June 28, 2010
David Brown, 45, has been beating the odds for 20 years. Diagnosed with HIV in 1990, when he was 25, he had seen many of his friends and one partner lose the battle against AIDS. "I knew that it was a death sentence for me too," Brown says. But lifesaving antiretroviral medications and good health-care providers gave Brown, and thousands of other people living with HIV/AIDS, a new lease on life and life expectancy.
More than a half-million individuals who have been diagnosed with HIV/AIDS since the epidemic began have died, and two-thirds did not live until age 45. Still, recent surveillance data from the Centers for Disease Control and Prevention show that the number of people living with HIV/AIDS (PLWHA) who are at least age 50 has doubled since 2001 to more than 155,000. There are approximately 1.1 million Americans overall living with HIV/AIDS, of whom 48 percent are Black. Of PLWHA in this country, some 468,000 have AIDS itself.
Historically, PLWHA did not live long enough to experience the arthritis, heart disease, diabetes, renal failure or cancer that other people develop with age. But the same drugs that have extended their lives have opened the door to new health issues, including age-related diseases.
"When I was first diagnosed, doctors didn't give me a good chance to see my 30th birthday, but now they are talking to me about keeping my heart healthy and my weight under control so I won't have a heart attack or stroke," Brown says.
A meta-study of nearly 40,000 patients from Europe and North America found that even though AIDS-related deaths have dropped significantly, mortality related to non-AIDS-related disease has increased. In the case of certain conditions -- such as diabetes -- some antiretroviral treatments can increase the risk, especially for those already more likely to develop the disease, including Blacks and those who are over age 45, are overweight or obese, or have a family history.
The research also showed that some otherwise healthy men and women in their 50s taking antiretroviral medications have the immune systems of 88-year-olds, and chronic diseases often associated with aging tend to strike them sooner and harder. Blacks may also not fare as well as their peers because they are entering care later than their White counterparts are.
For some men who have been on the medications for a decade, this premature aging is leading to bone breaks and diagnoses of osteoporosis, which is common in postmenopausal women and in men in their 80s. "My doctor didn't tell me that this was possible because she didn't know," says Brown, who broke his wrist during a routine basketball game. In fact, the incidence of men under 70 with osteoporosis is so rare that Medicaid and Medicare will not pay for routine screening. Advocates are pushing for changes in payment policy for men taking antiretrovirals, because guidelines have not kept up with the lessons learned about this population.
Tyrone Davidson has lived with AIDS since 1997 and has been in treatment since 1999. "I am grateful to be alive, but I feel so old," he says. "I don't want to complain that I have chest pain or that my bones hurt or break, or that I can't remember things, because I feel so blessed to just be here." Davidson says that he's not sure whether his problems with memory are because he will hit 50 this year or because of the medications he's on -- and he doesn't really want to know. Research and surveillance studies show cognitive decline and memory loss in people in their 50s living with HIV/AIDS.
Experts say that those on antiretrovirals should manage aging side effects by vigilantly reporting to their doctors any symptoms and concerns. They must also reduce their risk factors for chronic diseases such as diabetes.
"As I get older, I have to really start thinking about all the things that go with being a Black man, like high blood pressure, cholesterol, heart attacks and my weight," Davidson says. "I write everything down and discuss it with my doctor. I don't assume that every pain is due to the medications I take. But then again, I don't assume it's not. It's all a part of wanting to live well as long as possible."
Freelance health journalist Andrea King Collier is co-author of The Black Woman's Guide to Black Men's Health.