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Laure Dasinières
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December 1, 2022
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Aging with HIV

In 2022, almost half of HIV-positive people in Switzerland are over the age of 50. How do they age when HIV has almost become a chronic illness in Western countries? Update with two experts on this matter.

They were screened at a time when the diagnosis of HIV was a near-certain diagnosis of death. [But, as Elton John might sing, «they’re still standing» and rather well, by the way. 'This is wonderful news: people living with HIV (PHAs) under treatment can now age very long if they take effective treatment,' states Professor Matthias Cavassini. Medical Director of the Outpatient Consultation of the CHUV Infectious Diseases Department and Head of CHUV Hospital HIV/AIDS Consultations as we begin our interview. 'The median life expectancy of this population is constantly increasing and almost reaching that of the general population,' said Dr Alain Makinson, an infectious diseases scientist at CHU Montpellier and president of Corevih.

However, this very positive news, which goes against the beliefs that still exist today, must not hide another reality: the healthy life expectancy of HIV-positive people is not yet aligned with that of the rest of the population.

Indeed, as Alain Makinson explains, 'PHAs who are getting older experience more associated diseases such as cardiovascular and renal disorders, lung cancers and cognitive disorders.'  In short, while it is not certain that HIV will accelerate aging, people tend to suffer more than others from diseases generally developed by seniors.

Effects of antiretrovirals

What is known about the causes of this phenomenon? First, that HIV does not only lead to AIDS but also to widespread inflammation of the body, which is particularly harmful to the condition of the vessels as well as to protection against cancer. If this is particularly evident during the period when the person is not being treated with antiretroviral drugs – a period that may have been particularly damaging in the future – it is also less so even when the viral load is undetectable. 'Despite this, inflammation remains at a very low level,' explains Matthias Cavassini, claiming the protective effect of antiretrovirals. This is a way to overcome the misconception that HIV treatments would have particularly destructive side effects on cardiovascular or renal functions. For cognitive impairments, Alain Makinson says, “It is not known if their prevalence is related to years when the virus has replicated in the body, treatments or other factors.”

Another factor behind the higher prevalence of co-morbidities in HIV patients is behavioral and environmental aspects. Studies on the lifestyle of PHAs in Switzerland have shown that they were almost 44% smoking and today, more and more PHAs suffer from cancers and cardiovascular diseases caused by tobacco. Many have also been drug users, whose long-term impact on cognitive and brain functions is well known. 

Aging with HIV and in precariousness

We also know, although it is difficult to draw generalizations, that PHAs often live in a certain precariousness, which can increase the risks by moving them away from a healthy lifestyle with a balanced diet and regular physical activity. Finally, as sociologist Christophe Imhof notes, “a reduced social environment and feelings of isolation and loneliness are themes present in people aging with HIV.” This is another factor of cognitive decline. 

It is also a factor of degraded mental health, and this is indeed the dark point in the lives of HIV-positive seniors, who constitute a population particularly affected by depression – 20 to 40% more than the rest of the population. In addition to financial worries and isolation, Christophe Imhof also notes the weight of body dissatisfaction, particularly related to treatment-induced lipodystrophy. Finally, of course, the stigma around HIV and LGBTIQphobias remains a major and particularly harmful burden on mental health. 

This fight against stigma and sero-phobia is now one of the key issues for people who are positive for HIV to be able to fully understand the healthy elderly and be accompanied in the best possible way.

This article was translated from 360 Magazine, find the original one here.

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