9 Healthy Aging Tips for People With HIV

How to Reduce Long-Term Risks of Infection

As the early testing and treatment of HIV have increased life expectancy rates to that of the general population, greater emphasis is now being placed on the health of those aged 50 years and older, who may experience premature illness as a result of long-term HIV infection.

According to data from the U.S. Centers for Disease Control and Prevention (CDC), as of 2016, more than 25 percent of the 1.2 million Americans living with HIV—or approximately 313,000 people—fall into this aging HIV population. Estimates suggest that, within the course of a few years, that figure could rise to as much as 50 percent.

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Premature Illness

While the mechanisms for this condition—known as premature senescence—are not fully understood, chronic inflammation can also cause effects similar to those of aging.

With HIV, a person's T-cells, central to the immune response, become less and less capable of identifying and neutralizing foreign agents when under the burden of this persistent, inflammatory reaction. And it appears to affect many, if not all organ systems to some degree.

The chronic inflammation associated with HIV has been implicated in the higher rates of non-HIV-associated diseases—such as cardiovascular disease, cancer, neurocognitive disorders, and type 2 diabetes—which often appear ten to 15 years earlier than what would be expected in the general, non-HIV infected population.

Even for individuals on HIV therapy who are able to sustain undetectable viral loads for years at a time, there remains a high risk for these aging-associated effects.

To complicate matters even further, both HIV and a number of antiretroviral drugs have been linked to increases in visceral (intra-abdominal) fat in people with HIV, which can add to the burden by secreting pro-inflammatory proteins directly into the bloodstream.

So what can a person do to live healthier with HIV and avoid the illnesses and conditions associated with long-term infection?

Get Tested Today

As many as 20% of Americans living with HIV have not been tested for the virus and, according to the World Health Organization (WHO), as much as 50% of the world’s HIV population has not yet been tested.

Current guidance from the U.S. Preventive Services Task Force calls for the one-time HIV testing of all Americans aged 15 to 65 as part of a routine doctor visit. Higher-risk groups, including sexually active men who have sex with men (MSM), are encouraged to test annually. Without testing, there is no way to implement the treatment.

Start HIV Treatment Today

In July 2015, a study presented at the 8th International AIDS Society Conference in Vancouver called for the immediate initiation of antiretroviral therapy (ART) for all people with HIV, irrespective of disease stage or CD4 count. The study, known as the Strategic Timing of Antiretroviral Therapy (START) trial, confirmed that prescribing ART on diagnosis reduced the likelihood of illness and death by 53%, while slashing the risk of non-HIV-associated conditions, like cardiovascular disease (CVD) and some cancers, by nearly two-thirds.

By contrast, even those rare individuals able to sustain undetectable viral loads without ART—people known as "elite controllers"—are twice as likely to be hospitalized, three times as likely to be hospitalized for CVD, and four times as likely to be admitted for psychiatric conditions when compared to non-elite controllers on fully suppressive ART. If there is one "must" to living long and well with HIV, it is getting started on treatment.

Stop Smoking

Those infected with HIV are twice as likely to be smokers as non-infected people (42 percent vs 21 percent respectively), resulting in nearly double the risk of acute heart disease, twice the likelihood of death from respiratory illnesses, and a 14-fold increase in the risk of lung cancer.

In fact, multiple studies have concluded that smoking remains the single greatest risk factor in the morbidity and mortality of people living with HIV, reducing life expectancy by 12.3 years compared to HIV-infected non-smokers.

While smoking cessation programs are not always easy—requiring an average of eight attempts before successfully quitting—access to treatment has been far simpler under the Affordable Care Act, with two annual quit attempts allowed by medicare and a variety of treatment programs offered through Medicaid in all 50 states.

Get Your Shots

Important vaccinations for adults with HIV include immunization for hepatitis B, human papillomavirus (HPV), pneumococcal pneumonia, and the annual quadrivalent flu shot.

The risk of anal cancer (strongly associated with HPV infection) is 25 times higher in people with HIV, while cervical cancer carries a five-fold increase. A three-dose HPV vaccine is expected to reduce the risk of these cancers by as much as 56 percent.

