You can age well with HIV
Today, more than half of all people living with HIV in the United States have 50 years or more. This is mainly because people live much longer with HIV thanks to effective antiretroviral therapy (ARV), and this is good news.
The bad news is that research shows more and more that the diseases that normally target HIV-negative people in their 60 and 70 years are occurring in people with HIV in their 40 and 50 years. These concerns have taken the issue of aging with HIV to the center of the stage.
What is the action of HIV disrupts this Aging with HIV
One of the biggest unanswered questions is why this is occurring. Whether it's heart attacks, bone fractures, kidney disease or certain types of cancer, the rates of these conditions in HIV-positive people are alarming.
It is not clear how much HIV contributes to these conditions and how much is explained by other factors (such as smoking, anti-HIV drugs and coinfection with other viruses).
What is aging? How to get old with HIV?
But most HIV-positive people can do much to slow down the aging process (that is, to age well with HIV and age well in general) and protect against the onset of age-related diseases. Before first, it is important to understand how aging works.
When we think of someone as "old," we tend to think of this person as having lived a number of years: 70, 80, 100. However, for the National Institute of Aging, the focus is not on how long someone has been alive, but on the inevitable decline in physical ability and health that occurs once a person comes to life later.
At the same time, researchers have sought a central cause of aging, but they have realized that a variety of factors - including our genes, our environment and infections with viruses and harmful bacteria - contribute to the phenomenon of aging in overlapping forms.
Some people win the genetic lottery. They inherit genes that allow them to stay healthy and vital well in their 80s and 90s, while others have genes that put them at higher risk of developing cancer or cardiovascular disease by the time they reach their 40 years.
Certain people are able to minimize the environmental and behavioral factors known to accelerate the aging process. They eat well, exercise and remain socially and intellectually involved in life. The effects of such environmental and behavioral factors on a person's health are profound.
Similarly, some people are able to avoid infection with the most harmful viruses and bacteria throughout their lives, or have immune systems capable of keeping infections under control. Others may have to deal with harmful infections such as:
- the Hepatitis B virus (HBV);
- the hepatitis C virus (HCV);
- viruses do papiloma humano (HPV),
- cytomegalovirus(CMV) -
- and HIV.
All of this can significantly increase the risk of health problems later in life.
These factors - genetic, environmental, and biological - can overlap and cause us to begin the aging process, called "senescence," and senescence goes to the level cell phone.
The cells in our bodies depend on a short time to reproduce. When we are young, the cells of our bodies also tend to be young, as they look and act in a similar way to the first generation of cells with which we begin to develop in the uterus.
As we age, however, the cells in our body are many hundreds or thousands of generations removed from the original cells, and the strands of code at the end of the DNA - the telomeres - get shorter. If telomeres are in good shape, as they are in young people, every new generation of cells works well.
When the telomeres get very short, however, each new generation of cellular functions and reproduces more badly, to the point where cells sometimes can not reproduce.
Weak muscles and bone hamper this aging well with HIV
Defective cells can lead to real problems. If our muscle and bone cells can not make new cells that work well - because telomeres have become too short - it makes our muscles and bones more likely to be weak.
Weak muscles and bones mean a greater risk of falling and a greater risk of breaking a large bone. Defective brain cells can lead to coordination and memory problems. Defective immune cells are not as capable of keeping infections and cancers at bay.
It is this last category of senescence, called immunosenescence, which has particular relevance for people who are trying to age well with HIV.How does HIV affect the aging process?
This state of constant battle, where the virus reproduces itself and the body fights against it, keeps the immune system chronically on high alert, a syndrome called chronic inflammation.
Inflammation is not inherent and necessarily bad - we need it to fight infections like the flu, repair bodily tissue damage, and ward off the growth of certain cancers - but uncontrolled inflammation can cause total upheaval in the body:
This causes the build up of fat plaques in our arteries and they are causing heart attack and stroke and stroke, growth of some types of cancer and unnecessary wear and tear on our immune system.
We have known since the earliest years of the epidemic that the immune system of people with HIV was chronically inflamed, but prior to the introduction of a combination of potent antiretroviral therapy (ART) in the mid to late 1990 years, most people with HIV died very young and too fast for the long-term consequences of this inflammation to be known.
With ART (which saved my life and also that of my wife) people have a longer life expectancy.
Once potent ARVs became available and people began to live much longer, scientists have finally been able to study the long-term effects of inflammation in people living with HIV.
