At the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.
Then he slipped one day while on vacation and broke his wrist. He underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm elevated, and then do physical therapy for two months to get to the point where he could lift a five pound weight. "It was one of the most difficult things I've ever been through in my life," he said. "I ran, biked, lifted weights and now all of a sudden I couldn't turn the page of a newspaper. It just really got to me."
After a few simple tests, the reason for Levin's fracture became clear: His bones were weak from osteoporosis, a disease that's most commonly seen in older women, but that's also associated with HIV.
"The giddiness of the age of HAART is over," said Levin, referring to highly active antiretroviral therapy, the life-saving drug regimen prescribed to people with HIV. "We should have an aging clinic in every hospital that's serving HIV patients."
Osteoporosis is one of many conditions associated with old age that is now being seen with increasing frequency in people with HIV. Research suggests that long-term exposure to the virus, and to the inflammation it triggers, make people vulnerable to premature aging and to a host of conditions seen with aging, heart and kidney disease, dementia, and osteoporosis.
Additionally, the overall population of people with HIV is getting older, thanks to improved medical therapy. At present, 1 in 4 people with HIV is age 50 or older. The U.S. Senate Special Committee on Aging has predicted that half of all adults with HIV will be older than 50 by the year 2015. Over the past few years, the National Institute of Health has increased its funding for research on HIV and aging, and the White House hosted a conference on October 27 on HIV and aging.
"The evidence is pretty clear," said Levin, who directs The National AIDS Treatment Advocacy Project (NATAP), a New York-based HIV education and advocacy group. "We're going to see early frailty, early senescence and people are going to start dying at earlier ages."
Compared to other conditions associated with HIV and aging, osteoporosis is relatively straightforward to forestall and treat. To maintain bone strength, it's important for all people with HIV to make sure they are consuming an adequate amount of calcium and Vitamin D. A recent article in the journal Clinical Infectious Diseases recommends 1,000 to 1,500 mg of calcium and 800 to 1,000 IUs of Vitamin D daily, as well as at least 30 minutes of weight-bearing exercise, such as jogging or walking, at least three days a week. Calcium is plentiful in dairy products and sardines, and is available in supplements such as calcium carbonate and calcium citrate. The National Institutes of Health has an online information sheet listing ways to get calcium. It's also important to avoid smoking and heavy alcohol use, since these can cause osteoporosis.
HIV is thought to be associated with osteoporosis for a variety of reasons. The infection, itself, causes inflammation, which in turn impacts the cells that maintain bones. Many conditions common in people with HIV, such as Vitamin D deficiency, being underweight and low testosterone, are associated with osteoporosis. Antiretroviral therapy and other medications frequently prescribed to people with HIV, such as Prednisone, also cause bone loss.
Even though many antiretrovirals can cause bone loss, osteoporosis is not a reason to stop taking them. "Antiretroviral therapy is life-saving, and we know that stopping antiretroviral therapy is not a good strategy for preventing complications," said Dr. Todd Brown, an endocrinology specialist at Johns Hopkins University who co-wrote the article in Clinical Infectious Diseases.
Brown and his coauthors recommend that all HIV-positive men older than age 50 and women who are past menopause undergo testing for osteoporosis, since it's a condition that usually doesn't cause symptoms until the person breaks a bone. His own research has found that osteoporosis is "alarmingly" prevalent among African Americans in inner city Baltimore. "Because of the perception that osteoporosis is a white disease, people of color get short shrift for screening," he said. "This concept that African Americans are protected shouldn't be a reason to neglect them."
Once someone is diagnosed with osteoporosis, it's important to take action to prevent falling, such as removing clutter and slippery rugs from the floor. Physical therapy can help improve strength and balance, which also reduce the risk of a fall. The person also should get his or her vision checked and review his or her medication list with a doctor to try to minimize any drug side effects or interactions that might cause drowsiness or unsteadiness.
A class of medicines called bisphosphonates can improve bone strength, but do have some rare risks. "While they do decrease the risk of fracture, they're not totally benign drugs," Brown said. "On the flip side, you shouldn't not use them in the patient who is at high risk of a fracture."
Levin urges all people with HIV to be assertive about discussing osteoporosis and other age-related conditions with their doctor. "My guess is that 90 percent of patients know nothing about any of this and a lot of clinicians and case managers don't know about it either," he said. "Every patient should ask their clinician, 'are you aware, are you monitoring me for heart disease, diabetes, bone disease, cognitive impairment, kidney disease?' This is an important issue for everybody."
A similar version of this article originally appeared on the website of New America Media.
Follow Erin N. Marcus, M.D. on Twitter: www.twitter.com/ErinNMarcusMD
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are the elephants in the room. Not very PC to discuss them tho.
Especially on how HIV affects sexual behaviors,
in the interest of colonizing new host bodies.
The article also does not mention that you also need Mg for yr. bones as well as other trace minerals.
Also fails to mention that one of the best sources of calcium is green leafy veggies and beans; esp important if you are lactose intolerant and can't use dairy products
And as for taking bisphosphonates, even the FDA is updating the public regarding information previously communicated describing the risk of atypical fractures of the thigh, known as subtrochanteric and diaphyseal femur fractures, in patients who take bisphosphonates for osteoporosis. http://www.fda.gov/Drugs/DrugSafety/ucm229009.htm
Please read the following:
http://drvittoriarepetto.wordpress.com/2010/09/15/getting-enough-calcium-into-your-bones-ten-facts-you-need-to-know/
She never knew about Osteoporosis and had never been diagnosed with it..
Funny how smart the older and uneducated were.
some time ago i tried to convince CBC that it is not carrying health stories ,it is carrying sickness stories
as in this article, Susan Blumenthal focuses on vatican like minutiiea of outofdate modern medicine
the innovation which is needed in health care is consciousness of stress releif and that means Maharishi Vedic medicine [ see MDs and PHD and neuroscientists at mum.edu for details ]
as distinct from this health care , the sickness care which Dr Blumenthal is focusing on needs innovation and such as is affordable and relatively free of side effects
the cure should not be worse than the sickness
allways the best practice would look to alternative first and only use modern medicine as a last resort or in conjunction with alternative [ integrative medicine ]
i know nothing
"Is it the meds or the Virus itself?" In general it's both. There is plenty of data already collected that can be analyzed to better understand the specific side effect factors / risks for POZ patients, whether on meds or treatment-naive. After 19 years experience I am pretty sure some problems can be attributed to the disease and many to the treatments (They are not all equal in efficacy or risks over the long term). I have lived many years both untreated and under ARV therapy. It's a "damned if you do, damned if you don't" sort of thing. Many studies have been looking side effects for some time, like HIV / HIV ARVs and heart disease. I have never thought taking powerful meds wouldn't have some secondary risks, especially after decades in the body. I am grateful for researcher s who work with those of us this predicament.
As for "alternative medicine", HIV does not respond to herbs or garlic (or crystals). That sort of nonsense was the official course in the Republic of South Africa until very recently, with tragic consequenc es (Millions dead, sick, or orphaned). Moderation in all things; meds, supplements, etc. My 2¢.