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Age 60
Jan 11, 2009

Hi Dr. Bob

I was negative in April 08 and diagnoed in July 08 positive at the age 60. My first CD4 in Sept was 472 VL 1300 just tested again in Dec. and CD4 was 622 and VL 3490. I have looked for info on hiv at 60 and find no real studies. I guess my question is in your thoughts on how long at age 60 someone can plan on living.

Thank you for your time.

Response from Dr. Frascino

Hi,

I would suggest that if you work closely with a competent HIV physician specialist and adhere to recommended treatment and follow-up regimens, you should plan on dying of old age rather than old AIDS. See below.

Dr. Bob

burn out at old hiv-pioneers (OLDER PEOPLE AND HIV/AIDS) Nov 27, 2007

Hi Dr. Bob.

Mikel again from Germanys online-support hotline :-)

on world aids day i will be interviewed by a radiochannel to the subject of "getting old with hiv"

gee, I am just 48 and within the hiv-community i am rated as "older" :-))- well never mind, i will hang on a few more years...

but getting serious: I remember i read in the newsletter some month ago a note about the situation of longterm-hivers who always have been pioneers and get worn out with this special situation, now that they will expect to be the first hivers entering homes for elderly people...

i would be grateful if you have an idea where i can trace back this interesting report.

by the way: the german aids campaign relaunched it's webside www.welt-aids-tag.de in an interactive platform, where everybody could apply for becoming a blogger. So I jumped into that to represent hivers on this platform. First a bit scared about exposing to the whole wide world, but with the encouraging feed-back i really do like it. have a look at my profile :-))

always like to watch thebody's newsletters.

let's live power on world-aids-day! :-)

stay well and take care!

Michael AIDS-Hilfe Wuppertal Germany

Response from Dr. Frascino

Hi Mikel,

Hopefully the information below will help with your interview. By the way, HIV "daddies" can still be hot!

Stay well.

Dr. Bob

data & longevity Jun 22, 2007

Hi:

thank you for all the insightfull information. I am compelled to write again. I was dianosed 1 yr ago on the 25th anniversary of HIV. (Not the best celebration for me!) I am in my very late 40s and am very sensetive to the nearing turn, its effect on me, my hiv, and longevity.

Do we really know that much about people with hiv over 40? It seems that more people like me are getting infected and we really have no idea of the future for us? Regular aging mixed with HIV, meds, and OIs, etc?? Can you shed some light.

I do love this site, but I must admit, I'd like to see a section/sections on POSITIVE results. I need the doses of reality provided by the questions and answers but many times I could use a "shot in the arm" or some good news, good results!

Is there any information/ site that has data on HIV infected over 50?

Thanks for all your continued help.

Response from Dr. Frascino

Hi,

First off, I must point out that 50 is the new 30. Next, we are continuing to accumulate data on "HIV-Daddies" year by year as more of us survive into our midlife crisis years. At this point all the news is "positive," so to speak. I see no reason you shouldn't plan on dying of old age. As a good friend who is also virally enhanced recently told me, "I plan to live forever. So far so good."

I'll print some basic information about HIV in older folks below.

Stay well. See ya in the old folks' home, OK?

Dr. Bob

Older People and HIV

How Many Older People Have AIDS?

About 78,000 people age 50 or over have AIDS in the United States. This is about 10-15% of all people with AIDS. In some cities, 15-25% of people with AIDS are 50 or over. The number of older people diagnosed with AIDS is increasing. About half of the older people with AIDS have been infected for one year or less. Many people don't consider age 50 to be "old." However, age 50 is being used more often to keep statistics on "older people" with HIV and AIDS.

Why Are Older People Getting Infected?

There are several reasons: Health care providers may not test older people for HIV infection Older people may lack awareness of the risk factors for getting HIV (see Fact Sheets 150 and 152) Many older people are newly single. They get divorced or lose their mates. While they had a partner they may have ignored HIV prevention messages.