In the last decade, numerous studies have yielded some important discoveries. We know that inflammation is greatly reduced in people capable of obtaining and maintaining their undetectable viral loads using ARVs.
This is one of the reasons why the Department of Health and Human Services (DHHS) treatment guidelines recommend that people start with HIV treatment earlier. Unfortunately, we have also learned that an undetectable viral load does not mean that the inflammation is completely blocked - it can still be detected and potentially cause problems in people who otherwise respond well to ARVs.
Does chronic inflammation affect the immune system itself?
Yes! While researchers are concerned about how inflammation directly affects the major organs such as the heart, liver and kidneys, they are also interested in how chronic inflammation affects one's own immune system. The longer a person's immune system continues to fight HIV - even if ARV therapy is being used - this person is more likely to experience immunosenescence, also sometimes called "immune exhaustion".
This condition means that the immune cells can not react properly when confronted with a new challenge. They also do not 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 exhaustion as HIV-negative people who are many decades older.
Do people with HIV age faster?
As mentioned above, any number of factors can make people more likely to have diseases and conditions related to age at higher rates and younger ages. People HIV-positive are more likely to have some of these risk factors than people HIV-negative, leading them to become poorer health as they grow older.
The researchers also wondered how or if HIV- by itself - is a risk factor for diseases and conditions related to age.
There is no dispute 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 do not live with the virus.
Here are some of those conditions that are embarrassing for those who try to age well with HIV:
Some experts believe that a number of factors besides HIV can contribute significantly to these problems. Consider the following:
- People with HIV receive ARVs, some of which may contribute to bone loss, kidney damage, redistribution of fat and high cholesterol, and triglycerides.
- People with HIV are much more vulnerable than the general population to be co-infected with either hepatitis B or hepatitis C or sometimes all three - and these increase the risk of liver cancer, liver failure, disease kidney and diabetes.
- People with HIV are often more likely to be chronically infected with human papillomavirus (HPV), which causes cervical and anal cancer, as well as head, neck and throat cancers.
- People with HIV are up to three times as likely to smoke tobacco, a leading cause of heart attacks, strokes, lung cancer and emphysema.
- People with HIV have mental illness and substance abuse rates that are often higher than in people who are not HIV positive, and these diseases increase the risk of many other diseases.
- HIV can directly infect key tissues in the bone, brain, circulatory system and elsewhere, and can cause inflammatory damage to the heart, nervous system, liver and kidneys.
The relative increase in biological and non-chronological age in people living with HIV
These factors probably play important roles in increasing disease rates and well or unsuccessful aging in people with HIV.
What the experts still have not agreed to is how much HIV infection can exacerbate the underlying risk factors (?) - by means of inflammation and immunosenescence - which contribute to problems related to aging.
Researchers are working to try to understand how quickly the inflammation and immunosenescence occur in people with HIV after being infected (?).
There is evidence that this begins to occur very soon after a person has contracted HIV, but good virus control (whether because a person naturally controls HIV as well as why he or she uses ARV therapy) may slow this process down a bit .
Experts have not yet agreed on the best way to measure inflammation and immunity and we still do not know how much they contribute independently to age-related illnesses, either in HIV-negative people or in people with HIV.
Current Research (???)
Research is ongoing, however, to try to answer these questions. However, there is much that the average person living with HIV can do to reduce the risk of many age-related diseases and conditions.
Is it possible to slow down the aging process?
We are far from discovering a source of youth, but a series of factors are consistently associated with reducing the risk of developing diseases and conditions related to age.
Do not smoke tobacco.Smoking tobacco is one of the most harmful things people can do to their bodies - and your chances of living a long and healthy life.Most people know that tobacco use can cause lung cancer and other lung diseases like pulmonary emphysema and I'm thirty thousand times more damn so.
Some even know it can increase the risk of heart attacks and strokes. But it is also associated with many 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 cancers.Click here
Some tips on how to quit smoking and "optimize" aging with HIV.
Minimize alcohol and drug use. Consistent data suggest that moderate alcohol consumption can 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 do not consume more than one. Studies have found that people who regularly drink more than this are at higher risk of stroke, diabetes, obesity and serious accidents. People with HIV who suffer from liver problems should take special care with alcohol.
How do various recreational drugs affect the process of aging as well as HIV ???
Data are less clear about how various recreational drugs affect the aging process, although chronic amphetamines ("crystal") and cocaine have been implicated in memory and thinking problems, bone mineral loss, and heart disease. In addition, excessive use of most drugs is associated with shorter lifetimes, increased risk of depression and suicide, and other serious health consequences.
