HIV and Immunoness – Premature Aging is Fact! And the Cardio Vascular Risk too!
Half of People with HIV Are Over 50 Years Old
HToday, nearly half of all people living with HIV are aged 50 or over. This is mainly because people are living much longer with HIV, thanks to effective ART, and that's good news.
The bad news is that research increasingly shows that Diseases that normally afflict HIV-negative people between 60 and 70 years old are occurring in people with HIV between 40 and 50 years old.
These concerns have brought the issue of aging with HIV to the center of the stage. One of the biggest unanswered questions is why this is happening. Whether it's heart attacks, bone fractures, kidney disease or certain cancers, the rates of these conditions in HIV-positive people are alarming.
It is unclear how much HIV contributes to these conditions and how much can be explained by other factors (such as smoking, HIV medications, and co-infection with other viruses).
But most people with HIV can do a lot to slow down the aging process and prevent the onset of age-related illnesses. First, it's important to understand how aging works.
What is aging? And HIV and Immunoness
When we think of someone like "old", we tend to think that this person lived a certain number of years: 70, 80, 100. For the National Institute of Aging, however, the focus is not on how long someone lived was alive, but in the inevitable decline in physical fitness and health that occurs when a person arrives later in life.
At the same time, researchers looked for a central cause of aging, but have since realized that a variety of factors – including our genes, our environment, and infections by harmful viruses and bacteria – contribute to the phenomenon of aging in overlapping ways.
Some people win the genetic lottery. They inherit genes that allow them to remain healthy and vital into their 80s and 90s, while others have genes that put them at greater risk for developing cancer or cardiovascular disease when they reach their 40s.
Some people are able to minimize environmental and behavioral factors known to accelerate the aging process. They eat well, exercise and remain socially and intellectually engaged in life. The effects of such environmental and behavioral factors on a person's health are profound.
External Agents That Cause Aging
Likewise, some people are able to avoid infection with the most harmful viruses and bacteria throughout their lives, or have an immune system capable of controlling infections. Others may have to deal with harmful infections, such as hepatitis B virus (HBV), hepatitis C virus (HCV), human papilloma virus (HPV), cytomegalovirus (CMV) – and HIV – which can significantly increase the risk of health problems later in life.
These factors - genetic, environmental and biological - can overlap and cause us to start the aging process, called “senescence”, which descends to the cellular level.
The cells in our bodies depend on small fragments of DNA, called telomeres, to reproduce. When we are young, the cells in our bodies also tend to be young, in the sense that they look and act similarly to the first generation of cells we started with when we were growing up in the womb.
As we age, however, the cells in our body are many hundreds or thousands of generations removed from the original cells, and the code strands at the end of the DNA – the telomeres – get shorter. If the telomeres are in good shape, as they are in young people, each new generation of cells works well. When telomeres get too short, however, each new generation of cells works and reproduces poorly, to the point where cells sometimes fail to reproduce.
Defective cells can cause real problems. If our muscles and bone cells cannot produce new cells that work well – because the telomeres have become too short – then our muscles and bones are likely to become weak.
Weak muscles and bones mean an increased risk of falling and a higher risk of breaking an important bone. – My Father was a healthy, vigorous man, who took more than an hour's walk daily, until he suffered a foolish fall from a step higher than the floor on a spiral staircase (avoid them at all costs ); he broke his femur, the surgery did not work and he died and died in less than eighteen months.
Defective brain cells can lead to coordination and memory problems. Defective Immune Cells are not as capable of keeping infections and cancers under control.
It's this last category of senescence, called immunosenescence, which has particular relevance for people with HIV.
How does HIV affect the aging process?
Educators often explain what happens in the bodies of people with HIV as a battle: a war between the virus and the immune cells.
HIV is not unique in this regard, however. The immune system is constantly “at war” with a series of harmful organisms – viruses and bacteria that enter our bodies – and also with our own cells that become defective and start reproducing very quickly – what we call cancer.
Where HIV differs from many other diseases is that in 99% of HIV-positive people, the immune system does not control the virus very well. This constant battle state, in which the virus reproduces itself and the body fights it, keeps the immune system chronically on high alert, an inflammatory syndrome.
Inflammation is not inherently bad – we need it to fight infections like the flu, to repair damage to body tissues, and to prevent certain cancers from growing – but uncontrolled inflammation can wreak havoc on the body: causing fatty plaque to build up in the heart, Plaques that cause attacks and strokes in our arteries, fueling the growth of some cancers and undermining our immune system.
