Holding back the years

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08 Sep 2015

The challenge for the older generation, says Jake Kendall, is — not just to be living longer with HIV — but to be living well with HIV.

Not so long ago, ageing with HIV would’ve been considered an oxymoron. In the early years, it was a rare occurrence; most people lived briefly with HIV before dying from AIDS. These days, effective treatment means people with HIV can expect to live a normal lifespan. But while modern medication works miracles, ageing with HIV brings new complications.

And some of those complications are only just being recognised. Research suggests many of the diseases associated with ageing appear to occur at higher rates among older people living with HIV (PLHIV) than in the broader population. Living with multiple medical conditions — such as cardiovascular disease, cancer, osteoporosis, diabetes and dementia — will become the norm as the HIV population ages.

Indeed, according to the most detailed analysis of likely future trends in HIV care for an ageing population yet conducted, the proportion of older PLHIV with at least one coexisting condition will increase from 29 percent in 2010 to 84 percent in 2030. And 28 percent will have three or more additional medical conditions.

Although the findings are based on the clinical needs of Dutch PLHIV (three quarters of whom will be over the age of 50 in 15 years’ time), they are relatable, say the authors, to other Western countries with maturing HIV-positive populations — such as Australia.  

Many of the health problems among older PLHIV will be driven by various forms of cardiovascular disease (high-blood pressure, high cholesterol, heart attacks and strokes), with 78 percent of older PLHIV having at least one of these conditions by 2030. In addition, the study found 17 percent will have diabetes and 17 percent will have a cancer.

But, wait, there’s good news, too! Chances are, as someone living with HIV, your health and well-being is being routinely monitored — far more than the average person’s. So if there were signs of anything worrying, your healthcare professional would more than likely pick up on the symptoms. Early detection often means a greater chance of effective treatment.

Speaking of effective treatment, thanks to a new generation of antiretrovirals, many older PLHIV have robust CD4 counts and are able to maintain an undetectable viral load, which we know reduces the risk of illness and infection. Research also shows us that older PLHIV have better drug adherence than younger people. And as the START study found, treating early reduces the risk of developing non-AIDS events by more than 50 percent.

On top of treatment, there are, of course, other ways you can lower the risk of developing age-related conditions. And, yes — yawn — you’ve no doubt heard all these recommendations before. But there’s a reason for that: they work.  

First up, if you smoke, stop. Now. No ifs or butts. Minimise alcohol and drug use. At the risk of sounding like your Mum: binge drinking leads to high blood pressure putting you at risk of strokes and heart attacks. Excessive use of amphetamines, such as ice and cocaine, can lead to heart disease.

Those are the don’ts. The dos: exercise regularly — it gets the blood pumping, reducing the risk of cardiovascular disease. Eat well. Choose a diet with an emphasis on fruits, vegetables, whole grains and beans. Fish and lean meat both get the Heart Foundation Tick of approval. As do ‘healthy fats’ found in olive oil, nuts and avocados.

According to the Cancer Council Australia, at least one in three cancer deaths are preventable and the number of cancer deaths could be significantly reduced by adopting a smarter lifestyle. Smoking, of course, is a no-no; as is unprotected exposure to the sun (“Slip, Slop, Slap”, and all that). Excessive alcohol, inadequate diet, and obesity are also triggers for cancer.

Calcium is key to reducing the risk of developing brittle bones, although calcium on its own is not enough to stave off osteoporosis. Vitamin D (salmon, tuna, eggs, cheese) and Vitamin K (herbs, green leafy vegies, asparagus, olive oil) also play an important part in protecting your bones. Omega-3s found in oily fish are beneficial to bones, too.

Regular exercise (three to five times a week for 30 minutes), adopting a Mediterranean diet (olive oil, vegetables, fish, fresh fruit and wholegrain breads etc.) not smoking (ever), and drinking moderate amounts of alcohol (wine especially) have all been found to help reduce the risk of developing diabetes  and dementia.

And finally, get out more. Adopt a hobby. Study after study has found people who maintain a social network and engage in activities, not only live longer, but also remain healthier than people who are socially isolated and who do not engage in meaningful pursuits. Many local HIV organisations run support groups and host social events.

Ageing — HIV or not — is no bed of roses. But if you take heed of some of the above, hopefully, it’ll be a long while before you’re pushing up the daises…