Nov 11 2009

One of my favorite writers, David France, has written an important and urgent article on an emerging crisis in the HIV/AIDS community. France's "Another Kind of AIDS Crisis" appeared in New York Magazine and for anyone interested in the epidemic it is a must read. In a time of a broadening HIV/AIDS epidemic and increasing complications for those on medications, the press is writing less instead of more about the worsening situation.

AIDS France writes about long term persons with HIV/AIDS and the serious aliments that are beginning to appear in this population. New York Magazine accompanies this important article with stunning photographs of long term survivors of HIV/AIDS. In "Another Kind of AIDS Crisis", France writes:

"Some fifteen years into the era of protease inhibitors and drug cocktails, doctors are realizing that the miracles the drugs promised are not necessarily a lasting solution to the disease. Most news accounts today call HIV a chronic, manageable disease. But patients who contracted the virus just a few years back are showing signs of what’s being called premature or accelerated aging. Early senility turns out to be an increasingly common problem, though not nearly as extreme as James’s in every case. One large-scale multi-city study released its latest findings this summer that over half of the HIV-positive population is suffering some form of cognitive impairment. Doctors are also reporting a constellation of ailments in middle-aged patients that are more typically seen at geriatric practices, in patients 80 and older. They range from bone loss to organ failure to arthritis. Making matters worse, HIV patients are registering higher rates of insulin resistance and cholesterol imbalances, and they suffer elevated rates of melanoma and kidney cancers and seven times the rate of other non-HIV-related cancers.

Whether this is a result of the drugs or the disease itself, or some combination, is still an open question and certainly varies from patient to patient and condition to condition. Either way, it is now clear that even patients who respond well to medications by today’s standards are not out of the woods. Current life-expectancy charts show that people on HIV medications could live twenty fewer years on average than the general population. “It’s spooky,” says Mark Harrington, who heads Treatment Action Group, a New York–based HIV think tank. “It seems like the virus keeps finding new tricks to throw at us, and we’re just all left behind going, What’s going on? "

The compelling article continues:

"It is true that the clinical picture of life with treated HIV disease is only now beginning to come into focus. A study presented at a conference in February in Montreal showed that otherwise healthy people on HIV medications at about 56 years of age had immune systems comparable to HIV-negative subjects whose median age is 88. Perhaps as a result, many diseases that typically attack the very old are striking younger HIV-positive people disproportionately, like diseases of the liver, kidney, heart, and veins. One study found that 55-year-olds who are HIV-positive have all the telltale signs of late-life frailty—muscle loss, fatigue, and rheumatological disorders.

The newest data show that middle-aged patients have dramatically increased rates of bone loss and fractures for their age. Some 60 percent of HIV-positive men in their forties have osteoporosis or its predecessor condition, a problem that typically isn’t diagnosed in men until well into their eighties. Jules Levin, founder and executive director of the New York–based National AIDS Treatment Advocacy Project, only found out about this two years ago, when he stumbled and shattered his wrist. He was 57 at the time and in exceptionally good shape, other than his undiagnosed osteoporosis. “This is what opened my eyes to all of this stuff,” he says. “Aging is the No. 1 problem in HIV today.”

Be sure to read France's entire article ASAP. It has an urgent message for us all