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Staying Positive

Jon Reinfurt

Staying Positive (continued)

In the case of MACS, Margolick says the study has yet to confirm which cancers (or other diseases) are caused by sheer aging versus some combination of long-term HIV infection, HAART treatment, co-infections (such as HPV or hepatitis B and C), and lifestyle choices.

Margolick is also a bit dubious of the connection between HIV and so-called “premature aging.” It has been observed that, in people with HIV infection, immune cells appear to break down sooner than in HIV-negative individuals, perhaps because of constant immune system activation. The result is an increase in the type of poorly functioning immune cells that are also seen in HIV-negative people as they age.

“But just because it resembles the way an older immune system looks doesn’t mean the reasons for the changes are the same as in an [uninfected] older person,” says Margolick. “We need to know the mechanism of how you got there. What is the mechanism of age-related changes? And is the mechanism the same for people with HIV? Until we know that, I’m cautious on the whole subject. I just wrote a newsletter to the people in our study where I said, ‘It’s premature to say there’s premature aging.’”

Although the potential differences in the mechanisms of age-related changes in HIV-infected and HIV-uninfected individuals are unclear, age-related diseases are becoming a reality for people with HIV. “We see more and more HIV-infected individuals confronting health challenges related to diabetes, bone disease, cardiovascular disease, cancers and other age-related co-morbidities,” says Keri Althoff, PhD ’08, MPH ’05, a Bloomberg School epidemiologist who has worked on the MACS and WIHS studies and specializes in aging with HIV. “Prospective studies are under way to determine if the incidence of these age-related diseases are different than what we observe in individuals who are aging without HIV infection.”

Althoff, an assistant professor in Epidemiology and in the Statistics in Epidemiology (STATEPI) group, has an interesting take on the study cohorts and how to perhaps best predict the risks they face for specific conditions given their current median ages. She notes that while the overall numbers in the cohorts are large, the median age of study participants—54 in MACS, 46 in WIHS—means they aren’t quite old enough to see large numbers of definitive conditions such as heart attacks and diabetes.

“These folks are not as old as [HIV-uninfected] baby boomers, those over 65. So it is likely that the wave of age-related co-morbidities [found in those over 65] is still on the horizon for our cohort participants,” notes Althoff. She suggests that a more robust assessment of risk in the cohorts might come from looking for the subclinical markers of illness and seeing whether they play out equally in the HIV-positive and HIV-negative participants. “Instead of studying diabetes, we can study markers of insulin resistance, which are on the pathway of progression to type 2 diabetes,” she says. ”Instead of studying heart attack, which happens more frequently in the aging general population but is a very rare outcome among our cohorts, we can study precursors for cardiovascular disease such as the thickness of arterial walls, statin use, blood pressure and CRP levels.”

Their findings may change treatment of HIV yet again.

  

Ask anyone aging with HIV what they’ve been through, and it’s rare to find someone who has come through the infection physiologically unscathed. Some, like Chris Camp, face a non-stop battle: Between serious complications that were part of the often-extreme toxicities inherent in early AZT and HAART treatment, and an ongoing daily regime of dozens of pills to control both his infection and numerous health issues, “there’s not a moment that goes by, living with it as long as I have, that I don’t know that I’m HIV infected, that I have this disease. It’s in my head all the time like a noisy alarm clock,” says Camp, his index finger tapping the center of his forehead for emphasis.

Others, such as 50-year-old Mike Willis, diagnosed in 1994, had extreme early struggles with HIV—various degrees of drug resistance had him, at one point, on a combination of seven different antiretroviral medications that knocked down his viral load, but “my liver, kidneys and pancreas almost shut down,” recalls Willis.

He nearly died as a result, but has long since stabilized on a modest two-drug HAART regimen. A diet and fitness devotee, Willis looks fit as the proverbial fiddle. Once on long-term disability due to his infection, he’s gone back to work and often bikes to the gym for long, energizing workouts. He cheerfully admits, “I don’t have a lot to complain about. I’ve done really well, and I’m grateful,” though he also notes that he’s had to exercise hard to stave off the effects of osteoporosis (he was diagnosed with the bone-loss condition at 43, and it’s since improved), and he takes medication for high cholesterol, both conditions perhaps relating to his HIV status and treatment.

Then there are those for whom HIV has proved more burdensome as the years have gone by.

Marilyn Burnett, 68, contracted HIV in 1991. She has successfully avoided the opportunistic infections associated with her AIDS diagnosis. Her generally good overall health allowed her to become a well-known Baltimore advocate for HIV education, notably with Older Women Embracing Life, an HIV support group run in partnership with Hopkins Medicine’s AIDS Education Center.

Comments

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  • SnO-FlAkE

    leland ms 09/18/2012 11:49:30 AM

    very very gd info

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