What about physical exercise?
Exercise. On average, people who exercise regularly are much healthier in many ways than people who do not exercise. Exercise is good for almost every part of the body. Benefits of regular exercise include reductions in the risk of:
- Cardiovascular disease, diabetes and metabolic syndrome
- Age-related cognitive decline
- Loss of mineral and muscular bone
Exercise also reduces inflammation throughout the body, improves symptoms of depression and anxiety, and accelerates recovery when the disease strikes (know the Home Project). Not everyone is equally able to exercise, and a doctor must sign on any exercise plan, but there are several ways to move.Click here
For some suggestions for life enhancement that would help in the process of getting older with HIV.
Eat well. In addition to exercise, diet also helps determine who will live a long and healthy life. Experts are divided into the ideal diet. Some argue against consuming almost any fat.
Others say that fats (at least healthy fats from nuts and fish) are not the problem, but that sugar is. Some advocate a vegetarian way of life, while others say the meats are good.
Fad diets that go and go just confuse things even more. All of this can make it quite difficult to decide on the best diet.
What the most respectable diets have in common is the observation of caloric intake, along with the emphasis on the inclusion of many fruits, vegetables, whole grains and beans, and then enjoying everything 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, olive oil, nuts and avocados - are really good for you.
What most respectable diets also agree on is that too much sugar and too many processed and fried foods are a major driver of diabetes, cardiovascular disease, and a host of health problems in the United States of America. Moving to a healthy way of eating food is difficult for many people - that is why diets so often fail. To learn more about nutrition and HIV,click here.
Treat HIV. Current HIV treatment guidelines recommend initiating ARV therapy at least as soon as your CD4 count falls below 500 (that changed in 2013 / 2014 and it is recommended to start treatment as quickly and quickly as possible after being diagnosed) .
Risks underlying cardiovascular disease, liver disease or other health problems.
The main reasons for such advice come from data demonstrating that untreated HIV and the resulting high level of inflammation can dramatically increase the risk of cardiovascular disease, liver disease and other conditions. Some experts now recommend treating even larger CD4 counts for the same reason, especially in those at high risk underlying cardiovascular disease, liver disease or other health problems.
Not all of them have the same underlying risks for the types of diseases that the panel was most concerned about, however. For example, people with no family history of heart disease who have never smoked and who do not have hepatitis C or B have a low baseline risk for becoming ill with cardiovascular, liver, or kidney disease.
(Knowledge already exceeded)
For these people, the decision about when to start treatment may differ from that of a person who has a family history of heart disease or who smokes or has HCV. In this respect, the guidelines offer some flexibility.
What of course, however, is that the more people wait after their CD4s fall below 500, the greater the risk of developing age-related diseases (I was harmed by the National STD / AIDS Coordination that marked the beginning of my therapy in a thesis that ignored this).In fact, one of the most potent predictors of a higher risk for most age-related diseases is a record of CD4 less than 200.
Treat other infections. Current HBV and HIV guidelines recommend that people with both infections begin HIV therapy (with a backbone of treatments that also fight HBV) as soon as possible. This is because treating HBV early significantly reduces the risk of liver cancer and other liver problems without significantly increasing the risk of side effects from the medication.
There are a number of highly effective treatments currently approved by the US Food and Drug Administration to treat hepatitis C. Many others are being studied in clinical trials or are awaiting FDA approval. For details on these medications, click here. To check the regimens recommended by AASLD for those who were not previously treated (called being naive from treatment), click here. For those who have failed in the previous cure attempt (called the tried treatment), click here.
Follow the guidelines for disease prevention and screening Researchers have begun to question whether certain age-related screening guidelines may need to start at a younger age in people with HIV. For example, some have questioned whether the most popular screening tool for assessing heart attack risk, based on data from the long Framingham study, should be modified for people with HIV.
Experts also question whether other tools, such as the FRAX score to assess bone mineral loss, may need to be adjusted for HIV-positive people. In fact, some now recommend that HIV infection be sufficient as a risk factor so that bone screening should begin at a younger age, particularly for HIV-positive men, than is usually recommended.
Studies are underway to help identify whether current disease screening guidelines for people over 50 years are sufficient for people with HIV. While we expect the results of these studies, however, it is important to ask your doctor what kinds of disease prevention and screening guidelines are in place for a person of your age and medical background and insist on following these guidelines in your own care. The US Preventive Services Task Force produces screening and disease treatment guidelines and can befound here.
