Getting Older With HIV And Neuropathy

Today's post from thebodypro.com (see link below) concentrates on what may be the core target group for this blog - those living with HIV and neuropathy. The blog has developed to address all people living with neuropathy but now and then, it's important to highlight the links between HIV and nerve damage - between 30 and 40% of all positive folks suffer from neuropathy.  However, now that so many people are living normal life spans thanks to new medication, people with HIV are facing other problems, that either the virus, or the medication has brought them and this is often ten years earlier than their non-HIV counterparts. Nerve damage is of course one of them and this article reveals interesting new information as to why HIV may cause neuropathy but also looks at other co-morbidities that make life with HIV less than comfortable at times. The article fails to mention the potential for HIV-related, neurological impairment (Alzheimer, Parkinson and others) but as a whole provides much useful information. Well worth a read.

 

Frailty, Nerve Injury and Falls in Middle-Aged and Older HIV-Positive People
By Sean R. Hosein From Canadian AIDS Treatment Information Exchange  September 13, 2017
 

More HIV-positive people are living longer thanks to the use of potent combination anti-HIV therapy (ART). As HIV-positive people enter their middle age and senior years, they will have to grapple with one or more aging-related issues. One issue that can have a large impact on the health and quality of life of older people is falling. Older people who fall can injure themselves, and according to U.S. researchers, such injuries can make pre-existing problems, such as physical inactivity or weakness, worse.

Some studies with middle-aged and older HIV-positive people suggest that being frail and physically impaired are relatively common. One study found that HIV-positive adults whose average age was 52 years were at a similar risk of falling as HIV-negative adults 65 years or older.

The Present Study

In a U.S. study code-named ACTG A5322 researchers enrolled more than 900 middle-aged and older HIV-positive people to study their health. One report that emerged from this research concerns frailty and falling. The researchers found that frailty was uncommon, occurring in 6% of participants. However, nearly 40% of participants were becoming physically weaker and labelled as "pre-frail" by the researchers.

Statistical analysis found that people who were frail or pre-frail were at increased risk of falling. People who were frail and had injured nerves in their feet/legs (peripheral neuropathy) were also at elevated risk for falling.

The study underscores one aspect of aging and that some HIV-positive people, even in middle age, will need screening for factors linked to an increased risk for falls.

Study Details


Researchers enrolled participants from across the U.S. between November 2013 and July 2014. Participants visited study clinics every six months where they were interviewed, completed questionnaires, underwent a physical exam and had blood drawn for analysis. Participants were also assessed for the presence of co-existing health conditions and, in particular, neurocognitive problems.

On average, participants were in their mid-50s; 80% of participants were men and 20% were women.

Researchers defined falls as "an unexpected event in which the individual loses their balance and lands on the floor, ground or at a lower level and/or hits an object." The researchers did not count falls that occurred because of a stroke or because a person was pushed or shoved.

The researchers used a validated method of assessing frailty that included the following:
the strength of a person's grip (using a dynamometer)
how fast or slow they walked for a distance of four metres (this is called gait speed)
self-reported unintentional weight loss
self-reported exhaustion
self-reported limitations in various physical activities

Results -- Falls

Researchers analysed data collected from 967 people and found that 174 people (18%) had at least one fall in the past year. The distribution of falls was as follows:
106 people (11%) -- one fall in the past year
68 people (7%) -- more than one fall in the past year

Among the 174 people who fell, 21% sought medical help as a result of falling. About 5% were found to have at least one broken bone.

Frailty

After assessing all study participants for frailty, here is what the researchers found:
55% were non-frail
39% were pre-frail
6% were frail

The distribution of frailty and falls was as follows:
among non-frail people -- 12% fell at least once in the past year
among pre-frail people -- 22% fell at least once in the past year
among frail people -- 49% fell at least once in the past year

Researchers found that participants with weak grip strength were more likely to have recurring falls than people without weak grip strength.

Also, participants who walked slowly were more likely to have had recurrent falls than people who walked at a normal pace.

Peripheral Neuropathy (PN)

People with HIV can develop injured nerves in their feet, legs and hands. There are many reasons PN can occur, including the following:

HIV-related reasons: Experiments with monkeys infected with a virus closely related to HIV called SIV (simian immunodeficiency virus) have found that monkeys can develop nerve injury because of proteins produced by SIV-infected cells. So it is very likely that proteins produced by HIV-infected cells can cause inflammation and injury in susceptible nerve cells, leading to PN in people with HIV.

 Furthermore, some studies have found that high viral loads are associated with an increased risk for PN, past use of one or more of a group of older anti-HIV drugs called "D-drugs" -- ddC (zalcitabine, Hivid), ddI (didanosine, Videx, Videx EC) and d4T (stavudine, Zerit). Although the use of D-drugs is no longer recommended by treatment guidelines in high-income countries, PN can be a lingering legacy of exposure to this group of medicines.

co-infection with a common member of the herpes virus family -- CMV (cytomegalovirus)

type 2 diabetes

deficiency of vitamin B12

excessive exposure to alcohol

shingles (herpes zoster)

impaired thyroid gland functioning

exposure to some antibiotics used for treating TB

After assessing participants, researchers found that 39% (373 people) had PN. Furthermore, the researchers stated that people who were frail and who had PN "were significantly more likely to experience falls than non-frail people."

