Aging with HIV
“Nobody asked me in my 20s what I wanted to be or what kind of life I wanted to live in my 60s because they didn’t expect me to,” says HIV advocate Vince Crisostomo.
Crisostomo, now in his 60s, learned that he was HIV-infected in 1989, two years after his infection. “People associate a lot of loss with HIV and AIDS, especially my generation,” he says. “I was lucky.”
In the 1980s and early 1990s, many people infected with HIV lived only 1-2 years after diagnosis. But thanks to new treatment and a better understanding of the virus, many people like Crisostomo are living long and healthy lives. Today, almost half of people living with HIV in the United States are over 50 years old.
Drug treatment for HIV has come a long way since the FDA first approved antiretroviral therapies (ART) for the virus. The treatment involved many pills, problematic dosing, food and drug interactions, and other gross symptoms.
“Initially, we changed medications because of the side effects,” says Janessa Broussard, vice president of medical affairs at the San Francisco AIDS Foundation. “But we’ve gotten to the point where we have agents who don’t have a problem that would cause me to switch my patient to another option.” The choices we make these days depend on individual preferences.”
HIV treatment can still have side effects, but modern ART is much more manageable. Successful treatment routines have made it possible for people living with HIV to have a life expectancy comparable to that of people without the virus.
“Before we had proper therapy, HIV was, as people say, a death sentence,” says Broussard. That has changed. “It’s a whole different conversation I have with my patients, which is wonderful. I can honestly say it really won’t affect your lifespan. You can still live a long, happy, healthy life.”
As people live longer with HIV, age-related health problems have become a new challenge. While HIV treatments reduce the chance of developing AIDS-defining diseases, certain non-AIDS diseases are more common among people with HIV. Some of these include:
HIV-infected people may notice these diseases earlier in the aging process than their HIV-infected counterparts. Researchers don’t know exactly why this happens, but they believe it’s related to changes in the immune system that cause age-related complications to start earlier.
Aging and HIV are also linked to chronic inflammation, which can lead to a number of health conditions.
In addition, long-term ART can cause complications such as osteoporosis, increased risk of fractures, kidney and metabolic disorders, liver disease, cardiovascular disease, and central nervous system disorders. However, it is difficult for experts to say whether ART directly causes these conditions or whether it is a combination of long-term ART and other factors.
A person’s genetics, lifestyle, time from infection to starting ART, and other health barriers can also affect the risk of age-related problems.
“As people age, many people develop chronic conditions that require medications that have side effects,” says Broussard. “It’s hard to say directly that long-term antiretroviral drugs cause a certain condition. They may have contributed to the development of certain conditions. But from a risk/benefit perspective, antiretrovirals, even with the effects, are significantly better than the effects of HIV infection on the body when it is not controlled by therapy.”
It is important to start ART as soon as possible, even if you are diagnosed later. In addition, there are many things you can do to live a healthy and long life with HIV:
Find a doctor who meets your needs. Your doctor needs to understand the needs of an aging person living with HIV. Your physical, mental and emotional requirements may differ from other people. It is important that your doctor recognizes these potential differences and is trained to provide you with the care you deserve.
See your doctor regularly. Ask your doctor how often you should have a routine health checkup. They need to test your urine and blood to see if anything has changed or if there is a detectable viral load, which means the virus is not affecting your body as much. As with any condition, it’s a good idea to monitor your health and let your doctor know if you notice any changes.
Choose a healthy lifestyle. You can reduce your risk of developing age-related diseases by not smoking, limiting alcohol consumption, and avoiding recreational drugs.
Eat well and exercise. Maintaining a healthy weight can help prevent health complications. Eat a balanced diet and exercise often to stay fit. Lifting weights can also help keep your bones strong, which helps fight the side effects of osteoporosis.
Seek social support. Support groups and communities can help you talk about your experiences and connect with others living with HIV. You can find groups that meet online or in person. Also, talking to loved ones can help you express your feelings and allow them to understand your point of view.
Maintenance mental health. Your mental health needs change as you age. It is important to focus on your mental well-being in addition to your physical health. Older people living with HIV are at greater risk of mental health problems and social isolation than HIV-negative people of the same age. This is due to stigma, loss of friends and loved ones, and the usual side effects of HIV, ART and the aging process.
These days, Crisostomo is working on his mindset. “I never planned a trip a year in advance in my adult life. I never had any goals except to get through the day or the month. I’m trying to change that,” he says.
Like him, more and more people are aging with HIV and discovering a stage of life they thought would never come. “People are capable of having relationships, loving them, and having children who are biologically related to them,” says Broussard. “This is in stark contrast to the lives of people living with HIV in the ’80s and ’90s.”