By Thea Lapham, Kalamazoo Gazzette
July 8, 2008
When the first HIV drug, AZT, appeared on the market in 1987, there was little concern about the side effects. The disease's mortality rate was so high that patients weren't expected to live long enough for the black lining in the new drug's silver cloud to matter.
Today, however, people diagnosed with HIV -- the human immunodeficiency virus, which can lead to AIDS -- are living long, productive lives because of antiretroviral medications.
But with the graying of the HIV population come new challenges for patients and doctors alike.
The U.S. Centers for Disease Control and Prevention estimate that 27 percent of all Americans living with AIDS are over age 50.
Health officials in Kalamazoo County estimate that of the approximately 340 people in the county who are HIV-positive but do not have AIDS, about 50 are over the age of 50, said David Feaster, director of client services for Community AIDS Resource and Education Services (CARES), based in Kalamazoo and with another office in Benton Harbor. Officials estimate that an additional 125 people of all ages in the county have AIDS, he said.
Cancer risks, faster aging
While data are sparse on the impact of HIV on aging -- and vice versa -- studies suggest that HIV-infected men and women have an accelerated risk of heart disease and certain kinds of cancers.
The first cases of AIDS were associated with cancers such as a rare skin lesion known as Kaposi's sarcoma. But while AIDS-related malignancies seem to be declining in this country, other types of cancer -- lung, rectal and gastrointestinal malignancies -- seem to be disproportionately affecting the HIV population, said Dr. Robert Kalayjian, a longtime infectious-disease specialist at Cleveland's MetroHealth Medical Center. Doctors don't know why.
Long-term exposure to HIV treatment also is a concern, and little is known about how well older Americans tolerate or respond to the arsenal of AIDS drugs now available.
Complicating this mix is the fact that new HIV diagnoses are also rising among older Americans. ``We're clearly seeing an increase in this demographic,'' Feaster said. ``There's this myth that just because you're not a teenager anymore, you can't get HIV. But that certainly isn't true. The statistics speak for themselves.''
Feaster noted that many of the symptoms related to HIV are similar to those that accompany the aging process.
``Aging weakens the immune system, triggers memory loss and leads to fatigue,'' Feaster said. ``So can being HIV-positive. Doctors need to be aware of this and not miss a diagnosis because the patient is `too old' to get HIV, or `too straight.'''
Kalayjian, too, likens AIDS to a fast-paced version of what everyone goes through as they age. The armor that protects humans against disease starts wearing thin, he said, causing vulnerability to attack from multiple fronts.
Kalayjian said HIV, which can go undetected for 10 years in some people, progresses more rapidly in older patients regardless of when they contracted the virus. His own research has found that even when older patients adhered to the daily grind of HIV treatment, they still recorded poorer outcomes than their less-compliant but younger counterparts.
Drug side effects
Kalamazoo's Feaster, 47, a graduate of New Jersey's Rutgers University who has been active in HIV and AIDS education since the early 1980s, noted that four new classes of HIV drugs have been developed over the last decade.
``Side effects are reported in only 20 percent of patients,'' he said. ``Most people will get an initial bout of headache and diarrhea, with symptoms typically disappearing in a few weeks.''
But older patients, many of whom already have high cholesterol and cardiac problems, face additional side effects. ``HIV drugs have the potential to raise cholesterol,'' Feaster said. ``They can also displace body fat, removing it from the arms and legs and loading the body cavity. This, in turn, can be dangerous for the heart.''
Feaster said that despite a lot of unknowns, ``doctors remain optimistic that any of the drug-related side effects can be effectively managed.''
Forgetting meds
What can be harder to manage is the risk of people, especially older patients, forgetting to take their HIV medications, he said.
``The drugs make the bloodstream a hostile environment to live in,'' Feaster said, ``so the virus migrates to the lymph nodes, where it typically doesn't replicate. We've now learned that smaller, multiple doses work best. If you skip a day, there's no more medicine left in your bloodstream, giving the virus full rein to multiply. Once it's unleashed again, the virus can mutate and become resistant to the drug you are taking.''
But that's just part of the problem. ``If the person transmits the disease to anyone else, they might be transmitting this resistant strain,'' Feaster said. ``That's why it's so important for people with HIV to take their medications regularly. This goes for everyone, regardless of their age.''
Newhouse News Service reporter Regina McEnery contributed to this report.
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