Aging

When I was diagnosed in 1988 with HIV, I thought it was a death sentence. The Olympic Games were only six months away and I had to make the decision whether to train or lock myself away and wait to die. The choice to train for the Olympics was a decision I didn’t come to lightly. Once that decision was made, I listened to my doctors and religiously took my AZT. Thank God I did. My decision paid off. I won two Olympic Gold medals and was able to reclaim my championships from the previous Olympic Games. But even while celebrating my success at the Olympics at 28 years old, I honestly didn’t expect to see my 30th birthday.

As people with HIV live longer, issues of aging are gaining more attention from HIV/AIDS researchers, clinicians, and advocates. Although by no means a focus of AIDS 2014, HIV and aging-related illnesses did take center stage in a mid-week “bridging session” that featured an in-depth presentation on the intersection of HIV, HIV treatment, and aging.

“More than 50% of HIV-infected adults in the US will be >50 years old in 2015……There is growing concern among patients and healthcare providers that this group is experiencing a premature or ‘accelerated aging’ process……We determined that HIV-infected older adults on effective ART (with suppressed HIV-1 viral loads) had diminished physical performance results when compared to normal reference controls…..Physical function was significantly diminished in older HIV+ persons when compared to reference standards for HIV- age/gender-matched controls. The magnitude of differences observed may be associated with poorer health, more disabilities, longer hospital stays, and higher costs, thus warranting intervention.”

Unsafe sex is the most common way people contract HIV worldwide. Many people mistakenly assume that older Americans are not sexually active and therefore not at risk for HIV infection. This is not the case.

For those at high risk, sexual behavior has more often been defined through the narrow prism of HIV prevention. But, sexual health is broadly defined as more than just the absence of dysfunction or disease. Sexual health is a significant element contributing to the quality of life of older adults.

Thanks to the effectiveness of combination Antiretroviral Therapy (cART), people are aging with HIV, and in many cases doing so successfully. Although we still struggle without a cure, this remains an exciting period in combating this epidemic in that prognosis and life spans are greatly improved. Yet, challenges remain as we observe either accelerated or accentuated aging in many with this disease in several areas (i.e., cardiovascular, renal, and metabolic disease; systemic inflammation); however, one area has received particular attention – brain health, specifically cognition.

Overlapping geriatric syndromes such as “frailty”, “disability”, “multimorbidity”, and “polypharmacy” require adaptation for those aging with HIV infection to account for the ongoing role of HIV infection and its treatment in modifying the aging process. Several complementary approaches to the measurement of frailty have evolved within the geriatric literature and these have been variably applied among those aging with HIV. The approach most often employed in the HIV literature, uses a triad of wasting, slowing, and weakness and is characterized by the frailty phenotype and the frailty related phenotype (Desquilbet et al, 2011; Fried et al., 2001). Another approach focuses on cumulative deficits across multiple physiologic systems (Clegg et al., 2013), but it requires 30 separate measures and has been deemed less feasible for routine care. Rockwood et al have proposed a reduction in the number of measures from 30 to 10. Some have suggested that a single measure of function, such as grip strength or the six minute walk test, might serve.

“In this study population over age 50 50% of participants had frailty or pre-frailty at higher frequencies than HIV-negatives…..49% had been exposed to zidovudine, stavudine or didanosine. Subjects had a median of 4 (IQR 3-6) co-

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine.

HIV providers in the current era contend with tremendous variability in the health of older persons with HIV/AIDS.