Aging AIDS epidemic raises new questions
Published: Wednesday, August 1, 2012 at 6:01 a.m.
Last Modified: Tuesday, July 31, 2012 at 9:41 p.m.
AIDS is graying. By the end of the decade, the government estimates, more than half of Americans living with HIV will be over 50. Even in developing countries, more people with the AIDS virus are surviving to middle age and beyond.
That’s good news — but it’s also a challenge. There’s growing evidence that people who have spent decades battling the virus may be aging prematurely. At the International AIDS Conference last week, numerous studies are examining 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’re only in their 50s.
“I’m 54, but I feel older,” said Carolyn Massey of Laurel, Md., who has lived with HIV for nearly 20 years.
“When I hear young people talk about, ‘Well, you get HIV and you take your drugs and you’ll be all right’ — that’s just not the truth,” she said. “This is a lifelong thing we’re talking about, and it unfolds every day on you.”
The graying isn’t just because people like Massey are surviving longer. Some of it comes from older adults being newly diagnosed, a trend U.S. health officials say is small but slowly growing. Yes, grandparents still have sex — and that’s an age group missed by all those hip safe-sex messages aimed at teens and 20-somethings.
“They let down their guard,” is how Dr. Kevin Fenton of the Centers for Disease Control and Prevention puts it.
Already, a third of the nearly 1.2 million people living with HIV in the U.S. are over 50, and by 2020 half will be, Fenton said at one of numerous sessions on aging at the world’s largest AIDS meeting.
People 50 or older accounted for 17 percent of new HIV diagnoses in 2009, according to the CDC’s latest data. That’s up from 13 percent in 2001.
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 these pioneering survivors 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.
“It’s almost created a new subspecialty of medicine,” Fauci said.
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’s even though the HIV patients had their virus well-controlled and weren’t 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, CDC’s Fenton 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.
At the conference, some older people with HIV lined up to have their photographs made and their personal histories recorded, part of a Web project called “The Graying of AIDS.”
It’s a chance to be counted, and share knowledge.
“We’re so concerned about the youth factor, we forget about the people who’ve brought us thus far,” said Massey, the Maryland woman, who leads an HIV group called Older Women Embracing Life and works with churches to raise HIV awareness.
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