Aging With HIV
Posted on April 24, 2011 by admin
Unique Health Concerns Can Arise – Even When Meds Keep the Virus “Undetectable”
When effective antiretroviral therapy (ARV) came on the scene in the mid-90s, it brought up a new topic for people with HIV: growing old. By now it is generally agreed that ARV therapy offers the opportunity for a “normal” life span. Yet no one denies that unique health concerns can arise for people with HIV as they age, even when the meds keep the virus “undetectable.”
Start with the gut. In the gastrointestinal tract, HIV infection results in malabsorption (poor digestion of nutrients) while also damaging the gut lining and allowing inflammatory products to spill into the bloodstream, spreading both virus and inflammatory responses.
Then there’s the lymph system and the immune system in general. Here, HIV damages lymph nodes and accelerates shrinking of the thymus gland, which you can think of as the training center for the immune system’s T cells. Some types of T cells begin to disappear, while others behave abnormally in a 30-, 40-, or 50-something HIV+ individual, responding to disease more as one would expect in an 80- or 90-year old.
Still other types of HIV-motivated aging affect the heart, veins, and arteries (cardiovascular system), and the brain and nerves (central and peripheral nervous systems).
The effects of these changes may include: increased risk of heart attack and stroke, neuropathy, cognitive problems (like forgetfulness), bone, kidney and liver disease, and increased risk for certain kinds of cancer (non-Hodgkin’s lymphoma, rectal and cervical cancer, and liver cancer).
Furthermore, while ARV drives down peripheral blood levels of HIV, it is accompanied by toxicities that do particular harm to the energy factories of cells, the mitochondria. Mitochondrial toxicity (which NYBC and its predecessor, DAAIR, have long been concerned with) underlies a number of clinical issues, including gut damage, muscle, liver and bone damage, as well as peripheral neuropathy and pancreatitis.
Add to that, infections may now cause bigger problems. This is starkly evident with the human papilloma viruses (HPV), leading culprits in rectal and cervical cancer. Similarly, pre-existing chronic hepatitis B or C infection makes the liver even more vulnerable, and can also increase risk of autoimmune disease, in which the body’s defenses attack its own tissues. The family of herpes viruses that can cause CMV or KS also contribute to the inflammatory milieu
Testing to stay ahead of problems…
Your blood work looks not only at the prime suspect, HIV, but also scans a whole array of markers, indicators of a range of potential problems. That’s why we recomend you should always take home a copy for yourself. Often, physicians will see that some markers are out of normal range, but have limited tools in their drug arsenal to manage them; they may be ignored. Still, some obvious signs of trouble crop up with routine testing.
Bad cholesterol (LDL) that’s high and good cholesterol (HDL) that’s low, together with rising triglycerides, point to risks to the heart. High sensitivity C-reactive protein (hsCRP) is another, more recently developed, test for cardiovascular trouble in the making. Liver enzymes and markers of liver function such as ALT, AST and gamma-glutamyl transferase (GGT) may be elevated, indicating need for attention to that organ. CPK when elevated can indicate kidney damage, an effect that may arise from tenofovir-containing regimens or from statin drugs. Elevated glucose suggests insulin resistance, a precursor to diabetes.
Some good news—plus, ways to keep the news good
The good news is that not everyone suffers these problems. Indeed, some stay healthy or have only minor issues. But we don’t advise resting on your laurels—any more than we suggest ignoring warning signs on the horizon.
One of the best ways to thwart HIV and medication side effects is to change your life: exercise, aerobic and resistance, not only sustains health but yields a stronger body to bear insults. You can also make better food choices, minimizing your intake of the toxic sludge peddled to us by Big Agribiz in the form of processed foods, fast foods, sodas and other products that aren’t really food. It is up to us to live our lives the way we want and to make the best choices we can, moment to moment. (Be here now, as the great meditators say!)
And there are specific ways to combat the ravages of time, HIV, and meds. Start with the gut: along with good food and drink, a multivitamin is essential. Probiotics like acidophilus, bifidus, and S. boulardii have shown their benefits. Consider a small amount (1-3 g) of glutamine daily to help gut turnover. If needed, use digestive enzymes.
For the heart, muscles, lungs, liver—and to help cells themselves function well–evidence of the benefit of N-acetylcysteine (NAC) keeps growing. By replenishing the body’s vital antioxidant glutathione, NAC offsets harm caused by all sorts of inflammation.
Do consult NYBC’s past SUPPLEMENT features on liver and cardiovascular health. Many underlying issues around these organs can be addressed with alpha lipoic acid (as in our lipoic-NAC combo, ThiolNAC), milk thistle, CoQ10, vitamin D3, fish oil (as found in Max DHA or Pro-Omega), as well as niacin for reducing LDL and increasing HDL. Chinese herbal formulations may help with anemia, neutropenia and liver health. Extra vitamin C and fiber can reduce hsCRP levels (worth a try before the problematic and costly statins).
While some supplements are supported by robust amounts of data (fish oil, niacin, and to a certain extent, NAC), our understanding of the benefits of others is more limited. Still, these constituents, such as curcumin, green tea extracts, resveratrol, and other plant flavonoids, have intriguing clinical data for people with HIV, and deserve consideration (and further research!). As ever, we serve as our own experts in our individual studies to evaluate these supplements.
http://nybcblog.newyorkbuyersclub.org/1269/aging-with-hiv/