Lack of HIV prevention education targeted at older people Belief that HIV only affects younger people No training in safer sexual activities (see Fact Sheet 151) Sharing needles with infected people (about 17% of infections of people over 50)

Unprotected sexual activity. This may be heterosexual or homosexual sex. Viagra and other drugs that help men get and maintain an erection may contribute to increased rates of sexual activity and sexually transmitted diseases among older people, as they do for younger people.

Is HIV Disease Different for Older People?

The first studies of HIV in older people were done before strong antiretroviral drugs (ARVs) were available. Most of them showed that older people got sicker and died faster than younger people. This was thought to be due to the weaker immune systems of older people. Also, older people usually have more health problems besides HIV. Normal aging leads to a decline in the immune system. Older people still tend to have long-term health problems. They may not do as well as younger patients with HIV. However, ARVs strengthen the immune system. Also, most older patients, unless they are drug users or have mental problems, take their medications more regularly (have better adherence, see Fact Sheet 405) than younger patients.

Is HIV Treatment the Same in Older People?

ARVs seem to work the same in older people as in younger people. Unfortunately, we don't have good information on older people because they were usually not included in clinical trials of new drugs. People who become infected when they are over 50 seem to do about as well as people who started receiving HIV treatment before age 50 and then got older.

Treatment side effects may not be any more frequent in older people. However, changes caused by aging can resemble or worsen treatment side effects. For example, aging is a major risk factor for heart disease and for increasing fat in the abdomen. Some older people without HIV lose fat in a way that looks similar to the changes caused by lipodystrophy.

What Other Health Problems Are Common?

As people age, they develop health issues that continue for the rest of their lives. These can include heart disease, depression, osteoporosis (see Fact Sheet 557), high blood pressure, arthritis, diabetes, Alzheimer's disease and various forms of cancer. Older people often take many different medications to deal with their health problems. This can make it more difficult for a health care provider to choose ARVs, because of interactions with other medications.

Some ARVs may increase the risk of diabetes, high blood pressure, or osteoporosis. This makes it harder to choose the right HIV regimen.

Mental Problems

Older people may have more problems with thinking and remembering than younger people. These symptoms can be the same as HIV-related mental problems. Fact Sheet 505 has more information on HIV and nervous system problems.

These problems, sometimes called dementia, are less severe than they were before the use of strong ARVs. It is difficult to know what is causing mental problems in older people with HIV. Is it normal aging, or is it HIV disease? Research studies have linked both age and higher viral load (see Fact Sheet 125) to mental problems.

Rates of depression and substance use haven't been well studied in older people. However, these problems may be related to HIV disease, aging, or both. They need to be diagnosed and treated correctly.

The Bottom Line

The number of people over 50 with HIV or AIDS is growing rapidly. Between 10% and 15% of people with AIDS in the United States are over age 50.

Older people get HIV the same way as younger people. However, they may not be aware that they are at risk of HIV infection. They also may not know how to protect themselves from HIV transmission.

Older people have to deal with other health issues. These can complicate the selection of ARVs. They can also be confused with some of the side effects of ARVs.

ARVs work about as well in older people. Also, older people may be better about taking their medications than younger people.

This article was provided by AIDS InfoNet.

How Long?(LIFE EXPECTANCY) (PROGNOSIS) Dec 12, 2008

If you are infected by HIV would you have a normal life span like any other human without?How long could you live without meds and how long can you live with the medications?

Response from Dr. Frascino

Hello,

The course of HIV/AIDS varies considerably from person to person. Many factors are involved, including viral strain, concurrent illnesses, age, immune integrity, etc. As for life expectancy with HIV/AIDS, see below.

