New worries over ageing with HIV

2010-07-22 10:54

The world will face a mighty social and medical challenge as

millions of people with HIV survive into old age, the world Aids forum has


The problem is only now becoming apparent as the first generation

living with the human immunodeficiency syndrome (HIV) head towards their 60th

birthday and beyond, thanks to the lifeline of antiretroviral drugs, say


These survivors are mainly in western nations, where the precious

therapy first became available from 1996.

But they will soon be followed by millions of counterparts in

sub-Saharan Africa and other poor countries where the drug rollout started in

the middle of the last decade.

That these men and women should have stayed the course is itself a

stunning testimony to antiretrovirals – and, say some of the survivors

themselves, something of a miracle.

“We lived from day to day,” Jean-Luc Romero (51) a councillor for

the Paris region, said, as he recalled the situation in 1987, when he learned of

his HIV status.

“There was no point planning beyond that. We saw people dying all

around us, and we would say, ‘That will be us one day.’

We didn’t think about

the future, because the present was all we had. I remember thinking, ‘I won’t

live beyond 30’.”

Aids first came to light in 1981.

Before antiretroviral treatment

developed, people usually progressed to the disease within a decade after

infection by HIV, and died a year or two afterward.

For many of those now advancing into old age, living with HIV will

be fraught with medical problems, loneliness and stigma and worries about

finance, a seminar at the 18th International Aids conference heard


“There have always been older people with HIV, but what is new is

the numbers, that will require new public health thinking compared to the past,”

said Gottfried Hirnschall, director of HIV/Aids at the UN’s World Health

Organisation (WHO).

“We have to discuss this subject,” he said.

 “Ageing with HIV is not

just a clinical challenge, it is a clinical and a social challenge, and it’s not

just confined to one part of the world versus another.”

Lisa Power, policy director with the British Aids charity the

Terrence Higgins Trust, said that even though people with HIV were living

longer, their quality of life was often darkly overshadowed by worry.

Her organisation carried out a questionnaire of 410 people with HIV

aged more than 50 living in Britain, which was then followed up with 40 in-depth


The respondents were likelier to be unemployed than healthy

counterparts and had meagre savings, often because they had expected to die

before they got old and so had never put money to one side.

Many were socially isolated, fearful of the double discrimination

against old age and Aids, and fretted about the day when they ultimately would

be admitted to hospital or a nursing home.

Research presented by Margaret Hoffman-Terry of the American

Academy of HIV Medicine provided statistic evidence of the scale of the


In the United States alone, less than 20 000 people with HIV in

1995 were older than 50.

In 2005, this figure was 120 000.

In the 55-plus group, Americans with HIV were three times likelier

than a healthy man aged 70 to have a chronic health problem, she said.

The complications of HIV – and the side-effects of powerful

antiretrovirals that have to be taken each day for the rest of one’s life –

breed a long list of sicknesses.

They include depression, hypertension, diabetes, lipodystrophy (a

redistribution of fat around the body), metabolic disorders, osteoporosis,

heart, liver and kidney disease and cancer.

“In the future we are going to see patients living decades, and we

are going to have to figure out ways of getting them to a healthy old age,” said


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