HIV and Aging

 

Is it HIV or is it age?

Many of the health changes that occur with aging can be similar to the symptoms of HIV or the  side effects of HIV drugs. Let’s take a look at some of the health conditions associated with both aging and HIV.

Overall immune system decline

As you age, your immune system becomes less effective at protecting your body from infection and disease. This is why untreated HIV progresses more quickly in people who are older and why early diagnosis of HIV is so important.

HIV damages the immune system, but much of this damage can be reversed when people start treatment and achieve and maintain an undetectable viral load. However, some HIV-induced injury persists: for instance, the immune system can lose its ability to remember its exposure to germs it had once encountered. Complicating this situation further, the immune system grows weaker with age. This does not mean that older people who are taking HIV treatment and who have improved CD4 cell counts will get AIDS, but it does mean that you need to stay healthy. Speak to your doctor about the annual flu shot and vaccinations against shingles and pneumonia. Depending on your medical history, your doctor may also recommend other vaccines.

Kidney disease

In the general population, kidney function starts to slowly decrease after the age of 30. As a result, the risk for kidney disease increases as people get older. However, because HIV infection causes general inflammation in the body, all people with HIV are at higher risk for kidney disease whether or not they have an undetectable viral load. This risk is higher for people whose CD4 count is below 200 or whose viral load is not controlled.

When untreated HIV infection is the cause of kidney problems, HIV treatment might help. Some antiretroviral medications do, however, have the potential to cause kidney injury. Tenofovir disoproxil fumarate (TDF) is a drug sold as Viread and is also found in Atripla, Complera, Delstrigo, Stribild and Truvada. In clinical trials it has been found to cause kidney damage in a small number of users. A newer version of tenofovir called TAF (tenofovir alafenamide) has been shown to be safer for the kidneys. It is found in Biktarvy, Descovy, Genvoya, Odefsey and Symtuza. If you are on a TDF-based regimen, your doctor should be monitoring your kidney function as part of your routine blood tests. If you are experiencing kidney-related side effects, they may switch you to a TAF-based regimen.

Cardiovascular (heart and blood vessel) disease

Cardiovascular disease is a broad term that includes coronary artery disease, heart attack and stroke. It is often referred to as heart disease. Everyone’s risk of developing heart disease increases as they age, whether or not they have HIV. Women older than 55 and men older than 45 are at higher risk of developing heart disease than younger people. If someone in your family has heart disease—a father, a mother, an uncle or a sibling, for instance—your risk of developing heart disease will be higher than a person who doesn’t have a family history.

While you can’t control some risk factors for heart disease, such as your age and family history, there are many lifestyle factors you can control. These include:

  • smoking
  • being overweight
  • lack of exercise
  • poor diet
  • alcohol intake
  • high blood cholesterol and blood lipids or fats
  • pre-diabetes and diabetes
  • high blood pressure (hypertension)

People with HIV are at a significantly higher risk of developing heart disease, and of developing it at an earlier age, than people who are HIV negative. The relationship between HIV and heart problems is still not fully understood. However, some studies show that HIV drugs, especially older ones like protease inhibitors, can increase the risk of heart problems by raising the level of cholesterol and triglycerides in the blood. Research has also shown that lifestyle factors such as smoking, injection drug use and a lack of regular exercise can increase risk. Other studies suggest it may be HIV itself that causes heart problems. When HIV is present for a long time, especially when untreated, it causes inflammation in the blood vessels that can be a risk factor for heart disease and other conditions. Clinical trials on drugs to decrease inflammation are underway. Even if the side effects of HIV drugs increase people’s risk of heart problems, it is clear that the benefits of anti-HIV treatment still far outweigh the risks.

