Holding Back the Years

HIV in the United States is changing. This is some of the news we learned at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting, held in San Francisco in the fall. For example, by 2015 half of HIV-positive people will be over the age of 50. Currently, only about 20% are over 50. Further, from 2000 to 2004, people ages 40 to 49 had the highest rates of HIV infection over any other age group. What this means is that the HIV epidemic is "graying." People with HIV are not only struggling with their disease but also dealing with problems associated with aging. These problems -- like heart disease, thinning and weakening of the bones, diabetes, and cancer -- occur at a younger age in people who are HIV-positive. Roughly, HIV (even in people who are on their anti-HIV treatments and doing well) may accelerate aging by about 10 years. The explanation for this might be inflammation. After infection, HIV enters into the bloodstream and inserts itself into DNA. Although starting anti-HIV meds can destroy most of these cells, a "reservoir" of cells remains where the virus can quietly exist. Medications cannot destroy these sites. In addition to producing more virus particles, these sites can also direct the body to produce inflammatory proteins that put stress on organs like the brain, heart, and kidneys. Why this occurs more in some people with HIV and not in others is still unknown, but researchers are actively looking into this. So what, then, can people do to try to prevent some of these early complications? > Make every attempt to lower your viral load to the lowest detectable level. Any amount of detectable virus leads to more inflammation and greater organ and immune-system damage. If your viral load is detectable, talk to your primary care provider about maximizing your antiretroviral therapy. > Avoid habits like cigarette smoking and recreational drug use. Both of these have been shown to increase inflammation in the body and increase the risk of organ damage, in particular in the brain and lungs. > Be sure that you engage in some sort of physical activity -- if possible, every day. Exercise of any kind has a great ability to decrease inflammation in the body and might prevent some of these early aging complications. > Be sure to have your care provider monitor you for diseases like diabetes and heart disease. These conditions, when present, increase your risk for accelerated aging. > Be sure to get appropriate screenings for colon, breast, prostate, anal, and cervical cancers. These cancers, if caught early, have a good chance of being cured. > Lastly, to keep your mind "young," keep socially active with friends and family and learn how to effectively deal with stress. By following these very simple steps, you can reduce your risk of accelerated aging. Urbina is an HIV specialist and the medical director of HIV education and training at St. Vincent's Comprehensive HIV Center as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.