With HIV, growing older faster
Many gained years of life through drug 'cocktails,' but the ailments of aging are showing up earlier.
WERE STILL HERE: Dennis Golay, 60, left, and Larry Gibson, 63, in the garden of their Palm Springs home. Both men tested positive for HIV in the days before antiretroviral drugs. (Don Bartletti / Los Angeles Times)
It was Nov. 14, 1981 -- Golay's 34th birthday.
Seven years later, both men tested positive for the AIDS virus, an almost certain death sentence in the days before antiretroviral drugs. Having dreamed of growing old together, they were devastated.
"We had something so special," said Gibson, 63, looking back at that dark time. "To be cheated out of its maturity just didn't seem right."
"I guess it wasn't," said Golay, now a silver-haired 60. "We're still here."
Much attention has been paid in recent years to how the human immunodeficiency virus disproportionately infects African Americans and Latinos, including women, many of them poor. But the new reality of HIV is not just black or brown. It is also gray.
The graying of HIV/AIDS is a little-recognized new phase of the epidemic in the United States, and it comes with its own complications. Gibson and Golay are growing old together, true. They are also growing older faster. Ailments common to aging, including depression, are showing up sooner than expected in many people with HIV, according to patients and the doctors who treat them.
"We're seeing things that my mother is experiencing," Golay said, "and she's 86."
Golay had a heart attack last year at 59, despite a lifetime of healthful eating and regular exercise. He underwent a quintuple bypass. ("He never does anything small," Gibson said.) His father had died of a heart attack -- at 70.
Gibson has the sunken eyes and cheeks of an old man, side effects of the antiretroviral drugs that keep his HIV in check. Lipodystrophy, as the condition is called, rearranges fat in the body and at one point gave Golay a humped back. It can lead to insulin resistance and raise cholesterol and triglyceride levels in the blood.
Some longtime survivors develop a bone disease possibly linked to the use of corticosteroids against pneumocystis pneumonia, one of the most lethal of the opportunistic infections that prey on HIV-weakened immune systems. Called avascular necrosis, the bone disease can lead to the need for a hip replacement. Others aging with HIV are developing memory deficits and liver and kidney diseases.
"I have a population that, having survived this terrible illness, is now getting illnesses of old age 10 or 20 years sooner than normal," said Dr. Ardis Moe, a physician at UCLA's Center for Clinical AIDS Research and Education. "That's the bad news. The good news is that they're not dead."
Early on in the epidemic, the quickly mutating virus developed resistance to the first drugs found to suppress it. Then, in 1996, researchers discovered that multi-drug "cocktails" of three antiretroviral drugs were better barriers to mutation than single drugs. Deaths plummeted.
Today more than 25 anti-HIV drugs are on the market, allowing numerous combinations to combat resistance and adjust for side effects. But health problems persist, and doctors have few guidelines for teasing out which conditions are caused by the virus, which are side effects of medications and which are merely signs of aging.
Until the last decade, there were too few people aging with HIV to study.
Now more than a quarter of the estimated 1 million Americans living with HIV are, like Gibson and Golay, older than 50, according to the federal Centers for Disease Control and Prevention. By 2015, half will be older than 50. At least two long-range studies of people aging with HIV are underway, by the National Institutes of Health and the Veterans Health Administration.
A 2006 study by the New York-based AIDS Community Research Initiative of America on the interaction of HIV and aging on mental health found depression to be almost 13 times higher in longtime survivors than in the general population. As do the very elderly, whose suicide rate is the highest of any age group, longtime HIV survivors often grow despondent over health disabilities and the deaths of friends.
"Everybody I knew died in the late '80s or early '90s," said Los Angeles resident and longtime survivor Thomas Woolsey, 59. "It sounds like I'm the lucky one, but I don't really think so. What good is a life without any friends?"