Healthy heart habits

You can lower your risk for heart problems by adopting the following lifestyle habits:

  • eat a healthy diet (plenty of fruits, vegetables, whole grains and protein)
  • exercise regularly—especially aerobic or cardio exercise
  • quit or cut down on smoking
  • limit your alcohol intake
  • avoid cocaine, crack cocaine, crystal meth, ecstasy/MDMA, ketamine and GHB
  • see your doctor regularly
  • to monitor your heart health

Early menopause

For most women, menopause occurs between the ages of 45 and 55. During this time, the production of female hormones (estrogen and progesterone) declines, eventually causing menstruation (periods) to stop completely.

Although the impact of HIV on menopause has not been well studied, menopause does appear to occur earlier in women with HIV. In women living with HIV in Canada, the median age of menopause is 48; this is three years younger than in the general population. Just why is not clear, but there are many possible factors. They include:

  • a low red blood cell count (anemia)
  • decreased production of the hormones estrogen and progesterone
  • weight loss
  • reduced CD4 cell count
  • use of street drugs, such as heroin and methadone
  • co-infection with hepatitis C

Menopause brings with it an increased risk of many health problems, including:

  • cancer of the breast, lungs or ovaries
  • emphysema and other lung diseases
  • osteoporosis
  • cardiovascular (heart) disease

Many of the symptoms of menopause and HIV overlap. These include:

  • hot flashes
  • night sweats
  • skin and hair changes
  • trouble sleeping
  • forgetfulness
  • fatigue
  • emotional changes/mild depression

The fact that menopause and HIV have these symptoms in common can make it difficult to figure out what is causing the symptoms. As a result, an HIV diagnosis might be delayed, or it might be missed entirely. Talk to your doctor if you have a family history of any of the health conditions discussed above or if you have concerns about menopause symptoms.

Bone disorders

Your bones are living and growing. The strength of your bones, or bone density, is determined in part by the amount of calcium, magnesium, phosphorus and other minerals they contain.

When you have HIV, your risk of some bone disorders increases, whether or not you are on treatment. Research suggests that close to 50 percent of people with HIV may have early-stage bone loss or osteopenia. The risk of fracture in people living with HIV has been found to be almost three times higher than in the HIV-negative population.

Chronic inflammation due to HIV has been shown to be a factor in bone loss. Age is also a risk factor for bone problems, as is gender. Women have a higher risk than men of osteoporosis, a bone disease that causes bones to become thin and fragile and to break easily, particularly at the hip, spine and wrist. This is partly because women have an average of 30 percent less bone mass than men. Women are particularly vulnerable to osteoporosis after menopause, when the hormone estrogen—a key factor in maintaining bone strength in women—is no longer produced by the ovaries. On the other hand, HIV appears to cause more bone loss in men than in women. This means that, regardless of your gender, it’s important to pay attention to your bone health.

Other risk factors for both men and women include a family history of osteoporosis, smoking and lack of weight-bearing exercise.

Keeping bones strong

Since the exact cause of bone disorders in people with HIV is not known, preventing bone loss is the best strategy. You can help prevent bone loss by adopting the following lifestyle habits:

  • eat a healthy diet (plenty of fruits, vegetables, whole grains and protein)
  • increase your intake of calcium-rich foods (dairy, beans and green leafy vegetables) and take a vitamin D3 supplement
  • get lots of weight-bearing exercise, such as walking, running, hiking or weight training
  • limit or eliminate your intake of caffeine, cigarettes and alcohol

If you are diagnosed with osteopenia or osteoporosis, speak to your doctor about options for maintaining or increasing your bone density. 

Falls and frailty

Regardless of their HIV status, everyone’s risk for falling increases as they age. Falls increase the chance of breaking bones. There may be different reasons for falls, like rainy or winter weather. During these times you should take more care with walking and check your footwear to see if the treads are worn. Older people with HIV may be more likely than their HIV-negative peers to face certain medical issues that increase their risk of falling. In some cases, falls can suggest a range of issues including ear infections, balance problems, vision problems and difficulty coordinating muscles and movement. This is why it is important to discuss fall prevention with your healthcare provider.