We have known from the early years of the epidemic that the immune system of people with HIV was chronically inflamed, but before the introduction of potent combination antiretroviral (ARV) therapy in the late 1990s, most people with HIV died very young and very it quickly perished that the long-term consequences of this inflammation would be known. Once potent ARVs became available and people began to live much longer, scientists were finally able to study the long-term effects of inflammation in people living with HIV.
As well as lipodystrophy, another problem...
In the last decade, several studies have produced some important discoveries. We know that inflammation is greatly reduced in people who are able to get and maintain their undetectable viral loads using ARVs. This is one of the reasons the Department of Health's treatment guidelines and
Human Services (DHHS) recommend that people start HIV treatment earlier.
Undetectable Viral Load Not Blocked Constant Slam State
Unfortunately, we've also learned that an undetectable viral load doesn't mean inflammation is completely blocked – it can still be detected and potentially cause problems in people who are otherwise responding well to ARVs.
While researchers are concerned about how inflammation directly affects major organs such as the heart, liver and kidneys, they are also interested in how chronic inflammation affects the immune system itself. The longer a person's immune system continues to fight HIV – even if ARV therapy is being used – the more likely they are to experience immunosenescence, also sometimes called immunosenescence. "immunological exhaustion".
This condition means that immune cells cannot react properly when faced with a new challenge. They also don't reproduce easily or efficiently. In fact, when scientists look at the immune cells of people with HIV, they find that these cells generally have the same degree of immune exhaustion as the HIV negative people that are many decades older.
Are people with HIV aging faster?
As mentioned above, any number of factors can make people more likely to have age-related illnesses and conditions at higher rates and younger ages. People with HIV are more likely to have some of these risk factors than HIV-negative people, causing them to experience health problems as they age. Researchers also asked how or if HIV - by itself - is a risk factor for age-related diseases and conditions.
There is no doubt that many of the diseases associated with aging occur at much higher rates in people with HIV and at much younger ages than in people who are not living with the virus. Here are just a few of those conditions:
- Weakened bones
- Loss of muscle mass and fat redistribution
- cardiovascular disease disease
- liver disease
HIV and Other Factors
Some experts believe that several factors in addition to HIV can significantly contribute to these problems.
Consider the following:
- People with HIV take ARVs, some of which can contribute to bone loss, kidney damage, redistribution of fat and cholesterol, and elevated triglycerides.
- People with HIV are much more likely than the general population to be co-infected with hepatitis B or C – or sometimes all three – and this increases the risk of liver cancer, liver failure, kidney disease and diabetes.
- People with HIV are often more likely to be chronically infected with human papillomavirus (HPV), which causes cervical and anal cancers, as well as head, neck and throat cancer.
- People with HIV are up to three times more likely from smoking tobacco, which is a major cause of heart attacks, strokes, lung cancer and emphysema.
- People with HIV they have rates of mental illness and substance abuse many times higher than in people who do not have HIV, and these illnesses increase the risk of numerous other illnesses.
- HIV can directly infect essential tissues in bones, brain, circulatory system and elsewhere, and can cause inflammation-related damage to the heart, nervous system, liver and kidneys.
These factors are likely to play important roles in increasing rates of age-related illnesses and conditions seen in people with HIV. What experts have not yet agreed on is how much HIV infection itself can exacerbate underlying risk factors – via inflammation and immunosenescence – known to contribute to aging-related problems.
Inflammation and Immunoness
Researchers are working to try to understand how quickly inflammation and immunosenescence occur in people with HIV after being infected.
There is evidence that it starts to happen soon after a person contracts HIV, but good control of the virus (whether because the person controls HIV well naturally or because they are on ARV therapy can slow this process down a bit.
Experts have yet to agree on the best way to measure inflammation and immunosenescence, and we still don't know how much they independently contribute to age-related illnesses, whether in HIV-negative or HIV-positive people.
Research is ongoing, however, to try to answer these questions. In the meantime, the average person living with HIV can do many things to reduce the risk of many age-related illnesses and conditions.
You can slow the aging process?
We are a long way from discovering the fountain of youth, but several factors are consistently associated with a reduced risk of developing age-related diseases and conditions.
Do not smoke tobacco. Smoking is one of the most harmful things people can do to their bodies – and their chances for a long, healthy life. Most people know that it can cause lung cancer and other lung diseases. Some even know it can increase the risk of heart attacks and strokes..
But it's also associated with a number of other age-related diseases – including bone mineral loss, muscle wasting, memory and concentration problems – and age-related cancers such as anal, breast, cervical and prostate cancer.
