Get Well Wednesday: HIV Is Not Just A Problem For Young People

Dr. Steven K. Grinspoon is a Professor of Medicine, Harvard Medical School, Director of the MGH Program in Nutritional Metabolism, and Director of the Nutrition Obesity Research Center at Harvard. He has a long-standing interest in the metabolic and endocrine complications of HIV disease, with an initial focus on insulin resistance and body composition. He has served on the WHO Technical Advisory Group on Nutrition in HIV Disease and Chaired the AHA State of the Science Conference on Cardiovascular Disease in HIV-infected patients.

In addition, Dr. Grinspoon has served as Co-Chair of the Endocrine Society Research Affairs Committee. His work has suggested an increased myocardial infarction rate in HIV-infected patients and highlighted the relative contributions of traditional risk factors, including diabetes and excess visceral fat accumulation, and of non-traditional risk factors, including inflammation and immune activation. He has shown the efficacy of strategies to improve insulin sensitivity and reduce excess visceral fat.

HIV is not just a millennial issue.

Advances in treatment have meant more than 50 percent of people living with HIV today are over the age of 50 and by 2020, this number will soar to 70 percent, creating a new health crisis.

African-Americans have the most severe burden of HIV of all ethnic groups in the United States and today approximately 500,000 of the nearly 1.2 million people living with HIV/AIDS are African-American.

In 1981, African-Americans accounted for approximately one-quarter of all new HIV infections. Less than a decade later, African-Americans surpassed Caucasians in the number of new HIV infections, a trend that continues today.

Compared with other races and ethnicities, African-Americans account for a higher proportion of new HIV diagnoses, those living with HIV, and those ever diagnosed.

Recent research suggests that having HIV speeds up the aging process by about five years, on average and that people with HIV may be more susceptible to conditions like heart disease, diabetes, cancer, osteoporosis, liver and kidney failure, visceral adipose tissue (lipodystrophy) and depression.

It’s important that HIV long-term survivors talk to their doctors and receive appropriate medical care tailored to their unique needs and the many accompanying medical conditions they may face.

This is particularly true for African-Americans, who have a 45% higher chance of cardiovascular disease related hospitalization than Caucasians with HIV.

Yet there are no federal funds specifically earmarked for long-term HIV survivors in the 2017 Federal budget.

With a push this month to mark HIV Long-Term Survivors Awareness, we note the urgent “call to action” for increased research and support for long-term HIV survivors whose escalating needs have been ignored for too long.

Priority must be given to increased medical research that identifies the factors causing older people with HIV to experience poorer health than their peers. Long-term HIV/AIDS survivors also need more effective and sustained mental health services to help them better manage the stress and trauma.

You can help—go to Change.org and sign the petition to make a lasting impact—support increased research funding.

Social Media Hashtags: #HIVLongTermSurvivors #ForwardTogether #HIVresilient #HLTSAD2016

Dr. Grinspoon answers your questions next page:

I wish the Doctor had spend more time talking about PReP (pre-exposure prophylaxis) and nPEP (post-exposure prophylaxis) to prevent HIV. Our community is the least informed about these bio-medical interventions. Can you explain that now?

PrEP is a way for people who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. Much research has been done on this recently and there has been some good progress made. Good information is available at websites like AIDS.gov. There are very specific recommendations for who should take PrEP and what people can expect. For post-exposure prophylaxis, there are very specific protocols, and you should consult your doctor for these. Prevention and avoidance of risky behavior is always the best choice.

Do the meds make you gain weight over a period of time? And does it cause your legs to swell? If so, what can you do to change the swelling and weight gain?

Taking your HIV medications as directed is very important. The newer medications these days result less often in body fat changes, but patients can still experience gain in fat in the belly and sometimes loss of fat in the legs, which is more common than leg swelling. Overall these meds don’t tend to make patients gain weight, but increasing weight may come with improved health and eating more as the virus comes under control, so make sure you concentrate on good nutrition. Ask your doctor regarding leg swelling which could have other causes.

There are studies out there looking at quality of life. I’m not familiar with specific names, but one can go to Clinicaltrials.gov and do a search on HIV and quality of life and see the open studies.

People with HIV can develop a disease call Castleman disease. What is it and how is it treated? A relative recently died of the disease. The doctors discovered  while  hew as in the hospital. They wasn’t sure what it was or how to treat it. I don’t feel they were doing enough to save him….He died within a few days of them treating him after being in hospital for over two weeks.

This is not my specialty but it is a rare disorder of the lymph nodes, which can occur with other rare cancers in HIV. It is a very serious disease. I can’t comment on how your relative was treated but agree that more research needs to be done on this disease. I’m sorry for your loss.

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