Transcript Is it AIDS or Age - Positive Education, Inc.

Is it AIDS or Age
Joseph L. Lennox-Smith, M.Ed.
Executive Director
Positive Education, Inc.
Celebrating 10 Years of Service
Key Points
• 1. HIV/ AIDS in the US is shifting to a disease of middle
age and older
• 2. Age-related medical conditions
-Play an important role in overall management of HIV/
AIDS
-Can have a significant impact on the patient’s overall
quality of life
• 3. Although medications can have long-term effects,
often we are mealy experiencing the effects of aging
The Graying of HIV
• “Although AIDS is thought of as a disease of the young,
in the United States it is rapidly becoming one of middleaged and even the old. The number of Americans of age
50 infected with the virus that causes AIDS quintupled
during the 1990’s, ‘and a conservative estimate would be
that there are more than 1,000,000 now,’ said Dr. Marcia
G. Ory,” (McNeil, D. 2004,New Your Times)
• Unless there is a new explosion of HIV among teenagers
the majority of cases by the end of the decade will be in
people over 50.
• 71% live alone
– (McNeil, D., 2004, New Your Times, Aug. 7th 2004)
Advanced Decrepitude
• What we know
– In a article in The Gerontologist, Oct. 2004 Vol. 44,
iss. 1 the suggestion is that degree of functional
impairment by HIV+’s are much the same as those
negatives that are 5 years older.
– Of those with effective treatments for HIV over a third
of the veterans HIV older population have two or
more general medical co-morbidities (conditions) that
have a greater impact on survival and health related
quality of life (HRQOL) than do AIDS-defining
conditions.
• (Justice, A., Oursler, K., Katzel, L., Crystal, S., 2004)
Incidence and causes of death in HIV-infected persons
receiving highly active antiretroviral therapy compared with
estimates for the general population of similar age and from
the same geographical area.
• “Background Since the introduction of highly active
antiretroviral therapy (HAART), the incidence of
death in HIV-infected patients has dramatically
decreased, and causes of death other than those
related to HIV infection have increased, although it is
unclear how these parameters compare with those in
the age-matched general population living in the
same geographical region.”
Results
• There were 235 deaths among the 4471 patients on
HAART (5%). The incidence of mortality decreased over
time in HIV-infected patients (P<0.001; chi(2) test for
trend), although it has remained approximately five times
higher than that for the age-matched general population.
AIDS-related events were the most common cause of
death (n=95; 40%), although they significantly decreased
over time (P<0.001; chi(2) test for trend), whereas liver
diseases (P<0.001; chi(2) test for trend) and non-AIDSdefining infections (P=0.008; chi(2) test for trend)
significantly increased over time. Infections in general
(33 times higher), liver diseases (11 times higher) and
non-Hodgkin lymphoma (5 times higher) were
overrepresented as causes of death in the HIV-infected
cohort compared with the age-matched general
population.
Conclusion
• Conclusions Non-AIDS-defining infectious
diseases, liver diseases, and non-Hodgkin
lymphoma represent specific targets for
efforts to further decrease mortality in HIVinfected patients receiving HAART.
• Martinez E, Milinkovic A, Buira E, de Lazzari E, Leon A, Larrousse
M, Lonca M, Laguno M, Blanco J, Mallolas J, Garcia F, Miro J, Gatell
J., HIV Med. 2007 May;8(4):251-8.
Advanced Decrepitude
• “Overall, smoking, depression, and
hypertension demonstrated greater
population attributable risk of mortality
than any AIDS-defining condition,” along
with a similar pattern for HRQOL issues.
–
(Pursier, K., 2004)
• They also demonstrated a severe loss of
strength and endurance (aerobic capacity)
–
(Justice, A., Oursler, K., Katzel, L., Crystal, S., 2004)
Some Conditions
Jerome Ernest, M.D. The Body, Summer 2004
• Hypertension (bp > 135/85)
– Leads to stroke, heart attack, heart failure and
kidney failure (renal)
– Sped up by dyslypidemia, smoking, diabetes
mellitus, obesity, lack of exercise, high salt
diet, and situational stress.
