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"Premature Aging" and HIV: Dispelling Myths and Calculating Risk

September 19, 2012

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Making Sense of the Research

To determine whether HIV-positive people have a "greater" risk of developing certain health problems as they get older, researchers have to compare those HIV-positive people to a group of HIV-negative people. Who those HIV-negative people are, and what measurements researchers use to examine them, makes all the difference.

People with HIV who are visiting a Veterans Affairs hospital in Los Angeles are likely to be very different from your average HIV-negative people living in a Massachusetts suburb. For instance, they're more likely to be people of color; they're more likely to be from an inner city; and they're also just more likely to be sick in the first place, since they're the ones visiting a hospital.

Another slide from a presentation given by Amy Justice at an HIV/AIDS conference in 2012. It shows some of the key results from a study published in the Annals of Internal Medicine that corrected earlier research which drastically overestimated how much earlier people with HIV develop certain cancers, because it didn't properly take people's ages into account.

Another slide from a presentation given by Amy Justice at an HIV/AIDS conference in 2012. (Click the image to enlarge it.) It shows some of the key results from a study published in the Annals of Internal Medicine that corrected earlier research which drastically overestimated how much earlier people with HIV develop certain cancers, because it didn't properly take people's ages into account.

All of these kinds of factors -- race, location, gender, income, access to health care, average age, you name it -- can impact the risk a person has of developing a health problem. Sure, an HIV-positive black man working a low-wage job and living in an unsafe neighborhood in Los Angeles may develop heart disease many, many years earlier than an HIV-negative white man living in a million-dollar home in Weston, Mass. But is it the HIV that's to blame?

Studies like VACS try to level the playing field by comparing groups of people who are as similar as possible in every measurable way -- except that one group has HIV and the other does not. Very few studies like this exist, because finding enough HIV-positive and HIV-negative people to match in this way is extremely difficult (not to mention extremely expensive).

VACS is not the be-all, end-all of studies on aging and HIV. Researchers are constantly looking for ways to refine their studies, enroll more volunteers and make their results more reliable. But as you saw in the list above, what we've learned so far is enough to dispel some widely held myths about HIV and aging. It's also enough to give researchers some insight into how people with HIV can reduce the risk that they'll develop various health problems as they get older.


The Power to Change

"'Premature aging' -- I think it frightens the living daylights out of people," Justice says. "It suggests there's nothing you can do: You'll be 70 when you're 50, and when you're 70, you'll be 90. I don't think that's useful in clinical care."

In hopes of helping HIV-positive people and their health care providers combat this feeling of helplessness in the face of the relentless passage of time, Justice and her colleagues have developed a tool called the VACS Index Calculator. The tool, which is available online -- and even has a mobile-friendly version -- pulls together all of the research VACS has done to date and attempts to answer the question: "What are my odds of dying?"

VACS Index Calculator screen shot

A screen shot of the VACS Index Calculator.

OK, yes, it's a terrifying concept: You check off a bunch of boxes -- age, sex, race, CD4 count, HIV viral load, liver enzymes and so forth -- and the calculator spits out a single number called your "five-year mortality risk." In other words, your risk of dying within the next five years.

But here's why the tool isn't remotely as terrifying as it seems: It's not a prediction. It's just VACS telling you, "Among the people in our study who are similar to you, this many passed away within five years." Which means you and your health care provider have the power to change those odds.

"It's a way of gauging your overall burden of disease, your overall susceptibility to further injury," Justice explains. "Whether the [cause] is treatment toxicity, HIV disease progression, diabetes, smoking, alcohol -- it reflects all of those things, in terms of looking at their injury on your major organ systems. And, by determining what else is going on in your situation, helping you pinpoint what things you might be able to do to improve it."

The VACS Index Calculator is still in development; Justice hopes over time to add features that may delve more deeply into people's behaviors and life habits, and offer some suggestions about changes they can make to reduce their mortality risk and stay as healthy as possible. She encourages people to use the tool, offer comments on how it can be made even more useful for them (there's a survey link within the tool), and discuss the calculator's results with their health care provider.

"I think the more information you can give patients directly and the more time they have to think about what questions they may have for their providers when they go to see them, the better, the higher quality, the more meaningful the interaction is, and the more likely the behaviors [that increase their health risks] will really change," Justice says.