Dr. Bob

prognosis for us all (LIFE EXPECTANCY) (PROGNOSIS) Nov 14, 2008

dr. bob,

hope the wedding went well! congrats. i wanted to ask you about the prognosis for long term med use in relation to life expectancy. i have read quite a bit and it's always very interesting to say the least. i know you can't give a definitive answer, as no one can at this point, but i know you have dealt with this on a very personal level for many years and i value your opinion both as a person and medically. given that a person is "in good health" and starts HAART at the "appropriate time" AND (lol) "adheres to one's regiment faithfully", what do YOU think the life expectancy is for someone dealing with this illness. i have gotten solid but unemotional answers from my ID doc and i have read everything from 10 to 23.22222 (lol) years. i hope i'm not putting you in a spot, but there's no one who has this that doesn't bounce this question around at some point. without going on anymore, please be honest with me on a personal level. i know you understand this need and i hope i'm not being intrusive. your input is invaluable as i consider you a very talented and compassionate individual. thanks for at least reading this. peace and health to you and your husband.

dale

Response from Dr. Frascino

Hi Dale,

Your question is not intrusive or inappropriate in the least! Nor are you putting me on the spot. In fact, I've addressed this topic recently. See below.

The reason we can't give a more specific answer is that there are so many variables at play, such as age, viral strain, concurrent illnesses, immune integrity, immune response, etc., etc., etc.

Personally, I plan to die of old age. Care to join me at the old folks' home?

Dr. Bob

Does HIV always turn into Aids (SURVIVAL) (LIFE EXPECTANCY 2008) Sep 29, 2008

Hi Dr Bob,

first l would like to say what a great effort you put into the forum, and you are my hero, l am recently Hiv Positive not on meds yet, CD450.... when my cd drops to 350 in the future, and l can take meds well, what are the chances l will end up getting AIDS or dying from Aids ??? if HIV even when your on meds leads to AIDS how long in years does it take to go from hiv to aids ??? l know you dont have a crystal ball, but just your expert opinion will do.. l live in Australia..... and l hope obama wins the election and approves stemm cell reseach, ......... thank you for your time Dr Bob

frank

Response from Dr. Frascino

Hello,

I've recently addressed your question. See below. I have nothing new to add.

Dr. Bob

how many people die from HIV in 2008 (HIV/AIDS SURVIVAL) Sep 6, 2008

Hi Bob, l am recently infected with hiv and and live in Australia, 36 years old and my hiv specialist told me hardly no one dies of hiv-aids anymore in Australia, he said maybe 10% of pepole with HIV die in 2008 in auz, but people infected in 2008 with a CD4 of 350 and start treatment early, will have a healthy normal life span with todays and future treatment, without hep b and c.. l read that with todays treatment a 20 year old can live at least 40 years on meds is this true ???

Dr Bob you are one man that tells it as it is... please what is your information and opinion on the above...

thank you for your time, you are my hero Dr bob for prez of america

Response from Dr. Frascino

Hey there Aussie Dude (or Dudette?),

How many people die from HIV in 2008? Well, if you are asking how many HIV/AIDS-related deaths will occur worldwide (or in the Land Down Under) in 2008, we obviously don't know yet, because it's only September, silly boy (or gal). The most recent actuarial data we have is for the year 2006. That year, an estimated 2.9 million people worldwide succumbed to the pandemic.