Before embarking on any immunization series, be sure to meet with your doctor to discuss options and risks. While many will significantly reduce the risk of HIV-associated comorbidities, others can actually hurt you, particularly if your immune system is severely compromised.

Discuss Statins With Your Doctor

According to a study from the Johns Hopkins University School of Medicine, the use of cholesterol-lowering statin drugs, combined with ART, can reduce the risk of death in people with HIV by 67 percent. The investigators reported that, in addition to lowering harmful cholesterol levels, statins also appear to reduce chronic inflammation.

While this doesn't mean that statin drugs are indicated for all people living with HIV, there are benefits of regularly monitoring lipid levels and other indicators of cardiovascular disease—particularly in older patients or in those with associated risk factors (e.g., family history, smoking, etc.).

Consider Vitamin D and Calcium Supplementation

Low bone mineral density (BMD) is common among people with HIV, resulting in higher rates of bone and hip fractures, as well as premature development of osteoporosis. BMD losses of between two percent and six percent are commonly seen within the first two years of starting ART—a rate similar to that of women during the first two years of menopause.

As a result of this, it is currently recommended that all postmenopausal women with HIV and HIV-positive men over age 50 have DEXA (dual-energy x-ray absorptiometry) scanning to assess for possible bone loss.

A number of studies have suggested that co-administration of a daily vitamin B and calcium supplement may help reduce the risk of bone fractures. While the research remains far from conclusive, current U.S. guidelines recommend between 800 to 1000 mg of oral vitamin D per day and 1000 to 2000 mg of oral calcium per day. Patients with osteoporosis may benefit from first-line drugs such as alendronate (Fosomax) and zoledronic acid (Zometa), which may help prevent osteoporotic fragility fractures.

Diet and Exercise

People living with HIV are prone to increases in body fat due to the HIV infection, as well as the drugs used to treat the disease. And even for those on fully suppressive ART, it is not uncommon to see 40 percent gains in limb fat and 35 percent gains in abdominal fat, with an associative increase in both CVD and type 2 diabetes risk.

In addition to statin drugs, management of HIV should include a balanced, reduced-fat diet and a combination of aerobic and resistance training, irrespective of age, CD4 count, or disease stage. Before starting ART, lipids and blood glucose levels should be tested, with regular monitoring thereafter.

Bottom line: don't rely on tablets or diet alone to address weight issues. Work with your doctor and ask for referrals to qualified nutritionists and fitness experts in your area.

Get Regular Pap Tests and Mammograms

Special consideration should be made for women living with HIV to prevent cervical cancer and other related comorbidities, address issues relating to pregnancy, prevent mother-to-child HIV transmission, and address HIV serodiscordancy (i.e., where one partner is HIV-positive and the other is HIV-negative).

Women should discuss any plans regarding pregnancy upon initiation of care, while ensuring regular mammogram screening as indicated (annually for women over 50 and individualized for women between the ages of 40 and 49).

HIV-positive women should also be given a cervical Pap smear:

  • Annually until 2 tests in a row screen negative, then every 3 years.
  • At 6 months after treatment for an abnormal result, then annually until 2 tests in a row screen negative, then every 3 years.

Never Treat HIV in Isolation

Patients and doctors are changing the way that we look at HIV today. This means understanding that HIV cannot be treated in isolation, but rather as an integrated part of our long-term healthcare. With greater focus being placed on the long-term comorbidities, HIV is treated as a facet of primary care.

One of the misconceptions about HIV management is that it is bounded with a fixed number of lab tests (CD4 count, viral load) and routine screenings (STDs, hepatitis) and combined with regularly scheduled visits to your HIV specialist.

As such, it's important to always tell your HIV doctor about any specialist care you are receiving, including any hospitalizations or outpatient visits. And don't presume that something is necessarily "unrelated" to HIV, especially since the disease can manifest with any number of associated complications, from eye problems to oral/dental disease to neurologic disorders.

If your primary care physician is different than your HIV doctor, be sure that they always share results, including lab tests and other reports vital to your long-term care.

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