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UNTREATED HIV AND AGING

Aug 27, 2017

I was tested hiv+ in feb 2013 and refused arv because of terrible side effects. I have lost 15kg but remained healthy all that time.My concern is whereas,am now 61yrs,I look like 75yrs on my face though am still strong and active. Does hiv accellarate aging?

Response from Dr. Young

Hello and thanks for posting.

For purposes of this discussion, I'll assume that you live in the United States.

Currently recommended HIV medications rarely cause significant, are even less so cause terrible, side effects. Indeed, because medications are so well tolerated, we now know from several large, well designed clinical studies that treatments result in substantial reduction in death, progression to AIDS and serious non-AIDS complications, such as cancer and tuberculosis. Earlier initiation of treatment is associated with lower (not higher) risk of those uncommon side effects, and elimination of transmission of HIV to others (babies and sexual partners).

Though you may feel healthy, untreated HIV is associated with decline in your immune function and your report of accelerated facial aging suggests that there's more to this story. An lower pretreatment CD4 cell counts is associated with increased risk of a wide range of complications, such as heart disease and osteoporosis.

Aging among people with HIV is an important subject and one of increasing awareness. There's debate about just how much age-related complications (such as the aforementioned heart disease, but includes stroke, cancer, kidney disease, hypertension) is due directly to HIV or medications, or if there is a preponderance of other risk factors (such as smoking or hepatitis) in the very populations of people affected by HIV. Older people who don't start treatment are at vastly greater risk of having and AIDS complication while waiting to start treatment. It's also clear that older people living with HIV have attenuated (lower) CD4 cell recovery once treatment is started.

Taken together, while there is agreement in US and World Health Organization HIV treatment guidelines in recommending HIV treatment irrespective of CD4 or clinical symptoms, that recommendation, if anything, is even stronger for older individuals.

I hope this is helpful, BY



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