Transcript HIV and Aging: Living Long and Well

HIV and Aging: Living Long and Well
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New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Figuring it all out:
It’s a fishing
expedition!
Hugh Jackman in The River
HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
“CAM” vs. drugs?
No vs….just…does it work?
Evidence-based MEDICINE…
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
The Nature of the River
Physical health (e.g., physical symptoms, impairments, physical functioning,
treatment adherence, menopause, general well-being, physical resilience, quality
of life etc.);
Mental health (e.g., depression, anxiety, psychological well-being, addiction,
psychological resiliency, mastery, coping etc.);
Sexual health (e.g., sexual function, sexual activity, etc.)
Social participation (e.g., social networks, social supports, social engagement,
social resilience etc.)
Access to health services (e.g., service utilization, health services used, service
access)
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Negotiating the Rapids, Identifying the Fish…
 Cardiovascular Health – Heart, Veins/arteries
 Liver
 Coinfection with chronic Hepatitis B or Hepatitis C
 Medication Toxicities/Alcohol
 Kidneys – Tenofovir and Protease inhibitors
 Close monitoring of eGFR ≤ 60
 Bones – preventing/managing osteopenia/osteoporois
 Neurological
 Peripheral Neuropathy
 Cognitive Function/Depression
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HIV and Aging: Living Long and Well

New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Stirring up the Silt: Underlying Issues
Inflammatory Cytokines – IL-1, IL-6, TNF-, d-Dimer, TGF-ß
Compromised gut function – HIV in the gut damages ability to absorb nutrients; most
lymphocytes are there; Diarrhea, constipation; LPS translocation
Neurological damage – peripheral neuropathy, cognitive function and coordination
declines: much arising from inflammation
Endocrine disruption – Testosterone levels decline; HPA axis/cortisol
HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
The River’s Ecology: Prevention, Management, Maintenance
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Modifying Life habits
 Eating better
 Sleeping better
 Exercising more – Resistance and Aerobic
 Eliminating or reducing tobacco, alcohol, recreational drugs?
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Reducing inflammation with medications and supplements
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Mindfulness Meditation, Centering, Focusing, Relaxing

Having joys in life!
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
What Goes in the River:
A simple Multi and HIV: Effect on Rate of Progression
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HIV and Aging: Living Long and Well

New York Buyers’ Club (NYBC), New York, NY December 2, 2014
What Goes in the River:
The Microbiome: Probiotics, Prebiotics, Synbiotics
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HIV affects gut function; high virus load in gut
Reduced lactobacilli associated with pathologies: translocation, bacterial
vaginosis
May reduce duration or severity of diarrhea (determine cause);
additionally, glutamine can help
Probiotics – live bacteria or fungi that help the gut ecology
Prebiotics – insoluble fibers that help digestion and growth of good bacteria
Synbiotics – the combination of the two
HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
The Shell inside the River:
Bones: Osteopenia, Osteoporosis
- Get your Vitamin D level checked for baseline
- Supplement or consider, e.g., 50,000 IU shot of D3
- Other necessary ingredients: Vitamin K, Calcium, silicon,
magnesium, zinc, copper, manganese, potassium, boron
- Resistance EXERCISE
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
The River Screams: Neuropathic Pain
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Consider Switching if on regimen e.g., stavudine (d4T, Zerit)
Acetylcarnitine – amino acid variant of L-carnitine: 3 g/day
Alpha lipoic acid – up to 600 mg/day
Vitamin B12 – Although this may not apply so much to ARV-PN:
still, may help
• Cannabis – smoke cannabis, if tolerable, manages neuropathic
pain
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
How the River Flows:
Cardiovascular Risks
High LDL and/or low HDL:
Arrhythmias, MIs
Niacin, fish oil
CoEnzyme Q10 (CoQ10); 400 mg/day
Reducing inflammation: NAC, lipoic,
curcumin
GOOD NUTRITION! EXERCISE!
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Cleaning the River:
Liver, Hepatitis Coinfection
Treat the Hep C – if you can get it despite Gilead!
A range of supplements I use: NAC, lipoic, Chinese herb
formulae, Curcumin, Probiotics, Evening primrose, CoQ10
And of course: Exercise, nutrition, sleep…
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
A Turbulent River?
Mental Health – Depression, Anxiety
Meditation – but not if it worsens things; it’s a practice
Exercise! (Again??)
Address substance use: alcohol, recreational drugs (meth),
tobacco, Coca-Cola and the like (sugar), meds (efavirenz?)
Supplements: SAMe, NAC/lipoic, fish oil, vitamin D3, 5-HTP
Possibly, GABA. Assess drug interactions.
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Navigating the River - I
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What is the intervention?
What is it supposed to do?
Are there any studies? In humans?
Are there any worries about interactions with other meds?
How can I assess it?
- Bloodwork changes/improvements?
- Symptoms?
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HIV and Aging: Living Long and Well

New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Navigating the River - II
- Consult knowledgeable professionals, friends with HIV, community
resources: NYBC, Spencer Cox, The Body, PozHealth, PubMed…
- Share your protocol with your physician(s)
- Look for the original research (if any)
- Is it a study in a test tube? Animal model? Humans?
- If humans, is the work randomized? Controlled?
- Are there other similar studies?
HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Navigating the River - III
As you start reading studies or about studies, consider:
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P – Population
I – Intervention
C – Comparator
O – Outcome
S – Study Design
Who was studied? Men, women, kids? Mice?
What was studied?
Was it observational? Was there a placebo?
What was the PRIMARY outcome? CD4? Etc.
Observational? Randomized controlled trial?
- Look for meta-analyses. Read studies carefully.
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HIV and Aging: Living Long and Well
New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Every
BODY’s
Different
Allow your protocol to evolve with your changing situation…
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HIV and Aging: Living Long and Well

New York Buyers’ Club (NYBC), New York, NY December 2, 2014
Thank you!
We’re here to help—and learn from you as
well.
800-650-4983
www.newyorkbuyersclub.org