Aging Well With HIV
Much has changed since the early days of the HIV/AIDS epidemic in the United States — including the idea that HIV is a young person’s disease. People over 50 are now the fastest growing demographic of patients living with HIV.
“By 2020, we project that more than half of patients living with HIV in the United States will be older than 50,” notes James Sosman, MD, medical director for the UW Health HIV/AIDS Comprehensive Care Program and a practicing HIV specialist at the UW Health Infectious Disease Clinic.
Although there’s always the risk of new HIV infections later in life, the changing demographics are mostly due to patients surviving longer than ever thanks to improved treatments, Sosman says.
“Twenty years ago, we didn’t have the luxury of calling this a chronic disease. Now we’re projecting an almost normal longevity for someone with HIV, similar to someone who has diabetes or rheumatoid arthritis,” he says. “The treatments are very effective. In the best case scenario, a 25 year old person can live 50 or 55 years after diagnosis.”
HIV might shorten one’s life expectancy by 5 or more years, Sosman says, and patients with HIV might also “age earlier” by developing age-related conditions sooner than they would otherwise.
“Heart disease, arthritis, diabetes and cognitive issues, including dementia, are all a risk,” Sosman says. “We certainly see those conditions in patients without HIV, but we’re concerned that they’re going to happen a lot sooner in individuals with HIV. So instead of developing those conditions at 70 or 80 years old, someone with HIV might develop those conditions 10 or 15 years earlier.”
Researchers don’t know for sure what causes patients with HIV to “age early,” but one theory is that it’s related to the chronic, inflammatory nature of the infection. “Even in patients whose HIV is well controlled, there are still some things we can’t control and still some unchecked inflammation that’s going on. And even a small amount of unchecked inflammation can have a negative effect on our blood vessels, liver, kidneys, and neurological system over time,” Sosman says.
Heart disease is the biggest concern for older patients with HIV. “People with HIV are much more likely to develop heart problems than an opportunistic infection like pneumocystis pneumonia,” he says. “Now we don’t see many of those infections in people who are on treatment, which is the majority of people today.”
While research is still ongoing about the best way to prevent age-related problems in patients with HIV, Sosman offers these tips on how to stay healthy as you age:
Adhere to your treatment. “You still have to make sure the virus is controlled. That’s still the No. 1 goal,” Sosman says. If you don’t, you’re more likely to be susceptible to the infections that caused the disease’s high mortality rate in the past.
Quit smoking. “We know it’s a problem for health, and with HIV, the smoking-related issues and complications could be worse,” Sosman says.
Watch your weight. A heart-healthy diet and regular exercise are key to lowering your risk of heart disease and stroke. Check out UW Health’s Heart and Vascular Care Preventative Cardiology Program’s bounty of resources for inspiration.
Protect your brain. “Just like it’s important to exercise your body, you want to stay active with your mind, and avoid alcohol or other drugs that might overlap and cause issues with cognition,” he says. Learn more about what the research says about how to protect your cognitive abilities as you age.
Strengthen your bones. Bone disease, including osteoporosis and osteopenia, are also more common as patients with HIV age. “We do think that low level of unchecked inflammation may be a cause,” he says. You can protect your bone health by getting enough calcium, vitamin D and weight-bearing exercise.
Stay up on cancer screening. Patients with HIV have an elevated risk of cancer, so don’t skip your annual check-up and report any concerning symptoms right away. “Certain cancers, like lymphoma, cervical and anal cancer, and certain head and neck tumors, are more likely,” he says.
Overall, the outlook for older patients with HIV is positive — as long as you take care of yourself, Sosman says. “It’s really important to know that while we’re seeing these issues that we might attribute to early aging, people with HIV can live a long, full life,” he says. “This is a chronic condition that takes ongoing effort to manage, and now more than ever, lifestyle modifications can make a difference.”
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Date Published: 11/29/2018