Aging with HIV – HealthyWomen

In 1986, Stephanie Brooks Wiggins had just moved from Brooklyn to Baltimore with her future husband and was excited to start their new life together when she was diagnosed with human immunodeficiency virus (HIV). She was barely 40 years old.

“I was very naive. I had never heard of HIV,” said Brooks Wiggins. Her biggest worry was her new husband. “How was I going to tell him I had this disease that was going to kill me? “

Now 76, Brooks Wiggins leads a full and active life, but she has faced many health issues in addition to HIV in the decades since her diagnosis. She caught tuberculosis in her 40s and battled pneumonia several times in her 50s and 60s. She was diagnosed with chronic obstructive pulmonary disease (COPD) in her mid-60s and had a heart attack in the early 70s.

“Now that I’m 70 and my HIV is pretty much under control, it’s not a problem anymore,” said Brooks Wiggins. “Aging – and what comes with it – becomes the problem.”

More than 1.1 million people in the United States are HIV-positive, and 23% of them are women.

With antiretroviral therapy (ART), it is possible to live a long life with HIV. Although more than 5,000 people died from HIV-related causes in 2019, the number of HIV deaths is down more than 80% from its peak in 1995. Because ART works so well to control the virus , people living with HIV live many years after diagnosis, and nearly half of people living with HIV in the United States are age 50 and older.

Before treatment became available, people diagnosed with HIV/AIDS could only expect to live one to two years after their diagnosis. “I remember the early days when a good year or two was important, especially for women because no one was studying women,” said Dr. Sharon Allison-Ottey, geriatric medicine specialist and member of the Advisory Board on HealthyWomen’s Health (WHAC). Now, she added, HIV is treated like any other chronic disease.

Aging with HIV means dealing with the same health changes that we all face, but these changes can affect people living with HIV differently — and the virus can increase the risk of some potentially serious health problems. Knowing what to expect can help you prepare for these changes.

Common conditions may be more common

Some of the health problems that often affect older people may be more common in people living with HIV. These include:

Experts aren’t sure exactly why people with HIV are more vulnerable to these conditions, but they think the chronic inflammation caused by the virus may be a big factor.

Not only are some health problems more common in people living with HIV, they tend to show up earlier. The early onset of age-related diseases such as cardiovascular and kidney disease affects HIV-positive people from the age of 36. And HIV-positive women may be more likely to have these illnesses than HIV-infected men.

More drugs, more problems

As we age, it is not uncommon to need an increasing number of medications to treat our various health conditions. For people living with HIV, tracking these drugs can be particularly challenging because of how they can interact with ART.

Medicines used to treat common conditions such as high blood pressure, heartburn, allergies and high cholesterol can all interact with ART. These drug interactions can make the medications you take less effective and/or cause health problems as serious as kidney failure.

Allison-Ottey says the best way for older people living with HIV to avoid drug interactions is to make sure all members of their care team – from GPs and specialists to pharmacists and family members – have a complete list of what they are taking, including over-the-counter medications.

When Brooks Wiggins began seeing an HIV specialist in addition to her GP, she arranged a conference call between the two medical professionals so they could compare notes on the medications and check for interactions. “It was important for me to know that they were on the same page.”

Challenges of “change” with HIV

Women with HIV may go through menopause earlier and have more severe symptoms than those who are not infected with the virus. Since ART alone can cause side effects similar to hot flashes, Allison-Ottey said, menopause can be very unpleasant for women living with HIV.

Menopause can also worsen immune system problems common in people living with HIV, which can cause inflammation linked to health conditions, such as heart disease and diabetes.

Hormone replacement therapy (HRT) may be an option to help relieve symptoms of menopause while preventing bone loss, which can be particularly problematic for people living with HIV. According to the Centers for Disease Control and Prevention (CDC), there are no known interactions between HIV medications and hormone therapy.

HIV and the brain

As the brain ages, many older people may experience changes such as memory loss or concentration problems. But in people living with HIV, these changes may be more frequent and more severe.

Between 25% and 50% of people living with HIV suffer from HIV-associated neurocognitive disorder (AID), an umbrella term that covers a variety of cognitive and mood disorders, including dementia. A study of more than 9 million people found that HIV increased the risk of cognitive problems and dementia by up to 80% compared to people without HIV. Lack of treatment with ART is the greatest risk factor for cognitive decline.

Certain HIV-related cancers

A few types of cancer, known as AIDS-defining cancers – Kaposi’s sarcoma, lymphoma and cervical cancer – are much more common in people living with HIV or AIDS.

HIV also increases the risk of other types of cancer. Compared to the general population, people living with HIV are:

  • 19 times more likely to be diagnosed with anal cancer
  • 8 times more likely to be diagnosed with Hodgkin lymphoma
  • 3 times more likely to be diagnosed with liver cancer
  • 2 times more likely to be diagnosed with lung cancer and cancer of the oral cavity/pharynx

Because everyone’s overall cancer risk increases steadily with age, it’s important for older people living with HIV to understand their risk and talk to their healthcare providers about screening, prevention and detection. early when possible. For people living with HIV, taking ART can significantly reduce the risk of getting these cancers, as well as certain other types of cancer (such as liver cancer) that are not related to HIV.

If in doubt, contact

Allison-Ottey said that as HIV-positive women age, they need to pay special attention to their bodies. When you notice an unusual symptom, she said, you should contact your healthcare professional immediately instead of trying to work through it.

Allison-Ottey and Brooks Wiggins said sharing their experiences can make a huge difference for older women living with HIV. Brooks Wiggins is co-founder of Older Women Embracing Life (OWEL), an organized network of older women that provides support to women affected by HIV/AIDS, as well as their families and caregivers.

“One of the reasons we started the band is because there was no band,” said Brooks Wiggins. “There was no one talking to older women – talking to women at all, really – about living with this disease.”

Along with making sure they have a support system, Brooks Wiggins encourages women living with HIV to work on self-acceptance. “Accepting who you are is an important part of living with the disease, even as you get older.”

This resource was created with support from BD, Janssen and Merck.

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