Growing old with HIV

A person living with the AIDS virus once had no hope of growing old. But within the next eight years, more than half of all Americans with the disease are likely to be over 50.

Rayford Kytle, in other words, could soon be a typical person living with HIV.

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At 65, he is a gay man who has been HIV-positive for more than 30 years. He exercises regularly, watches what he eats and doesn’t smoke. But he also has had his hips replaced. And every 18 months, a surgeon gives him injections to compensate for fat loss in his face, he said, “so I don’t look like a walking skull.”

The hip surgeries are related to his disease. The injections, which cost about $1,500, are fillers to counteract the facial wasting that is a side effect of the early, more toxic anti-HIV drugs.

The HIV/AIDS epidemic in the United States is often perceived as something that mostly affects young adults. But nearly 11 percent of the 50,000 new infections each year are in people 50 or older. The federal Centers for Disease Control and Prevention estimates that this group makes up 33 percent of all people living with HIV — a percentage that will increase to more than 50 percent by 2020.

As HIV-infected adults live longer, they are increasingly affected by such chronic illnesses as heart disease, diabetes, kidney disease and osteoporosis, common problems among many older people.

But studies suggest that those with HIV may be at higher risk for some of those illnesses and may get them earlier than usual.

HIV causes the immune system to fight the virus, and that inflammatory state continuously damages organs, even when antiretroviral medications are taken, researchers said. HIV-infected people are more likely to have hepatitis C or hepatitis B and are much more likely to smoke than the general population.

People with HIV are living into their 50s, 60s and beyond because of highly effective anti­retroviral therapies that became widely used in the mid-1990s. At the same time, experts say, some people over 50 are engaging in sexual behaviors that put them at high risk for contracting the AIDS virus, resulting in new infections.

Some older Americans have a poor understanding of their risk and don’t use condoms. Doctors also don’t do as good a job collecting sexual histories of patients 50 and older, because they consider them lower risk and fear angering or insulting them, according to a recent study in the American Journal of Public Health.

The challenges of managing as well as preventing HIV among older Americans were a major theme at the 19th International AIDS Conference in Washington this week, which closes Friday with a speech by former president Bill Clinton.

“It’s only fairly recently that we’ve come to appreciate that even in people with suppressed virus, there are continuing effects of being infected with HIV,” said Amy Justice, a professor of medicine and public health at Yale University who oversees an ongoing study on HIV and aging among veterans.

HIV does not exist in a vacuum, Justice said in one presentation. Smoking and infections such as hepatitis C contribute to the inflammation triggered by the virus. And like everyone else who is aging, older people with HIV are grappling with “the physiological burden of those things acting in concert,” she said in an interview.