As people with HIV age, they find themselves subject to the same issues that face healthier senior citizens.
Earlier this year, researchers at Georgetown University announced that a 71-year-old man was the first HIV patient to be diagnosed with Alzheimer’s disease.
That claim was challenged by Dr. Victor Valcour, associate professor of geriatric medicine in the department of neurology at the University of California, San Francisco, and co-director of the International NeuroHIV Cure Consortium. He said his team diagnosed an HIV patient with Alzheimer’s in 2008.
Whoever is correct, the point is clear: HIV used to be a death sentence. Now those that have it are likely get other diseases.
A Georgetown researcher clarified the importance of this discovery. The patient could change what researchers know about HIV and dementia, namely how some patients may be misdiagnosed with HIV-associated neurocognitive disorders when they may be developing Alzheimer’s disease, or both.
According to Dr. R. Scott Turner, a neurologist at Georgetown, “Chronic HIV infection and amyloid deposition with aging may represent a ‘double-hit’ to the brain that results in progressive dementia.”
It’s crucial to distinguish because the two conditions are treated with different drugs.
No longer a death sentence
This development is a consequence of the fact that HIV is no longer seen as a death sentence, and people with HIV now can live long and relatively healthy lives.
Their lifespan has increased dramatically with combination antiretroviral therapy, yet an 8- to 13-year gap in survival persists when compared to individuals without the virus, according to a Kaiser Permanente study published earlier this year in the Journal of Acquired Immune Deficiency Syndromes.
The study took place from 1996 to 2011, and looked at estimated life expectancy — the average number of years of life remaining — at age 20 in people with HIV and individuals who were not infected. It included nearly 25,000 HIV-infected adults, and more than 250,000 adults without the virus, who were matched for age, gender, medical center, and year. All individuals were Kaiser members.
The gap in life expectancy persists between people infected with HIV and individuals who are not, ranging from 8 to 13 years depending on when antiretroviral therapy is initiated, as well as demographics and risk factors.
“We observed a steep increase in life expectancy for HIV-infected individuals during the study period,” said lead author Julia Marcus, Ph.D., M.P.H., postdoctoral fellow at the Kaiser Permanente Division of Research, in a statement. “In 1996 to 1997, life expectancy at age 20 for HIV-infected individuals was only 19 years — meaning that an HIV patient was expected to live to age 39. By 2011, an HIV patient could be expected to live to age 73.”
Those figures differed somewhat from those in a 2013 study published in PLOS ONE.
It found that some men who have sex with men (MSM) with HIV could expect to live as long as the average American — 77 years — though nonwhite patients still lagged far behind. The average person infected with HIV in North America could expect to live to the age of 63.
“[It is] nothing short of miraculous, given where we were 20 years ago,” said Dr. Mark Smith, who treats people with HIV and also serves as president of the California Health Care Foundation. “It's a stunning success story for biomedical science and has contributed greatly to our understanding of other viruses and disease processes as well."
The study looked at 23,000 people with HIV in the United States and Canada from 2002 to 2007. Subjects came from a wide range of racial and socioeconomic backgrounds. Intravenous drug users and nonwhite patients fared the worst, with life expectancies of 49 and 58, respectively.
Still searching for a cure
There is still no cure for HIV.
With viral diseases, that cure often takes the form of a vaccine. But with HIV, the quest for such a vaccine has been a 30-year journey.
In a report published last year in Science, researchers from the National Institute of Allergy and Infectious Diseases took a look back at three decades of research and action into an HIV vaccine.
Although the AIDS epidemic is often associated with the 1980s and early 1990s, AIDS and HIV are still very much a part of many lives in the United States and around the world.
Editor’s Note: This story was originally published on December 18, 2013 and was updated by Roberta Alexander on August 8, 2016.