Americans infected with H.I.V. are defying all odds by aging into their golden years. However, once they reach their 50s, they often face numerous health problems, including heart disease, diabetes, social isolation, and cognitive decline. As a result, the medical research community is searching for new ways to ensure the well-being of older individuals living with H.I.V. A recent study revealed that statin drugs can significantly reduce the risk of heart attacks and strokes in middle-aged and older adults with H.I.V., shedding light on why this group tends to age faster than others. Several academic hospitals have established specialized clinics for older H.I.V. patients, offering a comprehensive range of medical and support services. Experts, who were once wary, now express optimism about better care for aging H.I.V. patients.
According to researchers, there is a growing population of older H.I.V. patients who require improved care, often referred to as the “silver tsunami.” In 2021, there were 572,000 Americans aged 50 and older diagnosed with H.I.V., a 73% increase from 2011. Surprisingly, two-thirds of deaths in the H.I.V. population are unrelated to the virus itself. Older individuals face a higher risk of various health conditions, including diabetes, liver and kidney disease, osteoporosis, cognitive decline, and different types of cancers. However, their most pressing concern is the doubled risk of cardiovascular disease compared to those without the virus. By 2030, it is estimated that over 75% of the Dutch H.I.V. population will have cardiovascular disease.
To combat this looming threat, the National Institutes of Health invested $100 million in a randomized controlled trial called Reprieve. The study tested the effectiveness of a statin medication against a placebo among 7,769 H.I.V. patients between the ages of 40 and 75. The participants were generally healthy and on stable antiretroviral treatment, making them unlikely candidates for statins. However, the trial, published in The New England Journal of Medicine, demonstrated that the drug reduced the risk of major cardiovascular events by more than one-third. Dr. Anthony S. Fauci, former director of the National Institute of Allergy and Infectious Diseases, described the results as even better than expected.
Donté Smith, a 37-year-old health consultant from Kansas City, Mo., began taking a statin earlier this year due to their family history of cardiovascular disease and diabetes. Smith emphasized that the virus tends to affect Black and L.G.B.T.Q. communities even more severely. Of the nearly 1.1 million Americans diagnosed with H.I.V., 63% are gay and bisexual men, and 40% are Black. Mx. Smith is committed to defying the trend and becoming an elder who can share and exist in spite of the challenges.
H.I.V.-positive individuals face a disproportionate risk of heart disease and other conditions due to environmental risk factors prevalent in this group. Factors such as smoking, excessive alcohol consumption, and cocaine use contribute to the increased risk of cardiovascular disease. Even without these risk factors, aging itself is accelerated in people with H.I.V. The virus causes chronic inflammation and immune dysregulation, even when suppressed by antiretroviral drugs.
Dr. Steven Grinspoon, lead author of Reprieve and a professor at Harvard Medical School, explained that the clinical trial measured chemical markers of inflammation in the participants’ blood and examined their coronary arteries. The researchers are analyzing this data to determine how the statin medication lowered cardiovascular events. These findings will be presented at an upcoming meeting in November. Dr. Fauci anticipates that the analysis will reveal how the statin reduced chronic inflammation, thereby preventing the buildup of plaque in the arteries.
Experts stress that the long-term care for people with H.I.V. relies on more than just prescription drugs. Older H.I.V. patients often face social challenges that exacerbate the difficulties of aging, such as poverty, loneliness, addiction, mental illness, stigma, and housing insecurity. Programs like the “Golden Compass” at the University of California, San Francisco, provide comprehensive services for aging H.I.V. patients, including cardiology, exercise classes, and mental health care. These programs are crucial for the well-being of patients like Paul Aguilar, who has lived with H.I.V. since 1988. Aguilar praised the psychological counseling and support he received, which helped him cope with personal loss and mental health struggles. However, the majority of older H.I.V. patients still lack access to high-quality care due to cost, staffing, and space limitations. Without support, many individuals are left to fall through the cracks.
After learning about the Reprieve study’s findings, Paul Aguilar requested a statin from his doctor. With a touch of humor, he mentioned that he plans to age gracefully and become the neighborhood curmudgeon who protects their lawn.
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