Thursday, April 19, 2012

Growing older with HIV: What do we know?

Its been over 30 years into the HIV epidemic, when the world came to the realisation of what would end up to be a global challenge. However with more advanced drugs to treat the virus, there are evidence of HIV positive people growing older.

This sounds as great news for many people infected and affected by HIV. However, the downside of this is the increasing challenges of co-morbidity, HIV drugs toxicity, and aging. As we grow older, our body will go through a process of breakdown that will require more medical attention. We have to deal with the issue of Alzheimer, Cancer, Diabetes and ever increasing difficulties of care.

Dr Graeme Moyle of Chelsea and Westminster, in a presentation at one of British HIV Association Conference in London, quoting the SMART study concluded that HIV viral load can also be contributing risk to Cardiovascular disease in people over 50 years. This is further compounded with the challenge of late presentation of HIV.

Dr. Graeme Moyle
Increasing the challenges for older HIV positive people is the type of drugs prescribed for the treatment of the virus. Certain protease inhibitors  like Lopinavir and Idinavir have shown an increase in fat accumulation called Lipid in older people living with HIV. This means that these drugs will increase the risk of other diseases like hypertension, Diabetes and other diseases like renal dysfucntion, reduce bone mineral density, fraility, non-AIDS defining cancer and neurocongnitive dysfunction.

 Another factor increasing the risk for older HIV positive people is the CD4 nadir at the time of diagnosis. The lower the CD4 cell counts the more possibility of aggravated old age diseases as listed above.

As HIV positive people grow older and more people get diagnosed late, the challenges to manage the disease in line with other old age diseases will come with more community advocacy around lifestyle changes.

Prof. Peter Kroker of Chelsea and Westminster Hospital London suggested that we should start addressing factors that will increase co-morbidity at old age, these include: Smoking, alcohol, diet, and inactivity. Coupled with this should be the regular assessment of risk factors like: blood pressure, lipids, cardiovascular fitness, vitamin status and renal functions.

Prof. Peter Kroker
He stated that the important thing to know is that living with HIV is a life time challenge on its own, this challenge gets complicated with aging, and old age defining diseases. Supporting older people living with HIV and other diseases should be a priority not just for the community but for the health care providers and the government.

There should also be more community led advocacy and training on HIV and aging. This is because according to the words of Prof Kroker " In 1996, I would never have thought I will stand here today, 30 years after the epidemic to be talking about HIV and aging? Back then we thought living over 5 years               will be more to luck than reality but here we are today"

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