In general, researchers did not find evidence that other co-existing conditions, including neurocognitive impairment, had any significant impact on frailty and falls.

A previous U.S. study with about 650 HIV-positive women also found a link between the presence of PN and an increased risk of falls.

CATIE's Practical Guide to HIV Drug Side Effects has a section on PN that has useful options to consider.

Points to Consider

This study confirms that HIV-positive people who have some degree of frailty (that is, they were frail or pre-frail) are at increased risk for falling.

Two standardized and measurable aspects of frailty -- strength and slow pace of walking (slow gait speed) -- were significantly linked to an increased risk for falling.

It is possible that the participants in this study may not be reflective of patients that doctors see in clinics. This possibility arises because the researchers stated that many of the people who entered the present study had a history of volunteering for HIV-related clinical trials. Nevertheless, it is possible that some HIV-positive people outside of this study are at increased risk for frailty and falls.

Advice From Researchers

Based on the results of their study, the researchers encourage doctors and nurses to incorporate simple evaluations of frailty, such as grip strength and gait speed, as possible ways of identifying their HIV-positive patients at heightened risk for falling. Patients with this risk can then be given education to help prevent falls. Also, the researchers noted that HIV-positive people with PN might also need screening for their risk for falls.

Bear in Mind

The present study has uncovered two aging-related issues affecting HIV-positive people: frailty and falls. These problems are traditionally seen in elderly HIV-negative people but in the present study they occurred in some middle-aged HIV-positive people.

An Aging Epidemic

Research suggests that by the early 1970s HIV had arrived in North America and its spread eventually led to the appearance of the first recognized cases of AIDS in 1981. HIV-positive people who survived that era are now well over the age of 50.

In several studies, despite the use of ART for many years with excellent adherence, researchers have found that HIV still persists in lymphatic tissues of participants and causes ongoing inflammation and activation of the immune system. This ongoing immune activation and inflammation may make some HIV-positive people more susceptible to aging-related complications. Therefore, researchers need to continue to engage in research with aging HIV-positive people to find ways to help them enter middle and old age with good quality of life.

http://www.thebodypro.com/content/80416/frailty-nerve-injury-and-falls-in-middle-aged-and-.html?getPage=2

Getting Older With HIV And Neuropathy

Neuropathy is definitely a disease which is more likely to appear as you get older. People with HIV are living longer thanks to advances in HIV-medication but one of the side effects of that is an increased risk of secondary diseases, including notably, neuropathy. Whether it comes from the virus itself, or older drug regimes, or one of the many other sources, the fact is that around a third of all people with HIV will eventually end up with neuropathic symptoms.
Today's video was made in 2008 but is still extremely relevant today, perhaps even more so as the numbers of HIV+ 50ers increases each year. It comes from thedailybeast.com (see link below) and is written by Jessica Bennett (see more about her under the article). It is important to note that, although the statistics and drug references may be out of date in 2012, the message behind the video and article most definitely is not. For another view on the same subject but written this year, please click on the following link:
http://www.thebody.com/content/66696/crimes-and-generations-or-how-we-throw-our-elders.html

‘A Lot of Unknowns’
Sep 17, 2008 8:00 PM EDT  Author - Jessica Bennett

Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations.

There was a time when Lee Chew was so sick, he'd lost all feeling in his lower body—forcing him to wear diapers and get around by wheelchair. At 6 feet 2 inches, the once-robust actor was a skeletal 135 pounds, with severe pain in his hands that prevented him from even holding a fork. It was 1996, nearly 10 years after his diagnosis, and AIDS was all around him: friends, lovers, even his doctor, all died of the disease. Funerals were a monthly ritual. "In a way, living through the AIDS crisis of the 1980s was like living through our own version of the Holocaust," he says. "It was a nightmare."

Chew slowly began to wake from that nightmare with the approval of a new antiretroviral drug, Crixivan, that would help nurse him back to health. Slowly but surely, he went from wheelchair to walker, walker to cane, and finally, back to the gym. Today, Chew, a New Yorker, by way of Roanoke, Va., is happy and healthy, tan and fit. At 59, he looks about 40. "I can be pretty vain," Chew jokes. "I like to make sure my pecs look good."

In reality, Chew worries about a lot more. He is a social worker for aging HIV-positive gay men, so AIDS remains a constant character in his life. And though he's healthy, Chew is getting older—which brings a whole new set of worries. His is the first generation to age with HIV. As he ages, there are changes in how his medications will interact. And doctors and researchers are only beginning to figure out what, exactly, that means.