However, I tend to doubt that is the real emphasis of your query, right? I assume you're more interested in prognosis, wondering more how many of us will live rather than how many of us are going to be pushing up daisies any time soon. This is a difficult question to answer definitively, as none of us (even Professor Trelawney from the Harry Potter series) has an infallible crystal ball that accurately predicts the future. What we can say with great confidence and a grand sigh of relief is that HIV/AIDS is no longer a death sentence with a short shelf life, at least for those of us fortunate enough to have access to antiretroviral medications and HIV-knowledgeable health care providers. I realize many well-meaning folks in the HIV/AIDS health care field have made the prediction that HIV/AIDS is now a "chronic manageable illness" and those infected should expect to live "a normal lifespan." Well, I'm perhaps the most optimistic person on the planet, but I'm also a scientist and realist. As such, I can't really claim that we have good data to support this claim. What information we do have clearly demonstrates that the introduction of potent antiretroviral agents in the mid-1990s has been nothing short of miraculous in decreasing AIDS-related morbidity (illness) and mortality (death). These drugs are literally life sustaining, but they are not curative! As I mentioned, nearly three million lives were snuffed out by the virus in 2006! Antiretroviral agents offer us a reprieve from HIV-related illness and death. How long the reprieve will last is still unknown. Years ago, we used to say the average life expectancy was 10 years from the time of diagnosis to death for HIVers. That was an average with a wide-shaped bell curve encompassing that 10-year mark, because patients often don't get diagnosed with HIV at the time they actually contract the virus. In fact, many don't get diagnosed for years and years afterward when their immune system is already shot to hell (or heaven?). Certainly, HAART (highly active antiretroviral therapy) changed this 10-year statistic in a very dramatic fashion. In fact, in 2006, there was a statistical calculation of projected life expectancy for young hypothetical HIV-infected patients. This computer model estimated 24-year survival. But again, this was only a computer-generated model, not real life HIVers. But it in essence doubled our previous "10 year" estimate. We also have a case-control, population-based cohort study of all HIV-infected persons receiving care in Denmark. Denmark, unlike the U.S., has universal health care that delivers quality HIV care and medications to all who need them at no cost!!! An epidemiological study of Denmark's HIVers revealed a median survival time of 32.5 years for 25-year-old HIVers infected between 2000 and 2005. If we excluded those co-infected with hepatitis C, that median survival number increased to 38.9 years! Great news, eh? However, it's still not as good as age-matched controls that did not have HIV or hepatitis C. Their median survival was 51.1 years! So the message is clear. Let's all pack our bags and move to Denmark! Well, in case that's not an option, because you would miss the kangaroos, koalas and that awful tasting vegemite stuff, what we can conclude from these studies is that life expectancy is dramatically improving from the bad 'ol days of the epidemic. And equally important is the fact that none of the studies can factor in the effect of new developments that will come online within the next decade or two. We've made incredible strides in the treatment of HIV over the past decade and should assume progress in new and novel therapies will continue to be forthcoming in the future. So should you plan on buying that piece of retirement property on the beach for your golden years? Well, as they say in Denmark, ya! ya betcha! (Oops, I think that's a slogan from the Scandinavian Midwest, but you catch my drift, right?)

Be well and let's get through this together, OK?

Cheers Mate!

Dr. Bob

Follow-up to "Just found out..." (SURVIVAL) (LIFE EXPECTANCY 2008) Sep 21, 2008

Sorry, had to do a follow-up... and thanks for the kind words. Made me and my b/f happy for a bit, but he's ever the optimist and I'm ever the... not.

I'm in law school... I don't work... I'm already scared of the costs of all this stuff, and if my insurance (mom's plan) drops me before 25 where they would anyway, what would happen to me? I feel so lost... and when I pulled up that site, it pointed to like 4 docs only and three of them were at the UT health science center here... so I dunno what that means, but I see a doc there and she's a resident psychiatrist.

I'm afraid of why I lost so much weight so fast... why there were weird spots on my skin, night sweats... I guess what I'm asking is it true that if ARS hits you bad you're a fast-progressor or will advance towards AIDS fast?

I'm of course worried as to what strain, if it'll even be treatable... heck, doc, can I just ask? Is it true everyone with HIV WILL get AIDS at some point? Or is the truth the other side, that you can avoid it with meds?

I'm not the thinnest person, so I'm worried I'm screwed in health already and it'll just get worse. I understand I need to make moves to find a doc, and I so will... just have to ask what an outlook is for someone like me, considering how well you've done! I envy you, it sounds like it doesn't affect you nearly as much as the media makes it seem a person would be hampered.

At early 20's, will I even see 40?

Response from Dr. Frascino

Hi,

First off, if you're covered by your mom's health plan until you are 25, you can't be dropped just because you've acquired a viral infection! And by the time you turn 25, Obama will be president and hopefully we'll have universal health care so that all Americans won't have to be terrified of getting sick! (All readers please remember to register and vote for Obama and the Democrats!)

As for the four certified HIV specialists in your area that you identified from the American Academy of HIV Medicine's Web site, use the criteria discussed in my last post (re-posted below) to help you make your final selection.

Regarding severity of ARS symptoms, this is not related to disease progression or longevity.

