Aging With HIV: What We Know and What You Can Do
August 31, 2015
Many studies show that older adults with HIV have a significantly higher number of bone fractures, due to increased rates of osteoporosis (bone thinning) and its milder form, osteopenia. Osteoporosis often occurs after menopause in women and later in life in men. In people with HIV, it may be caused by HIV or by certain HIV medications, as well as by traditional risk factors such as alcohol use and treatment with steroids. People with osteoporosis have a high risk of fractures when they fall.
Studies suggest that HIV-positive adults aged 50 experience falls at a similar rate as HIV-negative adults over 65, so falls are an important health concern for people with HIV. But falls are rarely caused by one specific thing. Rather, they are often caused by more than one risk factor, including certain medical conditions, medication side effects, or the person's physical environment. Peripheral neuropathy (nerve damage in the feet and legs), another common condition in people with HIV, can also greatly increase the risk of falls.
What you can do:
The best treatment for falls is prevention:
No Health Without Mental Health
In people with HIV, depression is also linked to high rates of social isolation and the negative effects of AIDS stigma. In one ACRIA study, over 80% of participants said socialization was what they needed most.
In ACRIA's Research on Older Adults With HIV (ROAH) study of almost 1,000 older adults with HIV in New York City, the most often reported illness in addition to HIV was depression. Many studies show that people with HIV have three to five times higher rates of depression than the general population, which is a prime predictor of medication nonadherence. In people with HIV, depression is also linked to high rates of social isolation and the negative effects of AIDS stigma. In one ACRIA study, over 80% of participants said socialization was what they needed most.
What you can do:
Kidney disease, leading to a reduction in kidney function, is more common in older adults with HIV than in those who are negative. This can be caused by HIV itself or by other medical conditions, or it can be a side effect of HIV meds and other meds. Monitor your kidney function on a regular basis, especially if you take Viread (contained in many HIV combo pills). Liver function should also be regularly checked, and you should be screened for hepatitis C and vaccinated for hep A and B. New drugs are available that can cure hep C -- if you can get them.
There is less scientific consensus on whether certain conditions like high blood pressure, diabetes, cognitive problems, frailty, and vision and hearing loss are more common in people with HIV. More studies are needed to clarify the relationships between HIV and these conditions. But they should be addressed by the health care team and patient. For example, in 2015 two large studies showed that older adults with HIV were at increased risk for macular degeneration (a leading cause of vision loss) and hearing loss.
These are just some of the conditions that can affect people with HIV, and many people face more than one. Having two or more chronic illnesses in addition to HIV is called "multimorbidity".
Less Can Be More
Managing multiple conditions often requires more medications. Taking more than five meds is known as "polypharmacy". Many people with HIV, when asked how many pills they take, simply answer "a lot".
Compared with two decades ago, the number of pills a person takes for HIV has been significantly reduced. But that decrease has been accompanied by the need for more pills to treat other illnesses, and pills to manage the side effects of those meds. Many also take over-the-counter drugs like vitamins, herbs, and pain relievers. Polypharmacy can lead to unwanted drug interactions and still more side effects. And, as the number of pills increases, it's harder to remember to take them, lowering adherence. The increase in side effects from polypharmacy can lead to problems such as organ damage, falls and fractures, cognitive decline, hospitalizations, and even death.
Managing multiple medications:
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication Achieve. Visit ACRIA's website to find out more about their activities, publications and services.
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