As AIDS Patients Age, A Complex Health Picture Emerges

AIDS patients who survived the first wave of the epidemic are now reaching the age when they might have expected to encounter health issues even apart from HIV. But the picture is complicated by the long-term effects of living with the disease, as well as by the medications they have taken to keep the virus in check, the AFP reported on May 30.

The long-term effects of living with the disease can include diminished memory, chronic neuropathy (nerve pain), and premature aging of the body's systems.

The article noted that older AIDS patients sometimes live not only with the physical stress of the virus and their pharmaceutical regimens, but also financial hardship and isolation.

"I've often said to my doctors, 'You're so worried about the AIDS but I'm gonna drop over from a heart attack,'" was how one longtime AIDS patient, Lou Grosso, 57, put it. "It bothers me; I'm having a good life and don't want it to be cut short because my body thinks I'm 80."

A National Institutes of Health news release from last September explained some of what patients who have lived with the disease over the long term may face.

"In those with long-term HIV infection, the persistent activation of immune cells by the virus likely increases the susceptibility of these individuals to inflammation-induced diseases and diminishes their capacity to fight certain diseases," the release said.

"Coupled with the aging process, the extended exposure of these adults to both HIV and antiretroviral drugs appears to increase their risk of illness and death from cardiovascular, bone, kidney, liver and lung disease, as well as many cancers not associated directly with HIV infection.

"In addition, a growing number of adults in their 40s and 50s with long-term HIV infection are experiencing syndromes that resemble premature aging," the release added.

That could mean greater risk of kidney failure, hypertension, osteoporosis, general frailty, mental diminishment, or some combination of health issues.

"A recent study found that 52 percent of HIV positive Americans suffer from some type of cognitive impairment," the AFP article said. "Only 10 percent of people in the general population, by contrast, experience such problems, according to the CNS HIV Antiretroviral Therapy Effects Research study."

Text at emedicine.medscape.com confirms that the virus affects the human central nervous system.

"Physicians frequently encounter neurologic and psychiatric complications in patients with human immunodeficiency virus (HIV) infection," the text reads. "This is not surprising, since HIV enters the central nervous system (CNS) early in the course of the infection."

Typically, however, dementia is less a problem in the short term for patients who are on an effective drug regimen.

"The development of dementia is usually delayed until severe immunodeficiency develops," the text states.

But over the long term, even patients who successfully manage their viral loads may find that they exhibit some degree of neurological impact, albeit usually comparatively minor.

"The rate of impairment in patients with HIV is much, much higher," Dr. Victor Valcour said last year at the 2010 International AIDS Conference, an Aug. 31, 2010, article at The AIDS Beacon reported. "About half of patients who have HIV will have abnormal testing," added Valcour, who is associated with San Francisco's Memory and Aging Center at the University of California.

The AFP article noted that older AIDS patients might also be at higher risk for cancer.

Longer Lives, Later Infections

It's a striking shift in the AIDS-related health care situation, the article said. In the 1980s, before the advent of the cocktail, many AIDS patients died young. But as new drugs made it possible to keep the virus in check for decades at a time, younger HIV+ people stopped dying in droves and started surviving to become older patients.

"Today, more than a quarter of HIV patients are 50 years or older, according to the US Centers for Disease Control," the article said, going on to note, "Experts are just starting to tease out which of these illnesses are caused by the virus, which are drug side-effects and which are just natural signs of aging."

HIV, the virus that causes AIDS, has proven remarkably hard to kill once it has infected an individual--partly because the virus mutates and adapts so rapidly, but also because it has the capacity to hide in tissues where it can lurk for years before re-emerging. Because of this, AIDS patients cannot simply take a course of treatment when the disease "flares up," as is the case with some other medial issues. AIDS patients need to take their medication every day for the rest of their lives to control the virus.

Modern medicine has identified promising new avenues to fighting the virus, from disabling its capacity to replicate to finding ways to prevent it from infecting T cells, the part of the human immune system that the virus directly affects. But those modes of treatment may still be years in the future. Meantime, the current cocktail of anti-retrovirals is adequate for most people to control their viral load, and for many, the prognosis for long-term, healthy survival is good--if they start their treatment regimen soon after infection. But living with the disease untreated for years can damage the body, and the drugs can also have serious side effects.

Then there's the stigma of the disease. While HIV+ people are not shunned and denigrated as much as they once were, there remains a lingering sense of shame for some sufferers and accusation from some elements of society that depict gays as "disease ridden"--the disease in question being HIV.

Indeed, anti-gay activists still use HIV as a veritable bludgeon against sexual minorities, often conveniently forgetting that in some parts of the world--Africa, for instance--AIDS is primarily a disease that affects heterosexuals.

In the U.S., the AFP article noted, "Long-term HIV patients are almost 13 times more likely to suffer from depression than other Americans, according to a 2006 study from the AIDS Community Research Initiative of America."

It's not necessarily the case that older AIDS patients were young when they contracted the disease. The virus does not discriminate on the basis of sexual orientation, gender, race, socio-economic status--or age. Indeed, in recent years, a trend has emerged of older people becoming HIV+. The dangerously mistaken notion that AIDS is a "gay" disease that heterosexuals need not guard against only makes the situation worse.

The age of a person at the time of contracting HIV can play a significant role in the eventual health outcome, the NIH release said.

"HIV disease progresses more quickly in older compared with younger adults, and antiretroviral therapy restores immune system cells less effectively, placing this older group at greater risk for illness and death from HIV infection than younger people who are infected for comparable periods of time," the release explained. "Moreover, the higher rate of pre-existing conditions in people of advanced age often complicates their treatment for HIV infection."

Further complicating the issue is an erroneous social expectation--shared even by doctors--that older Americans are less at risk. This can lead to a sense that people past a certain age no longer need to be tested for HIV, and the natural effects of aging can mask the symptoms of HIV.

"Many people mistakenly assume that older Americans are not sexually active and therefore not at risk for HIV infection," a government-run AIDS website, www.aids.gov, says. "This is not the case. A 2007 national survey of Americans ages 57 to 85 found that the majority of older Americans are sexually active. This is particularly true for healthy older Americans.

"However, older Americans do not always realize that they may be at risk for HIV infection," the site's text adds. "Many came of age in the decades before AIDS and did not receive the information about HIV prevention that younger generations did. Others were married or in long-term relationships for many years and tuned out information about HIV.

"Now, after being widowed or divorced, they are entering intimate relationships again for the first time in decades. Compare with those who are younger, they may be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves."

Regardless of whether older AIDS patients have lived with the disease for decades or have recently become infected, some fear that the health care system will be taxed by the graying of the HIV+ population.

"Our society is not prepared for the aging baby boomer generation. We don't have enough geriatricians to care for the sharply rising number of seniors," Marjorie Hill , the head of Gay Men's Health Crisis, said last year, EDGE reported on July 19, 2010. "We are even less prepared to care for populations with unique health care needs, such as HIV-positive older adults."