What doctors do know is that despite infection rates that remain level, people over 50 now make up the fastest-growing segment of those living with HIV—part of the reason why the AIDS Institute this week announced Sept. 18 as national HIV/AIDS and Aging Awareness Day. It's perfect timing: between 1990 and 2005, local Department of Health studies show that the number of AIDS cases in people over 50 shot up by more than 700 percent—today, 35 percent of people with HIV are aged 50 and older, and 70 percent are over 40, according to the AIDS Community Research Initiative of America (ACRIA). A large portion of those, say advocates, are gay men. Some of these older patients are newly infected, while most are long-term survivors.

Researchers know that HIV and age make for a complicated balancing act—a convoluted interplay of the disease itself, natural aging symptoms and the side effects of antiretroviral medication that may enhance those symptoms. Part of the aging process is already about a loss of immunity. So the fact that HIV is an immune disease may be one reason why its sufferers tend to age fast, in everything from body changes to cardiovascular disease, says Dr. Richard Havlik, an epidemiologist and former chief of the epidemiology, demography and biometry laboratory at the National Institute on Aging, in Bethesda, Md. But patients can also be plagued by ongoing side effects of drug cocktails, which range from high blood pressure to neuropathy—a painful nerve disorder that causes numbness in the hands and feet. And they must often fight fire with fire: a medication may heal one ailment, but in many cases, it only causes another. "All of those are bonuses—the side dishes—to the main course of HIV," Chew says.

With multiple HIV drugs on the market, allowing for physicians to mix and match to limit side effects and resistance, the medical community can often only make educated guesses as to what causes a particular ailment: Is it the virus? The meds? Aging itself? "From a health care viewpoint, that's one of the great black boxes," says Stephen Karpiak, ACRIA's associate director of research and the author of one of the only comprehensive studies on HIV and aging. "And the reality is we just don't know." Scientists didn't begin using the drug cocktails that turned AIDS from death sentence to chronic illness until 1996; prior to that, it was still considered a young person's disease, with everybody focused simply on survival.

Experts say that's not enough history to grasp the drugs' impact on the body, particularly in older patients. Clinical trials until now have been virtually nonexistent, and most big drug companies don't use older patients in trials—because of the possibility that those already at high-risk for disease would complicate the results. "It's very much to me kind of a good news-bad news situation right now," says Dr. Bill Stackhouse, director of the New York-based Gay Men's Health Crisis, the world's oldest AIDS-service organization. "The good news is that the meds are great, and people are living longer. But now there's a whole new set of issues to be faced."

Chew and his patients know that reality all too well. On a recent Wednesday in New York, Chew led an HIV-support group for Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE). The group regularly vents about doctor's visits, pill regiments and the laundry list of side effects that are becoming more complicated with age. For this session, Ernest Krysty, 61, has traveled from Connecticut; he says there isn't a support group closer to him. He describes the painful lesions on his stomach from the acid in his drug cocktail—12 different pills each day: six for HIV, and the rest for heart problems and lipodystrophy, a degenerative tissue disorder that redistributes fat, which commonly occurs in those being treated for HIV.

Another member of the group, Bruce Miller, 59, takes up to 20 pills on some days—and recounts the painful hip-replacement surgery he had to have last year. Miller isn't sure what caused the bone degeneration in the first place—as Havlik puts it, "there are a lot of unknowns"—but the procedure caused a hematoma that had to be surgically removed, resulting in nerve damage. During his rehabilitation, he was prescribed an antidepressant that he's now struggling to wean himself from. And now he needs a replacement in his knee, too. "It's sort of like a house of cards," Miller says softly. "The more pills you take, the more possibility for interaction. And as you grow older, there's more of a chance of that collision."

Chew himself has diabetes, high cholesterol and neuropathy—all ailments he never thought he'd be around to see. "Having been HIV-positive for so long, and lived through the earliest part of the epidemic, I think the notion was that it would kill us long before there was any question of any other physical ailments," says 53-year-old Mark Stewart of Manhattan. "Part of what's helpful about this group is that we share notes about … all those things you never thought you'd have to deal with, because you thought you'd be dead."
Those issues, of course, extend far beyond the physical. Stigma related to disease and age—and, in many cases, sexual orientation, too—has been shown to cause depression and anxiety. (In a 2006 study, ACRIA found rates of depression in HIV survivors to be nearly 13 times higher than in the general population.) Many of those aging with HIV don't have social networks they can count on, either: gay seniors, who make up a big chunk of this group, are twice as likely as their straight counterparts to live alone. "People with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer—outside of HIV disease," says Charles Emlet, a social worker at the University of Washington who studies the virus and aging.

In many ways, HIV-positive people over 50 are like guinea pigs, says Chew: they are the first to age with HIV, and the first to experience that process truly out of the closet. "With each step along the road, from the '80s to the '90s to now, every step has been a step in the dark," Chew says. "And there was always the thought that, well, this medication might result in heart disease, but if it keeps me alive now, then so be it." Sometimes a step forward can feel very much like a step back.

Jessica Bennett is a senior writer and editor at Newsweek and The Daily Beast, covering social issues, gender, sex, and culture. She has won three Front Page Awards, and has been honored by the Society of Professional Journalists, the New York Press Club, and GLAAD, among other organizations.

http://www.thedailybeast.com/newsweek/2008/09/17/a-lot-of-unknowns.html