As for whether everyone with HIV will eventually get AIDS, no one knows! What I can say is that we do not have a cure for HIV/AIDS, nor is there one on the foreseeable horizon. However, we have made remarkable progress in treating HIV/AIDS and this has improved life expectancy considerably. (See below.)

Will you live to see 40? If you turn off the computer and get your butt into an HIV specialist's office, I'd say your chances are phenomenally good.

Let's get through this together, OK?

Dr. Bob

Just found out... (CHOOSING AN HIV SPECIALIST) Sep 20, 2008

Well, doc, the feelings came and went and I got the nerve to test. It was positive... I don't know what to do now and I don't even know if I have long left cause of how bad I had the ARS and weight loss...

I want to live... I want to live a long happy life... I live in Texas, am I screwed? I'm a student in a grad school, so I'm poor, but what can I do? How do I move forward?

Response from Dr. Frascino

Hello,

Only those of us who have been through it really understand the full impact of hearing the words "your test came back positive." Many of us feel scared, wondering if we will soon get sick or die. We fear that we will be shunned, lose our jobs or maybe our housing; that we won't be able to have children; that we'll never be able to date, get married or have sex again. None of these things are, in reality, true.

The virus found me while I was working over 17 years ago! Back then, the prognosis for HIVers was about 10 years max. We've made remarkable, in fact miraculous, improvements in treatment of HIV/AIDS, which have dramatically decreased both morbidity (illness) and mortality (death) as demonstrated by the fact I'm still here answering your question rather than pushing up daisies. It is true we do not have a cure, but for many of those lucky enough to have access to antiretrovirals and expert (or at least competent) HIV medical care, "virally-enhanced," healthy and fulfilling lives are truly attainable. Here in the U.S., even for those who don't have or can't afford private health insurance (this includes undocumented immigrants, by the way), it is possible to get quality HIV care and support in most areas of the country.

Now that you know you are HIV positive, I would recommend two simple first steps:

1. Consult an HIV specialist. She will be able to assess the severity of your HIV disease and also help you access the health care system based on your health insurance or lack thereof. To locate an HIV specialist in your area, check the American Academy of HIV Medicine's Web site at www.aahivm.org. There you will find a roster of certified HIV specialists listed by locale. (I'll also print some information below from the archives that discusses choosing an HIV specialist.)

2. Get informed! Learn as much as you can about HIV and its treatments. This Web site is an excellent place to accomplish that. Begin by reviewing the information in the "Just Diagnosed" chapter that can be easily accessed on The Body's homepage under the Quick Links heading. Start with the articles found under the "Just Diagnosed Basics" subheading.

Finally, as far as living in Texas, well, yeah, that kinda sucks, but it really shouldn't impact negatively on your HIV disease.

Start learning more about HIV and get evaluated by an HIV specialist. I'm here if you need me. Let's get through this together, OK?

Dr. Bob

Need a Private doctor Aug 14, 2008

I am HIV Positive living in Seattle area. I currently don't have one and i am looking urgently in a private clinic? Do you know a good one? I asked this question earlier & was told about Peter Shalit who is fully booked until end of year. Please let me know if you have a good one in mind. Thank You.

Response from Dr. Frascino

Hi,

I would suggest you consult the American Academy of HIV Medicine Web site (www.aahivm.org). There you will find a list of certified HIV specialists arranged by locale. There are a number of well-qualified HIV specialists in the Seattle area. Be sure you hook up with one that you trust and with whom you can easily communicate. Your health insurance plan may have some restrictions, so remember to check this out as well. I'll repost some information below from the archives pertaining to locating an HIV specialist.

Good luck.

Dr. Bob

Choosing an HIV Care Provider

July 18, 2007

Why Is Choosing an HIV Care Provider Important?

Treating HIV disease is very complicated. There are choices to consider at every stage of the disease. It's best if you and your health care provider work together as a team. That makes it easier to choose and stick to your treatment plan. "Care provider" means a doctor, a physician's assistant, or a nurse practitioner.

There are several issues you may want to consider in choosing an HIV care provider. You might decide to have them be your "regular doctor" for all of your health issues. You might use a different care provider for most health issues and use your HIV provider as a specialist. If your regular provider isn't an HIV specialist, be sure they regularly get expert advice on HIV issues.

