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Is it AIDS or Age

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

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Is it AIDS or Age

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  1. Is it AIDS or Age Joseph L. Lennox-Smith, M.Ed. Executive Director Positive Education, Inc. Celebrating 10 Years of Service

  2. 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

  3. 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 middle-aged 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)

  4. 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)

  5. 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.”

  6. 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-AIDS-defining 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.

  7. Conclusion • Conclusions Non-AIDS-defining infectious diseases, liver diseases, and non-Hodgkin lymphoma represent specific targets for efforts to further decrease mortality in HIV-infected 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.

  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)

  9. Some ConditionsJerome 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.

  10. Some ConditionsJerome 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 + & -

  11. 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

  12. Some ConditionsJerome 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

  13. Some ConditionsJerome 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)

  14. Some ConditionsValcour, 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)

  15. 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.

  16. 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

  17. 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

  18. 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!!!!!

  19. 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 Hotline1-800-342-AIDS (operates 24 hours a day, 7 days a week) 1-800-344-7432 for Spanish1-800-243-7889 (TTY) www.cdc.gov • CDC National Prevention Information NetworkP. O. Box 6003Rockville, Maryland 20849-60031-800-458-52311-800-243-7012 (TTY) www.cdcnpin.org/scripts/index.asp

  20. Resources • National Institute of Allergy and Infectious Diseases (NIAID)Office of Communications and Public Liaison6610 Rockledge Drive, MSC 6612Bethesda, MD 20892-6612301-496-5717www.niaid.nih.gov • AIDSinfoP.O. Box 6303Rockville, MD 20849-63031-800-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

  21. Resources • National Association on HIV Over Fifty23 Miner StreetBoston, MA 02215-3318 www.hivoverfifty.org • Senior Action in a Gay Environment (SAGE)305 7th Avenue16th FloorNew York, NY 10001212-741-2247www.sageusa.org

  22. Resources • For more information on health and aging, contact: • National Institute on Aging Information CenterP.O. Box 8057Gaithersburg, MD 20898-80571-800-222-22251-800-222-4225 (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.

  23. Resources • National Institute on AgingU. S. Department of Health and Human ServicesPublic Health ServiceNational Institutes of HealthJune 2004

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