Some Conditions
Jerome Ernest, M.D. The Body, Summer 2004
• High Cholesterol and Triglycerides
–
–
–
–
High overall Cholesterol > 100 mg/dl
High LDL (low density lipoprotein) >100 mg/dl
Low HDL (low density lipoprotein) < 40 mg/dl
High Triglycerides > 150 mg/dl
• Most HIV patients have one or more risk factors
for heart disease and are prime candidates for
changing habits and lowering cholesterol
• No difference in + & -
What can you do
• Adjust diet – more fruit and vegetables, less
dietary fat
• Restrict salt
• Restrict alcohol & quit smoking
• Stress reduction/relaxation
• Weight Reduction & exercise
• Drug therapy (statins)
– Based on other medications
– Grapefruit juice can increase levels
Some Conditions
Jerome Ernest, M.D. The Body, Summer 2004
• Colorectal Cancer
– Currently there is no evidence that this is higher in
HIV+
– It does correlate to age
• Colonoscopy
• Prostate Cancer
– Currently there is no evidence that this is higher in
HIV+
– It does correlate to age
– African American males run greater risk
• Manual exam or PSA
Some Conditions
Jerome Ernest, M.D. The Body, Summer 2004
• Osteoporosis
– Bone density seems to be lower in both HIV+
men and women
– Does not seem to be solely correlated with
age
– A Spanish study suggest that the longer
someone is HIV +, the greater the loss of
bone density
– This may have to do with poor uptake of
calcium (metabolism)
Some Conditions
Valcour, V., Goodkin, K., 2002,The gerontologist vol. 42 Iss. 1: pg 81
• Neurocognitive Function
– “Preliminary analysis suggest a similar percentage of
older compared to younger individuals are 100%
adherent to HAART”
– Minor cognitive-motor disorders as more frequent in
older than younger HIV+ individuals
– Older patients had higher cd4/cd8 ratio
– More memory problems
– Possible increase in psychiatric issues (depression,
aging process, support systems, loss or isolation)
Other Issues
• Liver stress from years of antiviral treatment
• Alcohol and hepatitis related liver issues
• Increased risk of plaques associated with
Alzheimer’s disease accumulation that makes
them more vulnerable to dementia
• Condom use
• Sex
• Misdiagnosis of AIDS symptoms as to whether
age related or AIDS related.
IS HIV DISEASE DIFFERENT FOR
OLDER PEOPLE?
• “They may not do as well as younger
patients with HIV; However, ARVs
strengthen the immune system.”
• “Most older patients, unless they are drug
users or have mental problems, take their
medications more regularly (have better
adherence than younger patients).”
http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=616
IS HIV THE SAME IN OLDER
PEOPLE?
• Older patients seem to do as well when
diagnosed in later life as those that
became HIV+ and then aged
• It is suggested that t-cells do not recover
as readily as in younger patients
• Side effects may be more frequent
• http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=616
Conclusion
“If I had known that I would live this long, I
would have taken better care of myself!”
• Avoid isolation
• Be mentally and physically active
• Watch what you eat
• Stop or reduce drinking and smoking
• Reduce stress
• Don’t stop living!!!!!
Resources
• Health agencies in most cities offer HIV testing. The
following national organizations have information
about HIV/AIDS.
• Centers for Disease Control and Prevention (CDC)
National AIDS Hotline
1-800-342-AIDS
(operates 24 hours a day,
7 days a week)
1-800-344-7432 for Spanish
1-800-243-7889 (TTY)
www.cdc.gov
• CDC National Prevention Information Network
P. O. Box 6003
Rockville, Maryland 20849-6003
1-800-458-5231
1-800-243-7012 (TTY)
www.cdcnpin.org/scripts/index.asp
Resources
• National Institute of Allergy and Infectious Diseases
(NIAID)
Office of Communications
and Public Liaison
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
301-496-5717
www.niaid.nih.gov
• AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
1-800-HIV-0440 (1-800-448-0440)
Monday to Friday, 12:00 p.m. to 5:00 p.m. Eastern Time
1-888-480-3739 (TTY/TDD)
www.aidsinfo.nih.gov
Resources
• National Association on HIV Over Fifty
23 Miner Street
Boston, MA 02215-3318
www.hivoverfifty.org
• Senior Action in a Gay Environment (SAGE)
305 7th Avenue
16th Floor
New York, NY 10001
212-741-2247
www.sageusa.org
Resources
• For more information on health and aging, contact:
• National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
• Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a
senior-friendly website from the National Institute on
Aging and the National Library of Medicine. This website
features popular health topics for older adults. It is
simple to use, has large type, and a 'talking' function that
reads text aloud.
Resources
• National Institute on Aging
U. S. Department of Health and Human
Services
Public Health Service
National Institutes of Health
June 2004