September 24, 2012
It's a pleasure to welcome back Dr. Bruce Rashbaum, who generously answers real medical questions from real people living with HIV. Bruce is a nationally recognized authority on the care and treatment of persons living with HIV/AIDS and travels extensively lecturing on the management and treatment of HIV to both patients and fellow physicians. He is a primary investigator for many clinical trials with major pharmaceutical companies, allowing him to stay on the cutting edge of HIV research and treatment. You can send questions for Dr. Bruce to firstname.lastname@example.org.
Here is a question we received recently, and Bruce's answer:
Q: I've been living with HIV for 30 years, and for half those years I never imagined I would live to retire at 65. Now it's going to happen soon! What do I need to know? What different care will I need, and will I be able to get that care?
A: You are in good company. The number of individuals aging with HIV is increasing due to a number of reasons: the successes of HAART therapies, the identification of older individuals with newly diagnosed HIV, and the fact that HIV actually compresses the aging process so we, as providers, need to be well trained not only in HIV but all those medical conditions that occur as people age. In fact by 2015, it is predicted that > 50% of all people with HIV will be > 50 years of age. So, the problems that come to mind are that cardiovascular, liver and kidney disease are more prevalent as one ages and they are also among the more common causes of death due to HIV, not HIV-related causes. So, one should have a provider who is well versed in caring for an older individual in addition to having experience with HIV care. The systems do not function as well so the drugs we use to treat HIV may be metabolized less effectively, therefore, potentially allowing for greater incidence of toxicity. As I mentioned above, there is a greater chance for more comorbid conditions (additionally think about osteoporosis, neurocognitive decline, and immunosenescence -- aging of the immune system that naturally occurs with age) that will require more medications, so the polypharmacy that can happen with age has the potential to lead to more drug-drug interactions. So the big things to think about are that HIV is no longer the disease it was in the 90's, men and women are going to live to be old men and women and they will get the same diseases that older people get, only at an earlier age. The result will be potential for medication issues, toxicities, drug-drug interactions.
Lastly, a big problem today is that fewer and fewer doctors are accepting insurance, and this goes double for Medicare. So, it might be more costly to get your care or to even find a doctor that will be experienced who will take your insurance. I think it is important to be proactive and to be on top of your health care. So get colonoscopies at earlier ages and possibly more frequently. Get anal pap smears regularly and a chest x-ray every 5 years. See a dermatologist and get skin surveys annually to screen for skin cancers. Probably everyone with HIV should also be on a statin even if they have normal lipids. The issue here is that HIV is a coronary artery disease risk equivalent, just like diabetes, rheumatoid and psoriatic arthritis ... all because of inflammation. How do we manage those diseases? We put our patients on statins to prevent further augmentation of plaque disease due to inflammation that persists even with control of these disorders. This is controversial and this is one doc's opinion but this is how I manage myself and I, too, am a 33 year survivor and my reading and clinical experience suggests that I am doing the right thing.
Congratulations on 30 years. It is a tribute to your adherence with good medical care and the successful research that the pharmaceutical industry had produced to give us bigger, better and more tolerable medications.