Minimize the use of alcohol and drugs. Consistent data suggest that moderate alcohol consumption may actually protect the heart and lower blood pressure.
However, the American Heart Association recommends that men who drink alcohol do not consume more than two drinks a day and that women consume no more than one. Studies have found that people who regularly drink more than this are at increased risk for stroke, diabetes, obesity and serious accidents. People with HIV who have liver problems should be especially careful with alcohol.
Data is less clear on how various recreational drugs affect the aging process, although chronic use of amphetamines (“crystal”) and cocaine have been implicated in thinking and memory problems, bone mineral loss, and heart disease. In addition, overuse of most medications is associated with a shorter life expectancy, increased risk of depression, suicide, and other serious health consequences.
Exercise. On average, people who exercise regularly are much healthier in many ways than people who don't exercise. Exercise is good for almost every part of the body. The benefits of regular exercise include reducing the risk of:
- Cardiovascular disease, diabetes and metabolic syndrome
- Age-related cognitive decline
- Bone and muscle mineral loss
Exercise also reduces inflammation throughout the body, improves symptoms of depression and anxiety, and speeds recovery when illness strikes. Not everyone is equally capable of exercising, and a doctor should approve any exercise plan, but there are several ways to get around.
Eat well. In addition to exercise, diet also helps determine who will live long and healthy. Experts are divided on the ideal diet. Some argue against consuming almost any fat. Others say that fats (at least the healthy fats from nuts and fish) are not a problem, however sugar is.
Some advocate a vegetarian lifestyle, while others say meat can be eaten. Fad diets that come and go only confuse things further. All of this can make the decision on the best diet difficult.
Observed and Watched Caloric Intake
What the most reputable diets have in common is observing caloric intake., with the emphasis on including lots of fruits, vegetables, whole grains and beans, and then enjoying everything else in moderation.
Most also emphasize the importance of eating the healthiest types of fish – and limiting meat consumption to leaner meats such as chicken and turkey whenever possible. When it comes to fats, there is a growing consensus that “healthy” fats – for example, from olive oil, nuts and avocados – are really good for you.
What the most reputable diets also agree on is that too much sugar and too many processed and fried foods are the main causes of diabetes, cardiovascular disease, and a host of health problems in the United States. Switching from an unhealthy to a healthy diet is difficult for many people – that's why diets often fail. For more information on nutrition and HIV, Click here.
Antiretroviral Therapy is Necessary - Sine Qua Non
Treat HIV. Current HIV treatment guidelines recommend starting ARV therapy immediately after diagnosis. The main rationale for this advice comes from data showing that untreated HIV and the resulting high level of inflammation can greatly increase the risk of cardiovascular disease, liver disease and other conditions. Some experts now recommend treatment with even higher CD4 counts for the same reason, especially in those with an underlying high risk of cardiovascular disease, liver disease, or other health problems.
However, not everyone has the same underlying risks for the types of illnesses that most concern the panel. For example, people with no family history of heart disease, who have never smoked, and who do not have hepatitis C or B are at basic risk of becoming ill with cardiovascular, liver, or kidney disease. Even so, the START study made it clear that treatment starting quickly is the best course.
Therapeutic vacation? No way!
What is clear, however, is that the longer people wait until their CD4 count drops below 500, the greater their risk of developing age-related illnesses. Actually, one of the most potent predictors of a higher risk for most age-related illnesses is a CD4 count below 200.
Treat other infections. Current guidelines for HBV and HIV recommend that people with both infections should start HIV therapy (with a base of treatments that also fight HBV) as soon as possible. This is because early HBV treatment significantly reduces the risk of liver cancer and other liver problems, without significantly increasing the risk of medication side effects.
There are several highly effective treatments currently approved by the US Food and Drug Administration (FDA) to treat hepatitis C. Many others are being studied in clinical trials or awaiting FDA approval. To check AASLD's recommended regimens for those who are co-infected with HIV, please click here. (Treatment recommendations are based on hepatitis C genotype and liver function. If you do not know the virus genotype or liver function, it is advisable to discuss these things with your doctor.)
Follow disease prevention and screening guidelines
Researchers began to question whether certain age-related screening guidelines may need to start at a younger age in people with HIV.. For example, some questioned whether the most popular screening tool to evaluate the risk of heart attack, based on data from the long-term Framingham study, should be modified for people with HIV.
Experts also question whether other tools, such as the FRAX score to assess the bone mineral loss, may need to be adjusted for HIV-positive people. In fact, some now recommend that HIV infection alone counts enough as a risk factor for bone screening to begin at a younger age, particularly for HIV-positive men, than is normally recommended.
