people older than 50 are sufficient for people with HIV. While we wait for the results of those studies, however, it is important to ask your doctor what types of disease prevention and screening guidelines are in place for a person of your age and medical background and to insist on following those guidelines in your own care. The U.S. Preventive Services Task Force produces disease screening and management guidelines and may be found here.
Stay Socially and Mentally ConnectedNumerous studies have found that people who maintain social connections with their family, friends and colleagues and who engage in activities that they feel add meaning to their lives not only live longer, but also remain healthier than people who are socially isolated and who do not engage in meaningful activities. There are a variety of ways to get connected socially if you aren’t close to family and don’t have many friends. Many local AIDS service organizations (ASOs) have support groups for people with HIV to connect with one another. Volunteering with a charity that works on causes you believe in, or with a political campaign, can also help you connect socially. Finding local groups of people to exercise with would accomplish two goals: social connection and fitness. The website meetup.com can be a way to find others who share your interests and hobbies.
If you are unable to get out of your house easily, or if you live in a rural area without many opportunities meet like-minded folks, it is possible to connect with others online in forums. Check the AIDSmeds Forums for topics that interest you, and begin connecting with others today. Consider volunteer opportunties at the Living Affected Corporation, contact us at info@livingaffected.org
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