A new study by researchers at the University of California at Los Angeles (UCLA) suggests that HIV causes immune cells to age quicker than normal—potentially causing more rapid HIV disease progression in older people with HIV and earlier onset of aging-related diseases in younger people.
To read the full article discussing these findings, go to: http://www.poz.com/articles/hiv_telomere_sensescence_761_19813.shtml.
This article supports the concept of accelerated aging. Accelerated aging refers to a recent phenomenon in the HIV literature. Studies are finding that people living with HIV are demonstrating higher rates of illnesses typically found in older HIV-negative populations. Comparisons of brain scan patterns and bone marrow density of people living with HIV with the HIV-negative, and found that significant percentage of the HIV-positive participants have results similar to HIV-negative participants 10 and 20 years older. This article suggests that an explanation for accelerated aging lies in the way HIV impacts immune cell functions.
This area of research is still in a beginning phase, and the findings in any of these areas are not conclusive, nor can they be extrapolated to determine how living with HIV into midlife and beyond will affect any one person’s physical aging. Illness progression or age-related physical changes can be the result of many factors, including, but not limited to: the presence of HIV; aging; heredity; environment and lifestyle. Research on aging with HIV has correlated healthy aging with modifiable issues, such as social involvement, mood, treatment adherence, and alcohol use.
This research could result in treatment interventions that address accelerated aging on the cellular level. A growing concern for the expanding population of those living with HIV into midlife and beyond. Until this issue is more clearly understood efforts need to be taken to address the health concerns of people who have lived longer than they ever expected, and to help individuals determine what steps they can take to improve their lives.
Doctors at the University of California, San Francisco (UCSF), appreciate the unique challenges faced by their patients as they age with HIV. That is why the University has received funding to develop and evaluate programs that integrate HIV and geriatric services for HIV/AIDS patients who are 50 and older. Researchers at the San Francisco Department of Public Health and UCSF received a three-year grant to study new models of care and offer best-practice guidelines for treating HIV and aging throughout California.
To find out more about this timely study go to the UCSF website.
POZ magazine on line listed this video on Aging with HIV as one of the top ten for 2010. The article, posted on May 12th by Willette Francis, includes a video of GMHC Executive Director, Dr. Marjorie Hill, reporting the results of their study, “Growing Older With the Epidemic: Aging and HIV.”
In case you missed the original article and video, here is the link: http://www.poz.com/articles/GHMC_HIV_aging_2296_18404.shtml
Last Saturday Dr. Stephen Karpiak and I spoke at the SAGE National Constituents Conference, The Future of Aging is in Our Hands! Our workshop, “Aging with HIV: The Complications for Success,” was well attended by a mix of people, including gay men living with HIV, activists, and social workers from the LGBT community.
Dr. Karpiak presented the background statistics, using graphs compiled from CDC and other data, which clearly and dramatically demonstrated the magnitude of the issue. People over fifty make up a large and growing segment of those living with HIV. He also presented the findings from the ROAH study from ACRIA on HIV Over Fifty. The data gives a picture into the psycho-social issues faced by this group. Particularly striking to me was the multiple co-morbid conditions (issues including depression, physical illness, financial limitations, lack of social support) that impact the lives of people living with HIV over age fifty.
Dr. Karpiak shared his evaluation about the workshop with me: “It is always reinforcing to see research data supported by the observations of the clinician. This was clearly the case at our dual presentation at the SAGE Meetings this past weekend. ACRIA’s research on the older adult with HIV (ROAH) describes a population who are long-term survivors in the HIV epidemic. They have had to develop different coping strategies as they shifted from the expected short life following an HIV/AIDS diagnoses to a long life span due to effective drug treatment. And now they face another challenge. At age 50-60 they are developing multiple age-related disorders that would typically be seen in 75+ year old adults. We know that successful aging is achieved when the person has support from their social networks – caregiving. But the older person with HIV, like the older lgbt person, is largely without traditional family networks from which most caregivers are derived. They cannot fight this next challenge alone. How will our community respond to this need? Will they respond ?”