Studies are being conducted to help identify whether current disease screening guidelines for people over 50 are sufficient for people with HIV. While we await the results of these studies, however, it is important to ask your doctor what types of disease prevention and screening guidelines are in place for a person of your age and medical history and insist on following these guidelines in your own care. The US Preventive Services Task Force produces guidelines for screening and managing diseases that can be found here.
Stay social and mentally connected. Numerous studies have found that people who maintain social connections with their family, friends and colleagues, and who engage in activities they consider add meaning to their lives, not only live longer but also remain healthier than socially isolated people and who do not engage in significant activities. There are several ways to connect socially if you're not close to family and don't have many friends. several are local AIDS relief organizations (ASOs) have support groups for people with HIV to connect with each other.
Be Useful To Someone Who Needs
Volunteering at a charity that works for causes you believe in, or in a political campaign, can also help you connect socially. Finding local groups of people to exercise with would accomplish two goals: social connection and fitness.
If you can't get out of the house easily or if you live in a rural area without many opportunities to meet people with similar interests, you can connect with others online in forums. Check the POZ Forums to topics that interest you and start connecting with others today.
If you're looking for a more personal connection, such as a friend, boyfriend, or other important person, you might consider joining an online dating site like POZ Personals.
Are there experimental treatments to delay aging in people with HIV?
Many research teams are looking for ways to slow the aging process in both HIV positive and negative individuals. Until now, there are no proven methods to actually reverse aging. Here is a sampling of some of the most promising examples of research to slow aging and some examples of those that are riskier and require caution.
Reducing inflammation. As already explained, a chronically overactive immune system is harmful in a number of ways. Not only can it directly damage our blood vessels and vital organs, but it can also accelerate the renewal of our immune cells, leading to immunosenescence.
A variety of compounds – some currently available for other conditions and others experimental – are being tested in people with HIV to calm the immune system.
Available study drugs include aspirin, HMG-CoA reductase inhibitors (commonly called “statins” and used to lower cholesterol), the entry inhibitor Selzentry (maraviroc) and drugs commonly used to treat malaria. Experimental drugs include those designed to treat arthritis and other inflammatory diseases.
Telomeres – Should We mess with Them?
Lengthening and repairing telomeres. If damaged or shortened telomeres lead to immune exhaustion, then we should strive to repair or lengthen them, right? The best answer to that question is yes, but only if we can do it safely. There's a good reason we've evolved in such a way that our telomeres break if a cell reproduces too much: cells that can't stop replicating become cancerous. Drugs that stimulate the enzyme telomerase, which helps maintain telomeres, could hypothetically increase the risk of certain cancers. There are some promising drugs in early animal studies, but much research will be needed before they are ready for use in humans.
Major Risks - Low Calorie Diet
Well, there are riskier alternatives. One of the most written methods of prolonging the lifespan of animals and (hopefully) people is extreme calorie restriction. Studies have progressed from insects to small mammals, and so far, it appears that a diet containing about half the “optimal” amount of calories for an individual animal can significantly extend that animal's life expectancy and increase its health and vitality during those years. extras of life. However, we are a long way from being able to study this method in humans, and most researchers and health professionals would not recommend that people with HIV start a low-calorie diet.
But another common treatment in "longevity" clinics in the United States is the use of hormones such as testosterone, human growth hormone and anabolic steroids. While each of them has been approved to treat the common fat and muscle loss in people with advanced HIV disease (wasting), none have been approved to slow or reverse the aging process and all come with side effects that can actually increase some related age-related conditions such as cardiovascular disease, liver problems and diabetes.
A ART is not perfect – all available treatments can cause some side effects; the medications must now be taken with almost perfect regularity and for life; and everyone can stop working.
That said, many experts now agree that a person who starts ARVs early has a good chance of living a life. almost Normal.
Although age-related illness rates are much higher in people with HIV, this does not mean that all people who are HIV positive will have various illnesses by the time they reach 50 years of age. In fact, the actual rates of some age-related illnesses remain well below 10% in people with HIV..
What is still unclear is who will be most at risk for what diseases, how vigilant we need to be in screening for various diseases and whether treatment for any disease will need to differ in people with HIV.
Researchers are actively working on these issues. Meanwhile, the best methods available to prevent age-related physical and mental decline are old habits:
- Go on a diet;
- Practice exercises;
- Maintain social connections;
- And refrain from harmful behavior.
Translated and revised by Cláudio Souza from the original in HIV and Aging