HIV & Aging: Research and Community Perspectives
By 2015, more than 50% of all people living with HIV in the United States will be over the age of 50. This compelling statistic was shared by Dana Van Gorder, Executive Director of Project Inform, at a community forum hosted on September 18 by Van Gorder’s organization, San Francisco AIDS Foundation’s Positive Force program, UCSF’s Gladstone Institutes, and the San Francisco Foundation.
A testament to life-saving treatments, this statistical milestone nonetheless brings with it new challenges in the treatment of HIV disease, as people with HIV appear to be experiencing “accelerated aging.” Gladstone’s Elizabeth Blackburn, PhD, educated the audience on telomeres, the biological structures that cap chromosomes (which contain our bodies’ genetic material) and keep them from fraying, and telomerase, the enzyme that rebuilds telomeres.
Dr. Blackburn’s own role in the discovery of telomeres and telomerase earned her the 2009 Nobel Prize in Physiology or Medicine. According to Dr. Blackburn, telomeres shorten with age, leading to cells that no longer function properly. Her research has demonstrated that aging-associated diseases, such as cancers, heart disease, and dementia, are, at least in part, related to the shortening of telomeres and subsequent malfunction of chromosomes.
Eric M. Verdin, MD, took the podium next and outlined the current working theories as to why HIV-positive people are experiencing age-related health changes earlier. According to Dr. Verdin, chronic inflammation caused by uncontrolled HIV leads to accelerated aging; while inflammation is a natural immune response and a good process overall, constant inflammation causes the problems researchers are seeing in people aging with HIV.
As Dr. Verdin explained, research has demonstrated that, in terms of damage due to inflammation, the gap between HIV-negative people and HIV-positive people narrows in a direct relationship with how early effective treatment is initiated in the HIV-positive individuals. When a person takes effective medications, his or her virus is suppressed and inflammation is greatly reduced, though research is ongoing as to whether inflammation ever returns to normal levels in a person living with HIV.
Another potential aging accelerator, according to Dr. Verdin, may be our medications themselves. Telomerase is the only naturally occurring reverse transcriptase in humans, and nucleoside reverse transcriptase inhibitor (NRTI) drugs are the most common backbone of HIV regimens. Research is ongoing to determine whether NRTIs combating HIV are also inhibiting telomerase, thereby frustrating telomere repairs in the body. (That is not a reason to stop taking NRTIS, however; they are highly effective in combination with other anti-HIV agents and extend life far more than they may theoretically shorten it. Research is ongoing, and more solid answers are forthcoming.)
The event concluded with a panel discussion with the researchers joined by community members who are aging with HIV. The panel highlighted things that people living with HIV can do to maintain their health as they age. Dr. Blackburn noted that exercise has been shown to help maintain telomerase. Also mentioned was long-term aspirin therapy for heart health, which has also been shown to decrease rates of some cancers by as much as 50%.
The community members on the panel, Anna Jackson and Matt Sharp, encouraged individuals to be willing to participate in clinical trials testing new medicines, to become treatment advocates and activists, and to get involved through research councils and planning boards. In addition, they commented, researchers focusing on the aging HIV-positive population need to make concerted efforts to include women, particularly women of color and those from low socio-economic backgrounds, and develop relationships with gatekeepers within marginalized communities.
Community-based organizations can respond to this growing population by providing services tailored to people aging with HIV. For example, the foundation’s Positive Force program will offer a new service in the coming weeks that aims to help long-term survivors of HIV work through the trauma of their experiences. To launch its new service, Positive Force will host a benefit screening of “We Were Here,” the critically acclaimed documentary about the beginning of the HIV epidemic in San Francisco, on Monday, October 15, at 6:30 p.m. at the San Franciso LGBT Center. To purchase your tickets and support this new service, visit sfaf.org/WeWereHere.
Justin Patrick Jones, MA, is the program manager for Positive Force, which serves HIV-positive gay, bisexual, and transgender men who have sex with men who live, work, and/or play in San Francisco. Positive Force is committed to building a strong, connected poz men’s community in San Francisco. To learn more, visit stopaids.org/positiveforce.