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Challenges ahead for aging HIV and AIDS population

AIDs ribbon and blood cells
AIDs ribbon and blood cells generic CBS/iStockphoto

(CBS/AP) With more people living longer with HIV and surviving the AIDS virus, the U.S. government estimates that more than half of infected Americans will be over the age of 50 by 2020.

Even in developing countries, more people with the AIDS virus are surviving to middle age and beyond.

That's good news -- but it's also a challenge. There's growing evidence that people who have spent decades battling the virus may be aging prematurely. At the International AIDS Conference this week, numerous studies are examining how heart disease, thinning bones and a list of other health problems typically seen in the senior years seem to hit many people with HIV when they're only in their 50s.

"I'm 54, but I feel older," said Carolyn Massey of Laurel, Md., who has lived with HIV for nearly 20 years.

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"When I hear young people talk about, 'Well you get HIV and you take your drugs and you'll be all right' -- that's just not the truth," she said. "This is a lifelong thing we're talking about, and it unfolds every day on you."

The graying isn't just because people like Massey are surviving longer. Some of it comes from older adults being newly diagnosed, a trend U.S. health officials say is small but slowly growing. Yes, grandparents still have sex - an estimated 80 percent of 50 to 90-year-olds are still sexually active according to an editorial published in the Student British Medical Journal - and that's an age group missed by all those hip safe-sex messages aimed at teens and 20-somethings. The CDC recommends that everyone in the U.S. from 13 to 65 be tested for HIV at least once, with those at an increased risk - meaning they have multiple partners or have sex with men - get tested once a year.

The rates of sexually transmitted diseases have doubled among 50 to 90-year-olds in the past 10 years. And, the rates of syphilis, chlamydia and gonorrhea among 45 to 65-year-olds are increasing.

"They let down their guard," is how Dr. Kevin Fenton of the Centers for Disease Control and Prevention puts it.

In the U.S., currently one in five people are living with HIV and do not know they are infected, according to the U.S. Department of Health & Human Services. About every 10 minutes, someone is infected with the disease. Since the first case was reported in the U.S. in June 1981, 1.7 million people are estimated to have been infected with HIV. More than 619,000 have died from the disease and approximately 1.2 million were living with the disease as of 2008.

Already, a third of the nearly 1.2 million people living with HIV in the U.S. are over 50, and by 2020 half will be, Fenton said at one of numerous sessions on aging at the world's largest AIDS meeting.

People 50 or older accounted for 17 percent of new HIV diagnoses in 2009, according to the CDC's latest data. That's up from 13 percent in 2001.

There aren't as good counts in poor regions of the world, where access to life-saving medications came years later than in developed countries.

But even in hard-hit sub-Saharan Africa, home to most of world's HIV-infected population, studies suggest 3 million people living with HIV are 50-plus, said Dr. Joel Negin of the University of Sydney in Australia. By 2040, he said, that could reach 9 million.

There, challenges are different. Ruth Waryaro of Kenya, addressing the conference on her 65th birthday, said clinic workers hassle her when she goes to pick up her monthly supply of medication -- not believing a grandmother really needs it.

"If you're not strong enough, you just leave the medication and go home," said Waryaro, who raised four children of her own and now is raising four AIDS orphans. She also has diabetes and high blood pressure.

As Negin pointedly told the conference, "50 is not old." But for years, world health authorities didn't even measure HIV in people beyond age 49.

Today, people who are diagnosed and treated early can expect a near-normal life-span, Dr. Anthony Fauci, infectious disease chief at the National Institutes of Health, told The Associated Press.

The new focus is on what these pioneering survivors can expect as they reach their 50s, 60s and beyond. They're now getting chronic illnesses such as heart disease, diabetes, kidney disease and osteoporosis -- some of the common ailments when anyone gets old. But studies suggest people with HIV may be at higher risk for some of those illnesses, or get them earlier than usual.

"It's almost created a new subspecialty of medicine," Fauci said.

Perhaps the strongest evidence links HIV and an increased risk of heart disease. Some AIDS medications raise that risk. But in research published for the AIDS meeting, scientists at Massachusetts General Hospital uncovered another reason.

They scanned the arteries of people with and without HIV, and found the HIV patients had more inflammation inside their arteries, putting them at risk for the kind of clots that trigger heart attacks. That's even though the HIV patients had their virus well-controlled and weren't that old -- their average age was 52, the researchers reported in the Journal of the American Medical Association.

HIV triggers body-wide inflammation as a person's immune system tries to fight the virus, a process that persists and can quietly damage organs even with good medications, CDC's Fenton said.

HIV is not acting in a vacuum, said Dr. Amy Justice of Yale University, noting that people's histories of smoking, for example, also contribute to inflammation.

But she pointed to data from a Veterans Affairs study that said older people with HIV use more medications for other diseases than HIV-free patients the same age.

At the conference, some older people with HIV lined up to have their photographs made and their personal histories recorded, part of a Web project called "The Graying of AIDS."

It's a chance to be counted, and share knowledge.

"We're so concerned about the youth factor, we forget about the people who've brought us thus far," said Massey, the Maryland woman, who leads an HIV group called Older Women Embracing Life and works with churches to raise HIV awareness.

CDC's Fenton noted that those voices can help other older adults realize they're at risk, when they're getting back onto the dating scene after years of monogamous relationships. Older people don't use condoms as much as younger people.

"We still have this huge issue with stigma so thick you can cut it with a knife," says Massey, who also wants HIV testing to become a routine part of health check-ups. "We have to normalize the conversation."