Mental health care is very important.
Stay socially and mentally connected. Numerous studies have found that people who maintain social connections with their family, friends and colleagues and engage in activities that they feel add meaning to their lives not only live longer, but are also healthier than socially isolated individuals and do not engage in meaningful activities. There are a variety of ways to connect socially if you are not close to family and do not have many friends. I, Cláudio Souza, only succeeded in "improving myself" after I began a therapy work with a therapist, Maíra, who was able, after "years of court", to move to her professional and intellectual labors, which allowed me to I recognized myself, saw and confessed my mistakes, to the Therapist and to me and that, somehow, they allowed me to have some leniency from me to me.
Support groups and therapy for people with HIV help them (but me) to connect with each other.
Volunteering with a charity that works on the causes you believe in or on a political campaign can also help you connect socially. Find local groups of people to exercise with two goals: social connection and fitness.
If you are unable to leave your home easily, or if you live in a rural area without many opportunities, meet similarly minded people, you can connect to others online in the forums.
Are there experimental treatments to slow aging in people with HIV?
Many research teams are looking for ways to slow down the aging process in both HIV-positive and HIV-negative people. So far, there are no proven methods to actually reverse aging. Here is a sample of some of the most promising examples of research to slow aging, and some examples of those that are more risky and require caution.
Reducing inflammation. As already explained, a chronically overactive immune system is harmful in many ways. This can not only directly harm our blood vessels and vital organs, but can also accelerate the volume of business of our immune cells, leading to immunosenescence.
Good old aspirin
A variety of compounds - some currently available for other conditions, and other experimental ones - are being tested in people with HIV to calm the immune system. Drugs available under study include aspirin, HMG-CoA reductase inhibitors (commonly referred to as "statins" and used to lower cholesterol), the fusion inhibitorSelzentry, Maraviroc and other drugs typically used to treat malaria. Experimental medications include those that have been designed to treat arthritis and other inflammatory diseases.
Stretching and repair of telomeres.
If damaged or shortened telomeres lead to immune depletion, 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 is a good reason why we evolved in such a way that our telomeres break down if a cell reproduces too much: cells that can not stop replicating become cancerous.
The drugs that stimulate the enzyme telomerase, which helps to maintain telomeres can, hypotheticallyE (see here), increase the risk of certain types of cancer. There are some promising drugs in early animal studies, but much research will be needed before they are ready for evaluations, studies, and testing on humanoid beings and then humans.
More risky alternatives. One of the most written methods on stretching animal lifespans and (hopefully) people is an extreme calorie restriction.
Studies have already progressed insects for small mammals and so far it seems that a diet containing about half the quantity "Ideal" calories for an individual animal can significantly extend the lifespan of this animal and increase its health and vitality during these extra years of life (friends and gluttons and gluttons, it may be that eating less increases life expectancy: o) .
We are a long way from being able to study this method in humans, however, and most researchers and health care providers will not recommend that people with HIV start a diet of hypocaloric (hypocaloric feeding ... What is it? _).
Another common treatment in "longevity" clinics around the United States is the use of hormones, such as testosterone, human growth hormone, and anabolic steroids. Although each one has been approved to treat joint and muscle loss in people with advanced HIV disease Wasting syndrome), none are approved to slow or reverse the aging process and all bring side effects that can actually increase some factors related to age conditions such as cardiovascular disease, liver problems and diabetes (do not grow old so I seem to grow old).
Conclusion: ART is not perfect
Person initiating ARTs early gives a long but excellent shot in search of living an "almost" normal life
- The combination of potent combination ARV is not perfect - all available treatments can cause some side effects;
- drugs should be taken now with almost perfect regularity and for the rest of life;
- and everything may crash.
Having said that, many experts now agree that a person who initiates HAART early gives a long but excellent shot in the quest to live a "near" normal life.
Although age-related disease rates are much higher in people with HIV, this does not mean that all those who are HIV-positive will have multiple diseases when they reach their 50 years.
In fact, the actual rates of some age-related diseases remain well below 10% in people with HIV.
What is still unclear is who is at risk for which diseases, how vigilant we need to be in screening for these various diseases, and whether treatment for illness should be different in people with HIV.
Researchers are actively working on these issues. Meanwhile, the best methods available to prevent physical and mental decline related to age are the old ones:
- go on a diet,
- to exercise,
- maintain social connections
- and refrain from harmful behavior.
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