The world will face a mighty social and medical challenge as millions of people with HIV survive into old age, the world AIDS forum, held in Vienna from 18-23 July, heard.
The problem is only now becoming apparent as the first generation living with the human immunodeficiency syndrome (HIV) heads towards its 60th birthday and beyond, thanks to the lifeline of antiretroviral drugs, say specialists.
These survivors are mainly in Western nations, where the precious therapy first became available from 1996.
But they will soon be followed by millions of counterparts in sub-Saharan Africa and other poor countries where the drug roll-out started in the middle of the last decade.
That these men and women should have stayed the course is itself a stunning testimony to antiretrovirals—and, say some of the survivors themselves, something of a miracle.
“We lived from day to day,” Jean-Luc Romero, 51, a councillor for the Paris region, told AFP, as he recalled the situation in 1987, when he learnt of his HIV status.
“There was no point planning beyond that. We saw people dying all around us, and we would say, ‘That will be us one day’. We didn’t think about the future, because the present was all we had. I remember thinking, ‘I won’t live beyond 30’,” says Romero.
AIDS first came to light in 1981. Before antiretroviral treatment developed, people usually progressed to the disease within a decade after infection by HIV, and died a year or two later.
For many of those now advancing into old age, living with HIV will be fraught with medical problems, loneliness, stigma and worries about finance, the 18th International AIDS Conference heard.
“There have always been older people with HIV, but what is new is the numbers that will require new public health thinking compared to the past,” says Gottfried Hirnschall, director of HIV/AIDS at the UN’s World Health Organization (WHO).
“We have to discuss this subject,” he says. “Ageing with HIV is not just a clinical challenge, it is a clinical and a social challenge, and it’s not just confined to one part of the world versus another.”
Lisa Power, policy director with the British AIDS charity, the Terrence Higgins Trust, says that even though people with HIV are living longer, their quality of life is often darkly overshadowed by worry.
Her organization carried out a questionnaire-survey of 410 people with HIV aged more than 50 living in Britain, which was then followed up with 40 in-depth interviews. The respondents were likelier to be unemployed than healthy counterparts and had meagre savings, often because they had expected to die before they got old and so had never put money to one side.
Many were socially isolated, fearful of the double discrimination against old age and AIDS, and fretted about the day when they ultimately would be admitted to hospital or a nursing home.
Research presented by Margaret Hoffman-Terry of the American Academy of HIV Medicine provided statistical evidence of the scale of the problem.
In the US alone, fewer than 20,000 people in 1995 were older than 50. In 2005, this figure was 120,000.
In the 55-plus group, Americans with HIV were three times likelier than a healthy man aged 70 to have a chronic health problem, she says.
The complications of HIV—and the side effects of powerful antiretrovirals that have to be taken each day for the rest of one’s life—breed a long list of sicknesses.
They include depression, hypertension, diabetes, lipodistrophy (a redistribution of fat around the body), metabolic disorders, osteoporosis, heart, liver and kidney disease and cancer.
“In the future we are going to see patients living decades, and we are going to have to figure out ways of getting them to a healthy old age,” says Hoffman-Terry.
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