Cedars-Sinai Hosts Panel at the Pacific Design Center

BY JAMES F. MILLS

Dr. David Hardy, who has been treating HIV infections since 1982, says he never imagined doing a presentation on HIV and aging, but proved himself wrong when he appeared at the panel discussion on Sept. 24 at the Pacific Design Center in West Hollywood.

The average age of a person living with HIV/AIDS is now 48 years old, according to Hardy, director of Cedars-Sinai Medical Center’s Division of Infectious Diseases. People over 50 years old now account for 15 percent of all HIV cases in the United States. And it’s estimated that by 2015, half of those with HIV/AIDS will be older than 50.

Hardy sees patients who are now old enough to qualify for Medicare, the oldest being 76 years old, and dealing with Medicare and HIV has produced entirely new levels of bureaucratic headaches.

But more importantly, this aging HIV-positive population comes with problems that were never imaginable in the 1980s. People who were once told they had six months to live have survived a quarter century and are now contending with a variety of aging-related diseases that are compounded by HIV.

For example, prostate cancer is more common among HIV-positive men than in their HIV-negative counterparts. The same is true with anal, lung and colon cancers. Cardiovascular disease is also on the increase among HIV-positive patients, as is osteoporosis.

Kidney disease, another illness linked to aging, is also unfortunately more common among those living with HIV. One study found that 30 percent of HIV-positive patients showed evidence of kidney disease at age 42.

“HIV just accelerates all the problems associated with aging,” Hardy commented. “And even HIV drug interactions can change as the body ages.”

HAART, or Highly Active Antiretroviral Therapy—using three or more anti-HIV drugs from different classes in combination—is proving highly effective for reducing viral loads, especially since the drugs have become less toxic over time. However, Hardy points out that some patients have been taking certain drugs for years, despite their intended short-term use, potentially causing new health concerns as a result.

Another issue is the effect of HIV and aging on the brain. Dr. Enrique Lopez, a research neuropsychologist at Cedars-Sinai, reported that HIV affects attention and cognitive functions as well as motor functions. He noted that older HIV-positive patients have slower reaction times and more difficulty processing information than their HIV-negative counterparts.

Dr. Karl Goodkin, director of clinical research in the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, said that doctors should perform full cognitive function tests on all HIV-positive patients over 50. He pointed out that dementia is more common among HIV-positive patients, but they frequently aren’t diagnosed until they have full-blown dementia, often because dementia becomes obvious without any tests. There are many asymptomatic cognitive disorders that are never noticed. But if tests are conducted earlier, treatments to offset cognitive impairments could be prescribed.

Hardy noted that doctors need to prescribe drugs which can affect HIV in brain tissue. For example, AZT, a commonly used HIV treatment medication, and other reverse transcriptase inhibitors get into brain tissue easily, while protease inhibitors, like Reyataz, do not.

People can do things like crossword and Sudoku puzzles to keep the brain active and help offset mental deterioration. However, Hardy advised that people also need to change their behaviors. “To expect your brain to get better when you’re bombarding it with drugs and alcohol is fallacy,” since alcohol and drugs kill brain cells.

Dr. Pedro Cahn, outgoing president of the International AIDS Society, noted that taking sleep-enhancing drugs like Ambien can do dangerous things to memory, especially if taken nightly.

Another concern is rising rates of new HIV infections among older people. While they comprise a small percentage of the newly/recently infected, people age 50 and older are slower to get tested for HIV. Hardy noted that the perception in the gay community is that people over 50 rarely have sex, so the idea that a person over 50 might be at risk seems far-fetched, thus older people don’t automatically get tested even after possible exposure.

Once infected, older people tend to progress to AIDS faster than younger people. However, the good news is that once they get on a drug regimen, older people tend to follow it better than their younger counterparts who often try varying their meds or going off them entirely without consulting their doctor.