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Is It AIDS or Is It Aging?
Considerations for Aging With HIV

By Edwin Krales, M.S., C.D./N.

December 2004

Is It AIDS or Is It Aging?
As an HIV/AIDS nutritionist and health educator, I work with many people who are over 50. I know that aging brings on medical, economic, social, nutritional and energy problems even in the absence of any disease. HIV disease creates similar problems in infected people of any age. When aging and HIV collide in a person over 50, what are the consequences? Are the problems unique to this population? If so, how are they addressed to the best advantage of the infected older person?

Contrary to what we are taught, getting older is a good thing -- it means that we haven't died yet! Each aging person faces problems that are new to him or her, although the problems themselves are not new but re-occur in each generation as it ages. As people with HIV continue to live longer, they will also be encountering many of the usual problems of aging.

The following chart is my organizational approach to many of the issues that confront a person with HIV who is getting older. It attempts to help people answer the question, "is it AIDS or aging?"

There is no one right way to use the following chart. Reading from left to right or from top to bottom is not important. What is important is to locate an issue that has been on your mind and see if the information can give you an idea about how to deal with it better.

 Habits for YearsAgingHIV/AIDS
Lean Tissue and Muscle Mass LossWere you active and athletic or sedentary? The more lean tissue you have throughout life, the better you will be.As we age we tend to be less active, lose muscle and put on fat. Start exercising again today. Testosterone decreases as we age. Menopause raises related issues.The virus takes lean tissue and fat in weight loss. But more fat is gained back than lean tissue when weight is regained compared to weight gain in an uninfected person.
Drug Interactions and ReactionsDid you pop pills (any kind, over-the-counter, prescription, or street)? Did you use dope of any kind? Alcohol? Methadone? What was in that dope you bought in the street? What was it cut with? Does it interact with your medication? Have you told health care provider about your habits?As we age we tend to use more medication. At what point does the negative drug interaction start? Who is paying attention? Does any one provider monitor all of our medications?Lipodystrophy, breast enlargement, diabetes, heart disease and osteonecrosis. Can anything help with these horrible disorders?
Eating HabitsWere ketchup and mustard your vegetables? Did your vitamin C come from French fries? Were you on the SAD diet (Standard American Diet)? Were you constipated often? Did you have a hard time with certain food, such as milk? Did you know how your food was prepared? Malnutrition impairs immunity.Idiopathic bowel disease may come from a life-long habit of not eating enough vegetables and fruits. Our stomach acid gets weaker as we get older, making digestion less efficient and preparing the way for H. pylori and reduced amounts of Vitamin B12. Combine this with a loss of muscle tone in our GI tract and we wind up with gastrointestinal problems.HIV likes to live in our gut. This has a negative impact on digestion. A low T-cell count paves the way for various parasites to become established, and for H. pylori to grow in our stomachs. Combine this with a decrease in stomach acid and one of the results is we have to compete with the bacteria for the Vitamin B12 produced.
Vitamins, Minerals and PhytochemicalsDid you eat enough fruits, vegetables and whole grains or take a vitamin pill? Or were you on a junk food mission? Somewhere in between?As we age we tend not to get enough Vitamin B2, Folate, E, Selenium, protein, calories, calcium and vitamins A and D. Is there enough food at home? Do you skip meals?If you are HIV+ you need more vitamins B12, Folate, E, Selenium, protein, calories, other B vitamins, C, Zinc and iron. Can you cook? Do you have cooking facilities? Food?
IllnessesWere you ill often? Do you have any chronic illnesses? Any structural problems? Obesity? If you are gay or bisexual, do you feel left out or guilty about being HIV-positive?Cardiovascular disease, cancer, hypertension, vision, bone and skin problems, diabetes and Kaposi's sarcoma increase as we get older.Don't confuse AIDS-related dementia with Alzheimer's. Are opportunistic infections age-related, HIV-related, or a combination of both? End-stage liver disease is a top killer today.
Medical IssuesDo you have baseline medical measurements such as: cholesterol, triglycerides, PSA, Pap smear, mammogram, sugar levels, liver enzymes, kidney function, bone density, BIA, blood pressure, eye exams, dental care, vaccines?How have these test results changed through the years? How about macular degeneration? Glaucoma? Did you ever get baseline measurements done? Were they thought to be unnecessary or too expensive?How does HIV/AIDS alter these test results? Have you been tested for diabetes? Bone density? CMV retinitis? Hepatitis? HIV genotype and phenotype? Ultra-sensitive viral load test?
Psycho-Social Issues and StressClass, race, religion, sexual orientation, gender, education, neighborhood, and job all impact on how you relate to the world and how the world treats you. Do you love who you are? Do you have enough money to live?Aging is gentler when you are rich and healthy. Stress and hypertension are exacerbated by racism in people of color. Feeling "old" is more closely related to social attitudes and personal feelings than to age.Are you depressed? Do you feel like a pariah and expendable in the eyes of society? Do you hide out from others? Do you feel desirable?
Sex DriveUse it or lose it. Practice safe sex all the time. Do you compare yourself or your mate to the false images in our TV commercials and magazines? Do you fall short of perfection? The entire human race falls short. Do you feel guilty about your sexual desire?We don't describe our elders as sexy. "Dirty old man" or "little old lady" is what we say. Hormone levels do go down as we get older. Other problems may be the cause of impotence or decreased sexual interest in men. Do you feel vital and attractive?Hormone levels do decrease. Vaginal secretions decrease. Anemia, wasting and liver disease may add to fatigue and lack of sexual interest. Safe sex isn't important only for youngsters or people who are HIV-negative.
SmokingThe longer you smoke, the worse it gets. Smoking and drinking alcohol makes the ill effects of both drugs worse.Smoking is a systemic poison. The list of illnesses made worse by smoking gets longer every day. Stop completely, or at least cut down.Smoking is a great way to help the virus kill off you immune system. Stop smoking today, or at least cut down.

Edwin Krales, M.S., C.D./N. is an HIV/AIDS Nutritionist and Health Educator with the Momentum AIDS Project.

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