Americans living with HIV are achieving the once unthinkable: a steady march toward older age. But starting at age 50, many people with the virus face a host of health problems, from heart disease and diabetes to social isolation and cognitive decline.
So the medical research community, which three decades ago developed life-saving drugs to keep the virus at bay, is now looking for new ways to keep people with HIV healthy in their lives. last year
A recent study, for example, showed that a statin drug significantly reduced the risk of heart attacks and strokes in middle-aged and older adults with HIV, and may reveal biological insights into why this group tend to age faster than others. And a crop of academic hospitals have established specialized clinics for older people with the virus, offering medical experts as well as social workers, substance abuse counselors, psychologists and nutritionists.
“I’m incredibly impressed with how care for the older HIV population has grown,” said Dr. Nathan Goldstein, who heads one such clinic on Mount Sinai in New York City. “I get emails every day about new models, new grant funding. People are paying too much attention to it.” More than two dozen experts on HIV and aging also expressed optimism, in contrast to the harsher view many held a decade ago.
Researchers often refer to a looming “silver tsunami” of older people with HIV who need better care. In 2021there are 572,000 Americans age 50 and older diagnosed with HIV, increased 73 percent from 2011.
now, two-thirds of deaths in the HIV population is from causes other than the virus. This aging group faces an increased risk of diabetes, liver and kidney disease, osteoporosis, cognitive decline and various cancers.
But perhaps their most pressing health concern is a double risk of cardiovascular disease compared to people who do not carry the virus. Researchers in the Netherlands estimated by 2030more than three-quarters of the HIV population in that country will develop cardiovascular disease, including high blood pressure, high cholesterol, heart attack or stroke.
Seeking a defense against this growing threat, the National Institutes of Health invested $100 million in a randomized controlled trial, called recovery, which tested a statin drug against a placebo in 7,769 people with HIV 40 to 75 years of age. The volunteers were relatively healthy and on stable antiretroviral treatment, so they were generally not recommended a statin. But the results of that trial, published in The New England Journal of Medicine, showed that the drug reduced the volunteers’ risk of major cardiovascular events by more than one-third.
“This is really an important study,” said Dr. Anthony S. Fauci, who as the former director of the National Institute of Allergy and Infectious Diseases – he retired in December – was among the NIH leaders who approved Reprieve’s massive budget. “The results, in some aspects – they were better than I expected.”
Donté Smith, a health consultant from Kansas City, Mo., is 37 but started taking a statin earlier this year. Mr. Smith, who is genderqueer and uses gender-neutral pronouns, said they were motivated to take the drug because, in addition to HIV, they have a family history of cardiovascular disease and diabetes and smoke.
Mr. Smith also noted that the virus has taken an additional toll on Black and LGBTQ people. Of the nearly 1.1 million Americans diagnosed with HIV, 63 percent are gay and bisexual men, and 40 percent are Black.
“A lot of us don’t get there,” Mx. said Smith. “It’s important to fight that trend. The best revenge for me is to be old and to be able to share and exist and still be here.”
Heart disease and other conditions occur disproportionately in HIV-positive people because of environment risk factors which is more common in this group.
“People aging with HIV are more likely to continue to smoke, consume unhealthy amounts of alcohol and use cocaine than people aging without HIV,” said Dr. Amy Justice, a clinical epidemiologist at the Yale School of Medicine who studies this population. “Each of these behaviors increases the excess risk of cardiovascular disease.”
Even without risk factors, aging is sped up in people with HIV Researchers have long believed the reason to be chronic inflammation and immune dysregulation caused by the virus, even if it is controlled by antiretroviral drugs.
said Dr. Steven Grinspoon, the lead author of Reprieve and a professor at Harvard Medical School, whose clinical trial also measured several chemical markers of inflammation in the volunteers’ blood and scanned their coronary arteries. Researchers are now looking to see if these data help explain why statins lower cardiovascular events. The researchers will present their findings at a meeting in November.
Dr. suspected. Fauci that this test will likely reveal that the statin reduced chronic inflammation in the volunteers, and prevented the build-up of plaques in the arteries that can cause heart attacks or strokes.
But experts say the long-term care of people with HIV depends largely on prescription drugs. A range of social problems are especially prevalent among older people with HIV and can exacerbate the risks of aging, including poverty, sadnessaddiction, mental illness, stigma and housing insecurity.
Paul Aguilar, 60, was given five years to live when he was diagnosed with HIV in 1988. He survived, but not without a struggle. His face had been depleted of fat, a side effect of the toxic early generation of antiretroviral drugs. And he weathered waves of losing peers in San Francisco: first from AIDS and more recently from other diseases.
Last year, he started going to “Golden Compass” program for elderly HIV patients at the University of California, San Francisco, which provides a wide range of services, including cardiology, exercise classes and dental, vision and mental health care. She says the psychological counseling and support she received there helped her cope with the death of her closest friend by suicide and her own subsequent mental health crisis.
The university’s program was “really a godsend,” Mr. Aguilar said, noting that he had no out-of-pocket costs, thanks to his coverage from Medicare and Medicaid.
But most older people with the virus still lack the kind of high-quality care that helped Mr. Aguilar thrive, experts say. Such programs are often very expensive and present staffing and space requirements that many clinics cannot anticipate, especially in resource-poor areas.
“Patients are falling through the cracks,” said Jules Levin, 73, a leading activist who wields the bullhorn on behalf of HIV-positive seniors like himself.
After learning about the findings of the Reprieve study, Mr. Aguilar asked his doctor about starting a statin.
“I’ll be crotchy and tell the kids to get off my lawn,” he said.