Experts Voice Concerns About Health Problems Seen Among Long-Term HIV/AIDS Survivors

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Some experts and doctors recently havevoiced concerns that people who were diagnosed with HIV/AIDS in theearly years of the epidemic are experiencing "prematur[e]"or "disproportionate numbers" of ailments associated withaging, the New York Timesreports. CDCestimates show that the number of people ages 50 and older livingwith HIV increased by 77% between 2001 and 2005 and that thispopulation now represents more than 25% of all HIV/AIDS cases in theU.S. The "graying of the AIDS epidemic" has raised interestin the link between AIDS and cardiovascular disease, certain cancers,diabetes, osteoporosis and depression, the Timesreports.

Cardiovascular disease and diabetes are associatedwith lipodystrophy, which results in fat redistribution that canleave the face and lower limbs gaunt, the stomach swollen and theback humped. Lipodystrophy also raises cholesterol levels and causesglucose intolerance, which could be particularly harmful to blackpeople, who are predisposed to heart disease and diabetes. Accordingto the Times, there are no data that compare theincidence, age of onset and cause of aging-related diseases in thegeneral population with long-term survivors of HIV. However, expertssay they do not see HIV-negative people in their mid-50s with hipreplacements associated with vascular necrosis, heart disease ordiabetes related to lipodystrophy, or osteoporosis without the usualrisk factors.

The most comprehensive research has come fromthe AIDS Community ResearchInitiative of America, which has studied 1,000 long-termsurvivors in New York City. The ACRIA study, published in 2006, foundunusual rates of depression and isolation among older people livingwith HIV.

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The NIH-fundedMulti-Site AIDS Cohort Study -- which has followed 2,000 subjectsnationwide for the past 25 years -- will examine the effects ofHIV/AIDS and aging over the next five years. MACS investigators andother researchers say the slow pace of research on HIV/AIDS and agingis a result of numbers. They note that the first generation of peoplediagnosed with HIV/AIDS in the mid-1980s had no effective treatmentsfor 10 years and died in large numbers, leaving few people toparticipate in studies.

Charles Emlet -- an associateprofessor at the Universityof Washington-Tacoma and a leading HIV and aging researcher --said HIV/AIDS and aging research has been slow to start because of"the rapid increase in numbers." CDC's most recent data,from 33 states that meet certain reporting criteria, showed that thenumber of people age 50 and older with HIV or AIDS was 115,871 in2005, compared with 64,445 in 2001. In addition, the "routineexclusion" of older people from drug trials by largepharmaceutical companies has undermined such research, the Timesreports. The studies are designed to measure safety and efficacy butnot long-term side effects of drugs. The lack of research also limitsa patient's care, the Times reports.

"AIDSis a very serious disease, but longtime survivors have come to gripswith it," Emlet said, noting that although some patientsexperience unpleasant side effects from the antiretroviral drugs, avast majority find a regimen they can tolerate. "Then all of asudden they are bombarded with a whole new round of insults, whichcomplicate their medical regime and have the potential of being lifethreatening. That undermines their sense of stability and makes itmuch more difficult to adjust," he added (Gross, New YorkTimes, 1/6).

Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily HIV/AIDS Report, search the archives, and signup for email delivery at kaisernetwork.org/email. The Kaiser Daily HIV/AIDS Report is publishedfor kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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