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Aging HIV/AIDS Survivors Create New Class of Patients

Vidushi Sinha

Being diagnosed with HIV/AIDS used to be a death sentence.  Today, for many people, the disease is a chronic condition that can be managed with so-called anti-retroviral drugs.  Drug treatment has helped people with HIV infection live long and near-normal lives.  Now, as the HIV/AIDS population ages, they are facing a unique set of health challenges.

In sub-Saharan Africa, antiretroviral treatment (ART) has reduced the mortality rate among HIV-infected people by 20 percent. Many of the people receiving treatment who are now in their forties are expected to live well into their sixties.

Dr. Till Barnighausen, of the Harvard School of Public Health, says there is a need to recognize this population and their unique health issues, issues which did not exist until recently.

"We are now in a lucky situation that people infected with HIV in Africa and sub-Saharan Africa live to old ages," said Barnighausen.  "But with this prediction comes the challenge to prepare health and social systems to adequately respond to this new population, which will come into being over the coming decades."

Dr. Barnighausen says these people will have special disease burdens, and their treatment will require special expertise.  For instance, new clinical trials are needed to learn whether antiretroviral treatments could interfere with drugs that HIV patients might be taking for other chronic conditions, such as diabetes and cardiovascular disease.

"In old age this is really compounded by the fact that the physiology changes over the life course, by the fact that adherence to treatment might become reduced in older age. There are very specialized needs that have to be met in older patients," said Barnighausen.

Dr. R. J. Simmonds is Vice President at Elizabeth Glaser Pediatric AIDS Foundation, a group committed to fighting HIV and AIDS specifically in women and children. He says the issue of aging has emerged as a new challenge of the HIV epidemic.

"We are seeing that people are developing certain types of cancers at a higher rate - the combination of HIV and the treatment for HIV is leading to higher rates for diabetes, cardiovascular disease, Osteoporosis," Simmonds noted.

These older patients will put new demands on the health care system. Public health experts say that treatment services established in response to the AIDS epidemic will need to expand to address the unique health problems of the world's aging HIV/AIDS population.

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