Aging HIV Population Faces Increased Risk Of Health Issues
Monday, September 27, 2010
The Centers for Disease Control estimates by 2015, half of all Americans living with HIV will be over 50 years old. Doctors say the complex interactions between HIV, anti-retroviral therapy and aging aren't fully understood. But there is evidence that the disease increases one's risk of a variety of health problems.
SAN DIEGO The Centers for Disease Control estimates by 2015, half of all Americans living with HIV will be over 50. Doctors say the complex interactions between HIV, anti-retroviral therapy and aging aren't fully understood. But there is evidence that the disease increases one's risk of a variety of health problems.
San Diegan William Robinson, not his real name, is tall and painfully thin. He's 64 years old. Robinson has been living with HIV since 1985.
Back then, HIV was a virtual death sentence. But in 1987, the first drug to treat the disease was introduced. It was called AZT.
"And at that time they gave high doses, and people did not really do well with AZT," Robinson said. "But I was one of the fortunate ones, who have gone through that door and out the other side."
Since those early days, Robinson has taken a variety of different medications. He says his HIV has been well-controlled, and he's tried to keep a positive attitude.
Then all of a sudden, not too long ago, Robinson began coughing up blood.
"I worked in a medical field, so I knew right away it was an alarming thing to cough up blood," Robinson said. "So, I immediately was treated for that in an emergency room, and much follow up after that."
Robinson was eventually diagnosed with something called non-cirrhotic portal hypertension. The condition affects the portal vein in the liver. If left untreated, the disease can cause excessive bleeding.
Dr. Edward Cachay is Robinson's physician. He's a specialist in HIV at UC San Diego Medical Center.
Cachay says only a small percentage of people living with HIV have non-cirrhotic portal hypertension.
"However," Dr. Cachay pointed out, "the prevalence among those individuals just specifically exposed to the older generation of medications, it’s much higher. It goes in the range to 4 or 5 percent."
Cachay says this condition appears to be a previously unknown side effect of a drug called didanosine, and that people who have been living with HIV for years face other health consequences.
"People with HIV develop an increased likelihood of cardiovascular conditions, metabolic complications, diabetes, osteoporosis, and certain types of non-AIDS related cancers," Cachay said.
Researchers say in essence, the inflammatory nature of HIV prematurely ages the body. That puts people at a higher risk for a variety of health conditions.
Robinson says that, besides his recently discovered liver ailment, he hasn't felt as mentally sharp as he used to.
"Sometimes short term memory, I have difficulty with that," Robinson said. "I can remember things long ago, but yet something that might have occurred yesterday, I would have a hard time remembering."
Dr. Igor Grant directs the HIV Neurobehavioral Research Center at UCSD. He said mild cognitive problems affect about half of those living with HIV.
"Among people who are surviving into their 60s and 70s with HIV," said Grant, "you see somewhat more cognitive impairment than you would have expected."
Grant said it's unclear whether anti-retroviral drugs contribute to the problem. Grant stressed either way, medications don't wipe out HIV.
"Virus is never truly eliminated from the body," Grant said. "We can suppress it. Maybe you can't even see it in the plasma anymore, but it keeps causing this chronic inflammatory stress that may produce a cumulative kind of brain injury."
William Robinson says it's been challenging trying to keep his health together. In addition to living with HIV, he's had tuberculosis, and two bouts of pneumonia.
"But you do the best you can," he said, "and you continue to take your meds, and I believe that and being where I am mentally with this, is why I'm still here."
Researchers say it's important to keep in mind that the AIDS epidemic began less than 30 years ago, so how HIV effects aging is an emerging field. Scientists are just beginning to understand the long-term effects of the disease, and the therapies designed to control it.