In the meantime, Justice and her VACS colleagues -- as well as a number of other research teams around the country -- will continue their efforts to more reliably explore the real risks of HIV-positive people developing various health problems as they age.

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This article was provided by TheBody.com.
 
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Reader Comments:

Comment by: sasha (texas) Wed., Feb. 27, 2013 at 6:26 pm EST
Where do you go to take care of yourself when your primary doctor sends you to this doctor and that doctor and that doctor sends you to another doctor not knowing what the meds are doing to you Ex. due to hiv meds our bodies are falling apart and my leg was almost cut off and I did get a stent and they wanted to do an angiogram when my nerves are dying help me help myself for my bones are also so bad I finally asked for a b12 shot or something and 4 days later my doctor put me on 50,000 mgs of d2 can anyone help me please I have fought for to long to give up now.......
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Comment by: TIM (LONDON[UK]) Tue., Jan. 29, 2013 at 12:33 pm EST
I am a 57 yr non smoker,gym goer,and eat reasonably healthily.diagnosed in 97 hiv/aids started haart immediately.since then i have suffered lip-atrophy,kidney failure, liver problems,arthritis,neuropathy and oh yes i,ve had 2 heart attacks requiring bypass surgery.i also have to live with crippling fatigue. thanks to the NHS. I've had several courses of Newfill for my facial wasting[and yes, people think i look younger than my years]but that is an illusion.i am no professional,and whether it's down to the hiv or the side effects of the medication nobody can tell me that you don't age a lot faster with hiv.how can shoving 20 pills a day into your body NOT have a detrimental effect.some times there is a lot to be said for anecdotal evidence.
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Comment by: Mark (Aztec, New Mexico) Fri., Oct. 26, 2012 at 10:45 pm EDT
Not all pozzies have an AIDS diagnosis, which the study uses as a criteria. I am more than 27 years positive, took Crixivan for 11 years and AZT for 13, but never had an AIDS diagnosis. I have had all of the nasty side effects associated with first-line cocktails and also believe the ongoing inflammation caused by living with the virus long-term also has had an effect. I have no doubt my lifespan will be abbreviated. I am beginning to think most of these studies are rather useless because of the wide range of variables.
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Comment by: Paul (Edinburgh Scotland uk) Mon., Oct. 1, 2012 at 7:27 am EDT
In having had h.I.v. For 17years I find now that people are
Amazed at my age 56, 31-10-56. I alwayz looked older when I was 15 but now that I'm older they say that I am that age, I think for me its incidental, I had a wild life AMD lived it to the macs,I believe that if you can feed your self well and only occasionaly indulge your self you can make it. paul
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Comment by: allen s. (so Illinois) Fri., Sep. 28, 2012 at 11:20 am EDT
by the time I was 5o my hair was 20% grey now at 54 Iam 90% body hair included been full blown 30yrs
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Comment by: richard k. (ft lauderdale, fl) Fri., Sep. 28, 2012 at 6:34 am EDT
I think the important thing to consider which she mentions, is that HIV is an immune compromising disease, so that as the body ages, HIV+ individuals will be at higher risk than non-compromised individuals. However, immune compromised individuals in the general population that are HIV- also include cigarette smokers, excess consumers of alcohol and drug abuse. This is why I believe it is imperative for HIV + individuals to eliminate additional immune compromising factors in order to live longer, healthy lives.
I fail to understand given the above average use of those three factors in the gay population and especially in the HIV+ population that doctors do not intervene on behalf of their patients.
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Comment by: SÚrgio (Brazil) Thu., Sep. 27, 2012 at 3:53 pm EDT
I am not so sure about an early aging to positively charged people. I am a 48 years old male, who is positive now for 21 years. I am on meds for 11 years. I started meds when my CD4 count was 44. I work out very hard, practice judo and boxing. I am in many senses stronger and healthyer than when I was negative. I have colleagues in my work that, being 10 years younger than me, look and feel 10 years older than me. I have a healthy diet, go to work every day by skateboard, I do not drink or use drugs. Again, i feel younger than when I was 26 years old. I love my job, I am married with a six years old daughter, and, in spite of being positive and on meds, I plan to live at least until 80 years old. So, I think that all this studies about aging in positive people are just guidelines, but not a plain truth for all positively charged people on earth.
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Replies to this comment:
Comment by: dante (La) Sat., Oct. 20, 2012 at 11:52 am EDT
I am glad to hear u r doing great, keep it up


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