HIV and Aging

When I'm having a bad day, I don't go anywhere, and this is hard for my grandchildren to understand. They notice that I take a lot of pills, and they know I do that to stay healthy. More women need to come out and share how they feel. Maybe then, others can better understand what we’re going through.

-- Brigitte, 56

Early Menopause

For most women, menopause occurs between the ages of 45 and 55. During this time, the production of the female hormones estrogen and progesterone declines, eventually causing menstruation (periods) to stop completely.

Menopause appears to occur earlier in some women with HIV. Just why is not clear, but there are many possible explanations. They include: a low red blood cell count (anemia), lower levels of the hormones estrogen and progesterone, weight loss, reduced CD4+ cell count, and use of street drugs, such as heroin and methadone.

Many of the symptoms of menopause and HIV overlap. This can make it difficult to determine the cause of symptoms and can result in a missed or late diagnosis of HIV. These symptoms include:

• hot flashes
• night sweats
• skin and hair changes
• trouble sleeping
• forgetfulness
• fatigue
• emotional changes or mild depression

Menopause brings with it an increased risk of many health problems, such as osteoporosis, heart disease, cancer of the breast, lung or ovaries, and other conditions. Women with HIV may face a greater risk of these if they are taking anti-HIV drugs.

Talk to your doctor if you have concerns about any of these health conditions or menopause symptoms.

Bone Loss

Your bones are living and growing. The strength of your bones, or bone density, is determined by the amount of calcium, phosphorous and other minerals they contain.

When you have HIV, your risk of some bone disorders increases, whether or not you are on treatment. Research suggests that up to one-third of people with HIV may have early-stage bone loss, or osteopenia.

As we get older, we are more likely to develop bone problems. Women are at higher risk than men of developing osteoporosis, a condition that causes bones to become thin and fragile, and more prone to breaking, particularly bones in the hip, spine and wrist. This is partly because women have 30 per cent less bone mass than men. Women are particularly vulnerable to osteoporosis after menopause, when the hormone estrogen -- key to maintaining bone strength in women -- is no longer produced by the ovaries. On the other hand, HIV appears to cause more bone loss in men than in women, cancelling out or even reversing the advantage that men usually have.

Other risk factors for osteoporosis in both men and women include smoking, getting little or no exercise, and a family history of osteoporosis.

Keeping Your Bones Strong

Since the exact cause of bone loss in people with HIV is not known, preventing bone loss is the best strategy. Here's how:

• Eat a healthy diet.
• Increase your daily intake of calcium and vitamin D3.
• Do lots of weight-bearing exercise, such as walking, running, hiking or weight training.
• Limit or eliminate your intake of caffeine, cigarettes and alcohol.

If you already have osteoporosis, you can take steps to reduce your risk of fracturing (or breaking) a bone and possibly even build up your bone mass. Many people with osteoporosis live full and active lives.

Cancer

Before more effective anti-HIV drugs (called highly active antiretroviral therapy, or HAART) were introduced in the mid-1990s, the most common cancers in people with HIV were HIV-related cancers, such as Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer. Now, thanks to more effective HIV treatment, these cancers are less likely to occur when you have HIV.

On the other hand, the chances of developing both HIV-related and non-HIV-related cancers increase as you age. For example, both men and women 50 or older are at greater risk of developing colon and rectal (colorectal) cancer. People with HIV, especially people with a weakened immune system, can become more vulnerable to certain types of cancer.

Maintaining a healthy immune system with anti-HIV drugs and going regularly for screening tests lowers your chances of getting certain cancers. Fortunately, most cancers are not common and can often be successfully treated if they do occur in people with HIV who maintain healthy immune systems with anti-HIV drugs.

Diabetes

Diabetes occurs when your pancreas cannot make enough insulin. Insulin is a hormone produced by the pancreas to control the amount of sugar or glucose in your blood.

Are You at Risk of Diabetes?

• I am older than 45.
• I am overweight.
• I get little or no exercise.
• I have a parent, brother or sister with diabetes.
• I am of Aboriginal, African, Latin American or Asian ancestry.
• I have high blood pressure (hypertension).
• I have high levels of cholesterol and/or triglycerides in my blood.
• I am co-infected with hepatitis C.
• I take anti-HIV drugs.

If one or more of these risk factors applies to you, it is important that you get tested for diabetes.

If you have already been diagnosed with diabetes, your doctor will need to monitor your blood glucose levels closely, especially if you are taking anti-HIV drugs. There appears to be a link between treatment with anti-HIV drugs and a rise in blood sugar levels leading to diabetes.

Maintaining a Normal Blood Sugar Level

To help keep your blood sugar levels within the normal range:

• Limit the amount of sugar and starchy foods in your diet, such as desserts, soft drinks, white rice and potatoes.
• Choose whole grains, such as barley, brown rice and oats, and unprocessed foods that contain fiber.
• Eat smaller portions.
• Eat a balanced diet, including healthy protein-rich foods, such as lean meats and at least two servings of fish per week.
• Exercise as often as possible, ideally every day.