What conferences like the HIV + Aging meeting recently held by Emory in Decatur offer the visiting writer: anecdotes that illustrate issues of clinical care.
To illustrate her point that assumptions about who is likely to develop a new HIV infection may lead doctors to miss possible diagnoses, keynote speaker Amy Justice from Yale described a patient who was seen last year at Yale-New Haven Hospital.
A 60 year old man reported fatigue and had lost 40 pounds over the course of a year. Despite those symptoms, and the discovery of fungal and viral infections commonly linked to HIV/AIDS, it took nine months before a HIV test was performed on the patient, a delay Justice deplored.
Sex and substance abuse do not end at age 50, she said, citing data showing that the risk of HIV transmission can be greater among older adults, and that substance abuse is more likely among adults who are HIV positive compared to those who are HIV negative.
Justice also highlighted the issue of polypharmacy (interactions between prescription drugs at the same time), a concern even in people who are not living with HIV. Common blood pressure medications taken by older adults to prevent heart disease have been suspected of increasing the risk for falls. That’s a problem especially for people living with HIV, because HIV infection has been linked to weakened bone.
The term HANA (HIV-related non-AIDS conditions) is a big tent, encompassing heart disease, damage to the liver, cancers, bone disease and neurocognitive disorders. They may be a consequence of antiretroviral therapy or the chronic presence of HIV, although not necessarily active infection. Here is a link to a presentation by Justice on this topic.
The conference program included a discussion panel with four Atlanta community members living with HIV, and several presentations by doctors examining different aspects of HANA including Emory’s Bill Lewis (antiretroviral drugs’ effects on mitochondria, which in turn affects the heart and kidneys) and Igho Ofotokun (HIV-related bone disease). The panelists included a nurse at the Ponce Clinic’s Infectious Disease Program, a retired diplomat turned novelist, and a man who had developed an HIV infection at the age of 65.
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