For a long, dark time in the 1980s and ’90s, the Shanti Project and other agencies like it provided hospice-like services to the thousands of men suffering, and dying, from AIDS in San Francisco.And then there was monumental success: new drugs to fight the virus and lift the death sentence of HIV infection. With the virus under control in their bodies, patients were healthy and active. They had decades of living ahead of them.
any of them left the supportive care of places like Shanti, said Kaushik Roy, executive director of the program.
“Now they’re coming back,” he said.
More than a decade after the first truly successful AIDS drugs became available, a new image of HIV is emerging: People with the virus appear to be aging prematurely. After years of feeling healthy and recharged with the new drugs, they’re suddenly slowing down not from the effects of AIDS, but from old age – a decade or two earlier than their noninfected peers.
“When we have clients passing away now, it’s from cancer or heart disease,” Roy said. “It used to be AIDS.”
Patients are coming down with diseases and conditions most associated with aging even when their HIV is well controlled – even when the antiretroviral drugs used to treat it make the virus essentially undetectable in the blood, and by nearly all accounts a patient’s immune system is strong and stable.
They are having heart attacks and strokes in their 50s or 60s. They’re developing dementia and arthritis a decade earlier than they should be. They’re getting cancers that tend to strike only people in their 70s or 80s.
“In the last 18 months, in my clinic I’ve had four people under age 60 who’ve had either bypass surgery or heart attacks,” said Dr. Brad Hare, medical director of the HIV/AIDS ward at San Francisco General Hospital. “One of them was 37 years old. That’s something that would be more typical in somebody 70 or older.”
It is, Hare and other doctors admit, a good news-bad news scenario.
The drugs discovered to fight HIV have saved millions of lives and given patients decades’ more time. By 2015, the average age of an HIV
But it’s come at a cost that has caught patients and doctors off guard. In the United States, AIDS patients now are more likely to die of cancer, heart disease, liver disease or other effects of premature aging than they are of AIDS itself, according to multiple studies.
Researching a cause
“They call it the graying of the AIDS epidemic,” Hare said. “We do expect people with HIV to live long, healthy lives now. But there’s still a big cost to your health.”
Clinicians like Hare who work closely with HIV-positive patients first started noticing the effects of premature aging five or 10 years ago, and in the past year or two, scientists have begun work in the lab to determine what it is that’s causing the accelerated aging and how it might be stopped.
Some of the causes for early aging may be behavioral and may apply mostly to people who were diagnosed at the height of the epidemic. For example, smoking and heavy drinking often can cause early aging, and many people who were diagnosed in the ’80s or even ’90s kept their bad habits because they didn’t think they had long to live. Now, many years later, they may still be smoking or drinking, and suffering the ill effects of it.
“I’m living with HIV, and I have been for 10 years,” said Justin Jones, program manager of Positive Force, part of the San Francisco AIDS Foundation. “When I was first diagnosed, my primary-care doctor told me I really needed to quit smoking. He also told me he used to encourage people to not quit smoking, because he figured, ‘Hey, you’ve got HIV, if smoking brings you even a modicum of pleasure, do it.’