On March 29, every chair was taken at the World AIDS Museum & Educational Center, 1201 NE 26th St, Wilton Manors, FL, for a presentation by Dr. Patrick Kenney of Midland Medical, titled “HIV & AGING (Including info about PrEP).”
Most attendees were members of “Pozitive Attitudes,” an every Wednesday HIV plus support group led by Steve Stagon, the founder of the museum.
Dr. Kenney began by saying that no one likes to talk about aging and how it might relate to HIV. Everyone’s aging is dependent upon a number of variables some of which progress independently of the virus. He said, “HIV-plus people who age, deal with complications of three factors: the direct effects of the virus itself, the effects of medications that treat the virus and the natural effects of an individual’s personal genetic composition. Many older folks develop early-onset diabetes or osteoporosis (brittle or weakened bones.) HIV does not cause these diseases, but it can enhance them negatively.”
Dr. Kenney noted that the current batch of available medications is “pretty awesome” with fewer side effects and easier regimens, but the difficulty of aging with HIV has not improved. One significant factor is that as HIV-plus persons age, they may add additional medications to treat other ailments that come with age. These additional meds sometimes clash with HIV meds, causing problems for the user. He added, “As we age, our immune system is naturally less robust. The body of someone who is 50-plus years old when acquiring a new infection is going to have a difficult time dealing with the onslaught of the infection. The small consolation of dealing with that age group is that they adhere to protocols of medication much better than do their younger counterparts. It is also encouraging to be able to report that today the life expectancy for an HIV-plus person is equal to that of an HIV negative person. All the same, we can’t beat the clock, no matter how hard we try.”
Dr. Kenney reports that he is seeing more diabetes, cardiovascular disease and non-HIV malignancies in his older patients. They also frequently battle a host of ailments that come under the heading “inflammation.” He noted that a person’s gut has its own immune system necessitating its own treatment. He also noted that HIV can “cross over” into the brain, effecting cognitive functions, with an increase in neurocognitive disorders, some of which would occur with age and without the presence of HIV. One attendee asked how an HIV-plus person would know if his cognitive changes were related to HIV or not.
He said, “For example, I spent a week trying to recall the names of the brothers who formed the BeeGees. Should I seek treatment from my HIV doctor?” In response, Dr. Kenney distinguished between cognition and recall.
He said, “Cognitive problems are identified as instances when you might suddenly become incapable of performing routine repetitive things like driving home from work without getting lost, or placing leftovers in the refrigerator rather than the washing machine. Recall-difficulties happen to most people as they age.”
Dr. Kenney gave the group two pieces of significant advice. First, he stressed the importance of routine screening for cancer, vitamin levels and hormone levels.
He said, “We are not sure why, but HIV-plus people have greater instances of osteoporosis than their counterparts. We also see a lot of lung disease, not just from smoking, but from drug use and simple genetics. We use the umbrella term ‘frailty’ to describe a host of symptoms that can be observed as someone ages with HIV. For this reason, we try to get our patients to quit smoking, decrease alcohol and increase exercise.”
Second, he advised anyone living with HIV with a doctor not specializing in infectious diseases to be very specific in describing their conditions in any consultation and to demand that such a doctor become familiar with the current treatments and protocols.
He said, “We are trying to better educate doctors who are not specialists in HIV so that they can learn to ask the right questions of their aging patients. Currently there are no guidelines about timing and treatments that fuse gerontology with HIV treatment. This is an area where doctors must practice the art of medicine.” He elicited laughter when he added, “As you age, your T-cell levels may be great, but your immune system is still considered a little dysfunctional. But, aren’t we all?”
About PrEP (taking Truvada as “pre-exposure prophylaxis” to lower the chances of acquiring HIV) Dr. Kenney talked about how Truvada has been improved over the years to decrease its chances of causing bone weakening or kidney disease. The drug is still not perfect. He described the case of a bodybuilder who shattered his arm upon falling. He came from a family with a history of osteoporosis that should not have caused the onset of brittle bone disease at his age. His musculature was excellent, but his bones were weak. He had been on PrEP for two years. Therefore, the screening and vigilance needed by someone on PrEP is the same as that needed by someone who is HIV-plus.
Dr. Kenney concluded by saying, “HIV is become easier to treat, despite your age. Find a good provider and get regular screenings. There are some very promising new forms of injectable meds that will replace daily pills with a single monthly shot. The whole goal of HIV therapy is to make the virus more tolerable. I feel that with so many advances in gene therapy, we will see a functional cure for HIV within our lifetime, maybe in five years. We will probably see a vaccine even sooner.”