Training and Experience

Many people with HIV/AIDS get their care from physicians who are specialists in infectious diseases. However, especially now that people are living longer with HIV, it's important to deal with all of your health issues. You might prefer to have a family practitioner or a specialist in internal medicine as your primary physician.

No matter what their specialty, you will get better HIV care from providers who have experience treating people at all stages of HIV disease. Be sure to ask how many patients with HIV they have treated, and how many they currently see. HIV patients do better when their physicians have more experience treating HIV disease.

Do You Have Similar Ideas About Treating HIV?

Some providers are conservative. They prefer "tried and true" methods. Others are more aggressive. They are willing to try new and experimental treatments. Some are optimistic by nature, and focus on the hopeful or positive side when they talk about test results or future prospects. Others are more realistic. Some are pessimistic.

Some providers are comfortable suggesting "complementary and alternative" therapies such as massage, acupuncture, or herbs. Others stick strictly to Western medicine.

If you want a lot of emotional support, you probably won't be comfortable with a health care provider who only talks about test results. The more comfortable you are with their approach to HIV treatments, the easier it will be for you to get the kind of health care you want. Talk to providers and their patients before you make your choice.

The Provider-Patient Relationship

Many patients do better when they take an active role in planning their own health care. These patients do a lot of reading on their own, and bring information to their providers. They work together to make health care decisions.

Other patients are more comfortable with the provider making important decisions. Decide how you want to work with your provider. See if that fits with the way the provider likes to work with patients.

Help Your Provider Help You

Make sure that your provider has all the information needed to give the best advice about your treatment. This starts with your medical records, which may have to be transferred from another office. When you start working with a new provider, they will probably do a lot of tests to collect "baseline" information. This helps you see how well you're doing as time goes by.

Be sure your provider knows how you feel about using medications, and about your illness. Some people don't mind taking a lot of pills. Other people would rather take as few as possible. Are you willing to change your diet, or the amnount of exercise you do? Your provider should also know about other treatments you are using or want to try, including non-medical ones.

Be honest about your lifestyle. Your eating, sleeping, and work patterns can make a difference for your health care. So can your sexual practices and use of recreational drugs. If your provider seems too judgmental, try to change providers. It's better to have a provider who really knows you instead of holding back information.

Let your provider know about the important people in your life: the people who will support you if you get sick, or will help you make important medical decisions.

Availability

The best care provider won't do you any good if you can't get in to see them. Ask them (or their receptionist) how long it usually takes to get an appointment. Find out how well they usually stay on schedule during the day.

The type of insurance you have could limit your choice of a provider. Maybe the provider isn't on the list for your health maintenance organization (HMO) or insurance plan. Be sure to find out how you will be able to pay for their services.

Remember, you don't need an HIV specialist to help you with most of your health care needs. If a good HIV provider is hard to find, or if it's hard to get an appointment, use a non-HIV care provider for your general health care. Just be sure that when you are dealing with HIV issues, you see an experienced HIV provider, or one who consults with an expert in HIV.

Confidentiality

Some people are very concerned about keeping their HIV status private. You might choose to get your HIV care from a provider in another town to protect your privacy. You will need to find your own balance between confidentiality and convenience.

Changing Providers

Your health care needs might change as time goes by. Also, your ideas about treatment could change. Although you will probably get better medical care from a provider who has known you for a long time, you always have the right to stop seeing one provider and change to another.

To Find a Health Care Provider ...

You can get help finding a care provider from your case manager or from your local Department of Health. You can also ask other people living with HIV. The American Academy of HIV Medicine has a web page to help you find a doctor at http://aahivm.org/web/index.php?option= com_comprofiler&task=usersList.

The Bottom Line

HIV medical care is very complicated, and changes quickly. This makes it important to find an HIV care provider who works with HIV/AIDS patients and is committed to staying up to date. Your relationship with an HIV provider will be better if you are comfortable with each other's personal style and approach to dealing with health issues in general, and HIV in particular.



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