27 July 2012

Ageing Aids epidemic raises new health questions

By the end of the decade, the government estimates, more than half of Americans living with HIV will be over 50.


Aids is graying: By the end of the decade, the US 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 is good news - but it is also a challenge. There is growing evidence that people who have spent decades battling the virus may be ageing prematurely. At the 2012 International AIDS Conference, 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, an American 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."

Grandparents still have sex

The graying isn't just because people like Massey are surviving longer. Some of it comes from older adults being newly diagnosed; a trend US health officials say is small but slowly growing. Yes, grandparents still have sex - and that is 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 ageing at the world's largest Aids meeting.

People 50 or older accounted for 17% of new HIV diagnoses in 2009, according to the CDC's latest data. That's up from 13% in 2001.

There are not as good counts in poor regions of the world, where access to life-saving medications came years later than in developed countries.

3 million HIV+ are over 50

But even in hard-hit sub-Saharan Africa, home to most of world's HIV-infected population, studies suggest 3 million people living with HIV are 50-plus, said Dr Joel Negin of the University of Sydney in Australia. By 2040, he said, that could reach 9 million.

There challenges are different. Ruth Waryaro of Kenya, addressing the conference on her 65th birthday, said clinic workers hassle her when she goes to pick up her monthly supply of medication - not believing a grandmother really needs it.

"If you're not strong enough, you just leave the medication and go home," said Waryaro, who raised four children of her own and now is raising four Aids orphans. She also has diabetes and high blood pressure.

As Negin pointedly told the conference, "50 is not old." But for years, world health authorities didn't even measure HIV in people beyond age 49.

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, said.

The new focus 

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 were not 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."

The latest instalment of Ageing America is the joint AP-APME project examining the ageing of the baby boomers and the impact that will have on society.

(Sapa, July 2012)

Read More:

7 steps to an Aids-free generation

HIV stigma hinders treatment


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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