Aging and HIV: Long term effects of the disease and its treatment

In the early days of HIV treatment, most people suffered from or died from AIDS-related illnesses and at a fairly young age. Now, almost half of the people living with HIV in the United States are 50 or older. Treatments have improved, and HIV patients are living longer and are more threatened by chronic diseases we all face: like heart disease, diabetes and cancer. How does having HIV affect how we do with these diseases?

“HIV has evolved into a chronic disease as we have seen life expectancy for people living with HIV rising dramatically over the years,’ says Dr. Deborah Jones Weiss, a professor in the Department of Psychiatry and Behavioral Sciences at Miller School of Medicine and a co-lead investigator in the MAC/WIHS Study.

She says more than half of the men and women newly diagnosed with HIV infection in the United States are racial/ethnic minorities living in the South and that, according to the latest report from the Centers for Disease Control and Prevention, the Miami-Fort Lauderdale-West Palm Beach metropolitan area has the highest prevalence nationwide of new HIV diagnoses. That means she is in a great location to study the effects of long-term HIV and HIV treatment on an aging population.

The MAC/WIHS Combined Cohort Study

The National Institutes of Health has awarded University of Miami researchers $14 million for a seven-year project that has the Miller School of Medicine a key location for cutting-edge HIV research. Over time, the study will track cardiovascular and pulmonary disease as well as other non-infectious conditions that people with HIV – both women and men – experience as they age. The goal of that collaborative research effort is to understand and reduce the impact of chronic health conditions—including heart, lung, blood, and sleep disorders—that affect people living with HIV.

With people living with HIV more likely to develop chronic diseases than AIDS-related diseases, research advances will focus on:

• Identifying measurements of increased risk for chronic disorders in people living with HIV
• Determining how antiretroviral therapy (ART) affects other medical conditions
• Developing strategies for more effective interventions and treatments
• Learning more about the role of chronic inflammation from HIV infection in other health conditions

The MACS (Multicenter AIDS Cohort Study) part of the study, which studies men with HIV, has been going on since 1984. The WIHS (Women’s Interagency HIV Study) started collecting data in the 1990s. Both studies have given researchers good information on where to concentrate efforts at lessening the effects of HIV on chronic disease. As the combined study goes forward, it should help refine that information to change clinical practice.

“We know that men and women with HIV age more rapidly by about ten years, developing chronic diseases sooner and more seriously,” says Weiss. She says one theory for why this happens is a body-wide inflammation that ages cells.

In men, researchers have seen higher rates of prostate cancer, non-Hodgkin’s lymphoma and kidney disease.

Women have exhibited higher rates of lung cancer, breast and cervical cancer, and kidney disease. Osteoporosis rates are much higher, due in part to HIV patients going through menopause about ten years earlier, and the effects of some types of HIV medications.

Both sexes seem to experience more cardiovascular disease and periodontal disease, which can go hand in hand; along with changes in brain function.

The Role of ART (antiretroviral therapy) drugs in these chronic conditions

Weiss says part of the problem of effectively treating HIV is people going on and off medication because of side effects. “Over the years, ART has gotten so much better. I can remember in the early days of treatment, some patients were taking 80 pills a day. Now they can take one or two. Most side effects are temporary and much more manageable.”

HIV is actually a risk factor for some types of illness, such as cardiovascular disease and certain types of cancer. Being regular with health screenings and following care guidelines, both for HIV treatment and to manage chronic conditions, are important in controlling chronic diseases and changes to the body that lead to problems:

• Triglyceride levels and blood pressure can rise, due to chronic inflammation, raising risk for heart disease. Diet and other lifestyle changes help, along with medications like statins.
• Higher blood sugar levels may occur. Regular exercise, keeping weight within normal limits, and monitoring blood sugar all help prevent diabetes.
• Loss of bone density: To prevent broken bones, monitoring bone density and following good health practices are vital. Weight-bearing exercises like walking or weight lifting, taking calcium and vitamin D supplements may put off the need for osteoporosis medications.
• Sleep disturbances: Weiss says sleep disruption because of erratic cortisol levels reacting to inflammation is a common problem with HIV over time. Because poor sleep quality affects overall health so much, patients should make sure their doctors know about any sleep problems and get them the help they need.
• Cognitive problems: Although clinicians see fewer cases of HIV-related dementia in the modern era of HIV treatment, other elements of brain function may go down over time. Patients can learn new strategies for compensating for problems with mental organization.
• Cancer risk: Although for people without HIV, cancer screening frequency recommendations often go down as people get older, but that isn’t the case for people living with HIV. Women need early and continued screening for breast and cervical cancer as they age. The same applies to men and prostate cancer.

Advances and new discoveries made by the researchers will ultimately be included in clinical practice guidelines to help physicians optimize treatment of people with HIV.

Tags: aging, Dr. Deborah Jones Weiss, HIV, MAC/WIHS Study