As people age, they can become generally weaker and frail. Signs of frailty can include:

  • weaker muscles (finding it more difficult to lift and carry items)
  • walking more slowly
  • unintentional weight loss
  • feeling tired a lot

Studies have found that common health problems like cardiovascular disease and diabetes can contribute to frailty. However, frailty is not inevitable and it can be reversed if the cause(s) are found and the right interventions are taken. Physical activity and balance training can be especially useful. Talk to your healthcare provider if you find that you have some of the signs of frailty.

Cancers

Before combination HIV treatment was introduced in the mid-1990s, the most common cancers in people with HIV were HIV-related cancers, including Kaposi’s sarcoma, non-Hodgkin’s lymphoma and cervical cancer. Now, thanks to effective HIV treatment, you are much less likely to get these cancers if you have HIV.

On the other hand, the overall risk of developing a wide range of cancers increases as you age. Both men and women older than 50 are at an increased risk of developing colon and/or rectal (colorectal) cancer, for instance. Age-related cancers are now more common than HIV-related cancers among people on HIV treatment.

Some non-HIV-related cancers that are seen more often and at an earlier age in people with HIV than in the general population include:

  • lung cancer
  • skin cancer
  • anal cancer
  • stomach cancer
  • liver cancer (more often in those who are co-infected with hepatitis C)
  • oral (mouth/throat) cancer
  • Hodgkin’s lymphoma

The rates of breast, colon, and prostate cancers in people with HIV are similar to the rates in the general population.

People living with HIV who have cancer face more severe outcomes than HIV-negative people with the same type of cancer. There are screening tests available for some cancers (for more on these, click here). For early detection, which may improve your chance of survival, it’s important to take any screening test your doctor recommends. To prevent cancer, talk to your doctor about lifestyle changes you may want to make.

Diabetes

Insulin is a hormone produced by the pancreas to control the amount of sugar or glucose in the blood. Diabetes occurs when your pancreas cannot make enough insulin or when your body doesn’t respond to insulin as well as it should. 

Are you at risk of diabetes?

Risk factors for diabetes include:

  • being older than 45
  • being overweight
  • a sedentary (little or no exercise) lifestyle
  • a family history of diabetes
  • Indigenous, African, Latin American or Asian ethnic ancestry
  • high blood pressure (hypertension)
  • high levels of cholesterol and/or triglycerides in the blood
  • co-infection with hepatitis C
  • smoking tobacco

Some older HIV drugs are linked to an increased risk of diabetes. Fortunately there are many newer drugs that don’t have this side effect. However, HIV itself can increase the risk of developing diabetes, mostly for those who have had HIV for a very long time, aren’t on treatment and have a high viral load and low CD4 count.

There are several lifestyle measures that can help you keep your blood sugar levels within the range of normal:

  • Limit the amount of sugar and starchy foods in your diet, such as desserts, soft drinks, white rice or potatoes.
  • Choose whole grains and unprocessed foods that contain fibre, such as barley, brown rice and oats as healthy grain choices.
  • Eat a balanced diet, including healthy protein sources such as lean meats and at least two servings of fish per week.
  • Eat smaller amounts.
  • Exercise as often as possible, ideally every day.

If you have diabetes, try to get advice from a registered dietician experienced in both HIV and diabetes.

Sexual health

If you have HIV, you can still have a healthy and satisfying sexual life as you get older. In fact, sexual health is essential to your well-being. It may be reassuring that research has now proven that HIV cannot be transmitted sexually when you are taking treatment regularly and have a consistently undetectable viral load.

Sexual problems and low libido (sex drive) can occur in both men and women especially as we get older.

It’s a sensitive issue that often gets swept under the rug and not addressed. Some possible causes are:

  • HIV itself
  • drug side effects
  • hormone imbalances (including low testosterone in both men and women)
  • cardiovascular disease (this includes problems with the heart, arteries and veins)
  • diabetes
  • stress and depression

It’s important to talk to your doctor about sexual problems because, in many cases, they can be managed and you can have a satisfying and happy sex life.