For my part, I focused on what we know about aging from the gerontological literature and the unique concerns I identified in my research on HIV over fifty. People over age fifty living with HIV face many of the same challenges of aging as those who are HIV negative. However, HIV complicates the picture in a number of ways, including, but certainly not limited to, symptom ambiguity – the difficulty determining whether an ailment is age or AIDS-related. After presenting the challenges faced by people aging with HIV, I presented some of the solutions found in the gerontological literature to help people optimize their experience of aging.
The workshop included a lengthy group discussion in which audiences members shared their experiences, challenges, and what works for them. It was exactly the type of conversation that I advocate for in Aging with HIV: A Gay Man’s Guide, to empower people to define Optimal aging with HIV for themselves.
A reader, Loren M., recently completed a course on public policy in Aging with HIV at San Francisco State University, Gerontology program. He has researched the issues around Aging with HIV, and has shared the result of his studies. For a report on Aging with HIV Policy go to my post – Aging with HIV Goes to the White House and read his comment.
Thanks Loren M. for sending that information to us!
Medscape has been posting discussions with researchers who attended the 1st International Workshop on HIV & Aging in Baltimore on October 4&5. The latest interview is on the role of mitochondrial damage in Aging and HIV-disease with Douglas Wallace, PhD, a leading researcher on mitochondria. The full interview can be viewed here.
Dr. Wallace explains that mitochondria play a key role in aging. As we age mutations in our mitochondria weaken cellular functioning. Over time this damage lead to the clinical symptoms seen in aging.
Dr. Wallace adds that, “chronic HIV infection can result in sufficient mitochondrial dysfunction to generate many of the same clinical problems seen in aging.” While he points out that much more research needs to be done on the interaction between HIV and mitochondria, his statement suggests that this relationship may be an important feature in the symptoms currently referred to as accelerated aging in people living with HIV.
Several of the men I interviewed for my study talked about physical changes that accompanied aging with HIV. They said that often it was difficult to determine which symptoms were age-related and which were HIV-related. Many spoke of feeling older than their HIV-negative peers, and that they had symptoms common to much older men.
The science around aging with HIV has not evolved enough to explain whether these reports are symptoms of the physiological effects of living with HIV, the results of taking HIV medications, or of the emotional impact of living with HIV.
Until this relationship is clarified, people living with HIV must find strategies for optimal aging, addressing the physical and emotional complications of living with the virus into midlife and beyond. Talk to your doctor about any symptoms and develop a self-care regimen that works best for you.
There has been much discussion lately in the blog-o-sphere about accelerated aging among people living with HIV. The term “accelerated aging” refers to a collection of conditions (heart disease, bone loss, cancer and cognitive decline) that are more common in HIV-positive people in their 40s and early 50s, compared with HIV-negative people of the same age. There is a great deal of controversy about using this term given the lack of research in this area. Many argue that one cannot combine these conditions under the heading “aging.” Researchers are also unclear whether these conditions are a result of age, long-term HIV-infection, long-term use of highly active antiretroviral treatment (HAART), or the presence of other infections. The researcher, Dr. Charles Emlet, sums up the research on his blog and links to a POZ article on the subject.
In another related article, Medscape writer Bob Roehr, interviews Steven G. Deeks, MD, a professor of medicine in residence at the University of California, San Francisco (UCSF), and codirector of the Population and Clinical Sciences Core at the UCSF-GIVI Center for AIDS Research. In the interview Dr. Deeks discusses the controversial topic of accelerated aging. He focuses on chronic low-level inflammation demonstrated among people living with HIV taking HAART. He states that while the presence of elevated markers for inflammation is “well accepted” among scientists, the effect is “not particularly dramatic.” Dr. Deeks suggests that more research needs to be done on the relationship between chronic inflammation and CMV disease. He adds that inflammation levels are much higher in people who are untreated with HAART than in those who are treated. His recommendation – “For now, lifestyle changes such as diet and exercise may be the most useful interventions. They have demonstrated efficacy in dampening immune overactivation and restoring a more normal homeostasis.”
