I am so glad people are taking about this now. We are living longer and aging-related problems seems to show up earlier in long term survivors. As more and more doctos leave HIV practices for other fields that offer better reimbursement, or due to retirement, we need more doctors who can deal with the increasing needs of the long term survivor population.
Kaiser Daily HIV/AIDS Report
Public Health & Education | HIV/AIDS Experts, Doctors Voice Concerns About Health Problems Seen Among Long-Term HIV/AIDS Survivors
[Jan 07, 2008]
Some experts and doctors recently have voiced concerns that people who were diagnosed with HIV/AIDS in the early years of the epidemic are experiencing “prematur[e]” or “disproportionate numbers” of ailments associated with aging, the New York Times reports. CDC estimates show that the number of people ages 50 and older living with HIV increased by 77% between 2001 and 2005 and that this population now represents more than 25% of all HIV/AIDS cases in the U.S. The “graying of the AIDS epidemic” has raised interest in the link between AIDS and cardiovascular disease, certain cancers, diabetes, osteoporosis and depression, the Times reports.
Cardiovascular disease and diabetes are associated with lipodystrophy, which results in fat redistribution that can leave the face and lower limbs gaunt, the stomach swollen and the back humped. Lipodystrophy also raises cholesterol levels and causes glucose intolerance, which could be particularly harmful to black people, who are predisposed to heart disease and diabetes. According to the Times, there are no data that compare the incidence, age of onset and cause of aging-related diseases in the general population with long-term survivors of HIV. However, experts say they do not see HIV-negative people in their mid-50s with hip replacements associated with vascular necrosis, heart disease or diabetes related to lipodystrophy, or osteoporosis without the usual risk factors.
The most comprehensive research has come from the AIDS Community Research Initiative of America, which has studied 1,000 long-term survivors in New York City. The ACRIA study, published in 2006, found unusual rates of depression and isolation among older people living with HIV.
The NIH-funded Multi-Site AIDS Cohort Study — which has followed 2,000 subjects nationwide for the past 25 years — will examine the effects of HIV/AIDS and aging over the next five years. MACS investigators and other researchers say the slow pace of research on HIV/AIDS and aging is a result of numbers. They note that the first generation of people diagnosed with HIV/AIDS in the mid-1980s had no effective treatments for 10 years and died in large numbers, leaving few people to participate in studies.
Charles Emlet — an associate professor at the University of Washington-Tacoma and a leading HIV and aging researcher — said HIV/AIDS and aging research has been slow to start because of “the rapid increase in numbers.” CDC’s most recent data, from 33 states that meet certain reporting criteria, showed that the number of people age 50 and older with HIV or AIDS was 115,871 in 2005, compared with 64,445 in 2001. In addition, the “routine exclusion” of older people from drug trials by large pharmaceutical companies has undermined such research, the Times reports. The studies are designed to measure safety and efficacy but not long-term side effects of drugs. The lack of research also limits a patient’s care, the Times reports.
“AIDS is a very serious disease, but longtime survivors have come to grips with it,” Emlet said, noting that although some patients experience unpleasant side effects from the antiretroviral drugs, a vast majority find a regimen they can tolerate. “Then all of a sudden they are bombarded with a whole new round of insults, which complicate their medical regime and have the potential of being life threatening. That undermines their sense of stability and makes it much more difficult to adjust,” he added (Gross, New York Times, 1/6).