January 9, 2008
Several unexpected medical conditions among long-term AIDS survivors are challenging the perception the disease is manageable but chronic, according to patients, doctors, and scientists. To date there have been only small, inconclusive studies on age-related health conditions and AIDS, partly because so many early AIDS patients died quickly in the era before robust treatments were available.
Many experts believe some conditions seem to be both premature and disproportionate among long-term AIDS patients, including cardiovascular disease, high cholesterol, diabetes, certain cancers, osteoporosis and depression.
In 2006, an AIDS Community Research Initiative study involving 1,000 long-term survivors from New York City found unusual rates of depression and isolation. The Multi-Site AIDS Cohort Study, which has followed 2,000 volunteers nationwide for the past 25 years, holds promise of a comprehensive look at medical rather than psychological issues among aging AIDS patients.
No study has yet explained AIDS patients' unusual incidence of osteoporosis, a disease that is otherwise rarely seen in middle-aged men. Many experts believe avascular necrosis -- the death of cells due to inadequate blood supply -- among AIDS patients is caused by the steroids used in treating early patients for pneumonia.
Cardiovascular disease, diabetes, and high cholesterol are associated with lipodystrophy, which redistributes fat in many AIDS patients. Statins to treat high cholesterol have their own risk, as they are bad for people with abnormal liver function, and many older AIDS patients have liver disease from injection drug use and alcohol abuse. In addition, the more medications a patient takes, the greater the "chance of something else going wrong," said Dr. Sheree Starrett, the medical director for Manhattan's Rivington House, a residence for AIDS patients.