I am sure that there will be much more to say about this topic. Add your thoughts, personal reflections or research updates here or on the “community” page.
The CDC released its HIV surveillance report 2005-2008 in June and Dr. Stephen Karpiak of ACRIA just sent me the data on HIV prevalence in the over fifty population. The number of people over age fifty is increasing exponentially, and one of the greatest population increases is for people between the ages 50-65. These figures include increases in the rates of new reported cases of HIV, as well as people living with the virus over age 50. Looking at these figures I conclude that midlife and older people living with HIV are going to represent a growing percentage of those living with HIV in the US and the specific issues faced by this age group are a growing health concern.
|In 2007 the total estimated number of people living with HIV/AIDS climbed over the million mark, and the percentage of people estimated to be living with HIV/AIDS over age 50 was 31%. This percentage rose in 2007 from less than 26% estimated in 2005. Given the rate of increase (2.2%) we can estimate the current (2010) number of people living with HIV over fifty to be closer to 40%.
The CDC also estimates that in 2008 16% of new diagnoses of HIV occurred in people over fifty. This is an increase from the 2006 CDC estimate of 10%.
In a 2005 study of HIV over fifty Shippy and Karpiak described this group as having “fragile networks of social support.” The study participants had little support from family, and relied mostly on the involvement of peers, many of whom were living with HIV themselves. This finding concurred with earlier research on HIV over fifty. Study of this population found that people over fifty had a smaller network of social support, had fewer emotional and instrumental supports, were less involved in social service organizations, and reported less satisfaction with their support networks than younger people living with HIV.
A recent ACRIA needs assessment of older clients at GMHC conducted by Brennen, Karpiak, London and Seidel concluded that lack of support continues to be of concern. They found that the limits of social networks documented in earlier studies were also found in this population. And, that perceptions of support availability and adequacy were also low in this group. (A copy of this report will be available soon.)
There are many reasons why middle aged and older people would have less support than younger people living with HIV. As we age our networks of social involvement do get smaller. We tend to rely on smaller groups of more intimate companions. And, loss of family and friends can contribute to smaller circles of social support. Research in this area has also shown that middle aged and older people experience a double stigma of HIV and age and that anticipated stigma affects one’s interest in asking for help from friends, family, and service providers, including AIDS care organizations.
In my research I found that loss plays a significant role in limiting the support networks of middle aged and older people living with HIV. This generation of survivors have had their social networks decimated by HIV. Their peer group is gone, the very people they would rely upon to deal with the challenges of aging. And, many are reluctant to make new friends, for fear of opening themselves to further losses.
However, as this research implies, it is imperative that your social support system be strong to meet the challenges of aging with HIV.
To begin to assess the strength of your support network, ask yourself these few questions: How satisfied are you with your support network? Do you have someone to rely on if you were ill? If you needed someone to take you home from a medical procedure? To offer advice or assistance if you got caught in a financial jam? To talk to when you are stressed out? Is there someone you can lean on if you are feeling down? Someone who would drop everything if you needed them right away?
How often did you rely on the same person? What if they weren’t available?
Now, consider what steps you have taken to expand your social networks, to keep in contact with friends and family, to reach out to people, or make new friends. What gets in the way of doing more to build your social support?
Rebuilding, maintaining, and enhancing your social supports takes effort. In Aging with HIV: A Gay Man’s Guide I discuss strategies for developing a strong social support network. The book offers tools to assess the adequacy of your support network, strategies for overcoming obstacles to social involvement, and guidance on how to rebuild your networks of social support. Maintaining adequate social supports is an integral step to optimal aging with HIV.