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AIDS patients face an array of disorders as they live longer
Adam Doster
Published: Saturday January 5, 2008

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Antiretroviral drugs, made popular at the height of the AIDS epidemic, gave thousands of H.I.V. patients a new lease on life. But at what cost?

That is a question scientists, doctors, and patients are now considering as the first wave of AIDS survivors to reach late middle age are encountering an array of disorders -- prematurely or in disproportionate numbers -- usually associated with aging.

According to the New York Times, “there have been only small, inconclusive studies on the causes of aging-related health problems among AIDS patients.” But few experts believe that the trends are coincidental.

Instead, those in the medical field are beginning to think that prior to the development of antiretroviral drugs, the immune systems and organs of long-term patients “took an irreversible beating.” And because of their toxicity, the very drugs supposed to protect H.I.V. patients produced supplementary complications.

Take John Holloway of Chicago, who received a diagnosis of AIDS nearly two decades ago. Thanks to medication, he’s still alive at age 59, but the longevity has brought an array of unanticipated conditions, including chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip. Many of these are complex and difficult to treat.

“AIDS is a very serious disease, but longtime survivors have come to grips with it,” said Dr. Charles A. Emlet, an associate professor at the University of Washington at Tacoma and a leading H.I.V. and aging researcher. “Then all of a sudden they are bombarded with a whole new round of insults, which complicate their medical regime and have the potential of being life threatening. That undermines their sense of stability and makes it much more difficult to adjust.”

Dr. Sheree Starrett, the medical director at Rivington House, a residence for AIDS patients on the Manhattan’s Lower East Side, gave the example of heart disease and diabetes, which are not “terribly hard to treat, except that every time you add more meds there is more chance of something else going wrong.”

Given that no research on the connections has been conclusive, patient’s care is often limited as well. Medicare, Medicaid and private insurers will often neglect to cover necessary procedures.

The “graying of the AIDS epidemic” has raised interest in the connection between AIDS and certain cancers, diabetes, osteoporosis and depression. From 2001 to 2005, the number of people 50 and older living with H.I.V. has increased 77 percent, according to the federal Centers for Disease Control. They now represent more than a quarter of all cases in the United States.

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