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Major Diseases Decline in HIV-neg BUT NOT in HIV+
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from Jules: a national discussion in HIV & Aging is needed: we are experiencing severely increased cancer rates now among older HIV+ [see study link below]...we need better prevention & screening needs; better equipped doctors & clinicians are needed; a more focused approach to providing special services is needed for the increasingly silent majority of aged HIV who are increasingly experiencing less mobility, reduced capacity for independent daily activities; depression, isolation & increased substance abuse; income & housing problems. And an increased focus to find medical interventions; with increased diseases among older HIV+ the healthcare costs will be impacted & increased, premature death rates will occur, increased suicidal ideation....Federal AIDS officials & industry must be responsive to these issues & we need a focused national discussion......IDUs are severely impacted by HIV & HCV....injection drug use, cocaine use & HIV & HCV all increase immune activation & inflammation putting this patient population at greater risk for accelerated aging & comorbidities, this affects the overall aging problem we see in HIV & SVR in HCV decreases cardiovascular disease, kidney disease & diabetes, so unrestricted access to HCV DAAs is crucial for patients & for healthcare costs.
A Medical Mystery of the Best Kind: Major Diseases Are in Decline......http://mobile.nytimes.com/2016/07/10/upshot/a-medical-mystery-of-the-best-kind-major-diseases-are-in-decline.html
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BUT NOT IN HIV.......
'HIV accelerates aging by between 4-15 years various studies find'
High/Increasing Comorbidity Rates Among HIV+......Comorbidities of Patients with Human Immunodeficiency Virus (HIV) in the USA - a Longitudinal Analysis of Prevalent HIV Patients Over 11 Years......http://www.natap.org/2015/ICAAC/ICAAC_20.htm.......Renal Impairment Doubles......Cardiovascular Events Doubled in Medicaid......48% Have Hypertension in medicaid. 65% in medicare.....31% have diabetes in medicare....Diabetes Rates Doubled.....Fracture or Osteoporosis Rates increased about 40% in medicaid, doubled in medicare & increased 20% in commercial.....Hepatitis C -14% reported having HCV in Medicaid 2013, in Medicare 2.5% report having HCV which doubled from 2003
Cancer risk among the HIV-infected elderly in the United States - (06/07/16) ....."Cancer incidence was approximately 50% higher in HIV-infected compared with HIV-uninfected individuals.....the absolute risk of cancer in the U.S. HIV-infected elderly is sizeable, reflecting effects of both HIV and aging.....clear need for cancer prevention in this age group and the importance of screening, particularly for lung, colorectal, and breast cancers, for which accepted screening modalities are available.....These associations provide further evidence that elevated cancer risk is at least partly because HIV-infected individuals have poor immunologic control of oncogenic viruses
The First HIV/AIDS Generation Reaches Retirement Age
Safer therapies for chronic use in an aging population: a new unmet need......49% of drug treated HIV patients in the U.S. being over the age of 50 [30% over 60]....soon 50% will be over 65]....in NY & SF HIV+ are much older, 50% already over 60
Doubling of chronic
comorbidities in patients over 75 vs 50-75.....
http://www.natap.org/2016/CROI/croi_60.htm
HIV & Aging in SF: age-57; 35-60%
Impairment....http://www.natap.org/2016/HIV/041116_01.htm
"32% had severe/moderate loneliness, 50% low degree of perceived social support, 49.9% low physical social support, 26% moderate/severe depression, 33% possible cognitive impairment, 26.8% anxiety, 12.5% PTSD, 11% poor/very poor/fair adherence, 30% fair/poor health, 60% income <20,000, 30% illicit drug use......"On cognitive screening, 40% had MOCA (mental/cognitive) scores < 26; 58% had findings of loneliness; 60% the lowest levels of perceived social support; 55% depression; 50% anxiety; 12% PTSD (Table 2).....On functional screening, 26% (91) reported difficulty with IADL, 39% (136) reported they needed assistance with IADL [independent daily living activities] , and 40% reported falls in the previous year (Table 2).....slower gait speed and chair-to-standing times (p=0.002, p=0.003). They also had lower anxiety (p = 0.013) and less alcohol use (p=0.009)"
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By GINA KOLATA
July 8, 2016
Something strange is going on in medicine. Major diseases, like colon cancer, dementia and heart disease, are waning in wealthy countries, and improved diagnosis and treatment cannot fully explain it.
Scientists marvel at this good news, a medical mystery of the best sort and one that is often overlooked as advocacy groups emphasize the toll of diseases and the need for more funds. Still, many are puzzled.
"It is really easy to come up with interesting, compelling explanations," said Dr. David S. Jones, a Harvard historian of medicine. "The challenge is to figure out which of those interesting and compelling hypotheses might be correct."
Of course, these diseases are far from gone. They still cause enormous suffering and kill millions each year.
But it looks as if people in the United States and some other wealthy countries are, unexpectedly, starting to beat back the diseases of aging. The leading killers are still the leading killers - cancer, heart disease, stroke - but they are occurring later in life, and people in general are living longer in good health.
Colon cancer is the latest conundrum. While the overall cancer death rate has been declining since the early 1990s, the plunge in colon cancer deaths is especially perplexing: The rate has fallen by nearly 50 percent since its peak in the 1980s, noted Dr. H. Gilbert Welch and Dr. Douglas J. Robertson of the Geisel School of Medicine at Dartmouth and the Veterans Affairs Medical Center in White River Junction, Vt., in a recent paper.
Screening, they say, is only part of the story. "The magnitude of the changes alone suggests that other factors must be involved," they wrote. None of the studies showing the effect of increased screening for colon cancer have indicated a 50 percent reduction in mortality, they wrote, "nor have trials for screening for any type of cancer."
Then there are hip fractures, whose rates have been dropping by 15 to 20 percent a decade over the past 30 years. Although the change occurred when there were drugs to slow bone loss in people with osteoporosis, too few patients took them to account for the effect - for instance, fewer than 10 percent of women over 65 take the drugs.
Perhaps it is because people have gotten fatter? Heavier people have stronger bones.
Heavier bodies, though, can account for at most half of the effect, said Dr. Steven R. Cummings of the California Pacific Medical Center Research Institute and the University of California at San Francisco. When asked what else was at play, he laughed and said, "I don't know."
Dementia rates, too, have been plunging. It took a few reports and more than a decade before many people believed it, but data from the United States and Europe are becoming hard to wave off. The latest report finds a 20 percent decline in dementia incidence per decade, starting in 1977.
A recent American study, for example, reports that the incidence among people over age 60 was 3.6 per 100 in the years 1986-1991, but in the years 2004-2008 it had fallen to 2.0 per 100 over age 60. With more older people in the population every year, there may be more cases in total, but an individual's chance of getting dementia has gotten lower and lower.
There are reasons that make sense. Ministrokes result from vascular disease and can cause dementia, and cardiovascular risk factors are also risk factors for Alzheimer's disease. So the improved control of blood pressure and cholesterol levels should have an effect. Better education has also been linked to a lower risk of Alzheimer's disease, although it is not known why. But the full explanation for the declining rates is anyone's guess. And the future of this trend remains a contested unknown.
The exemplar for declining rates is heart disease. Its death rate has been falling for so long - more than half a century - that it's no longer news. The news now is that the rate of decline seems to have slowed recently, although it is still falling. While heart disease is still the leading cause of death in the United States, killing more than 300,000 people a year, deaths have fallen 60 percent from their peak. The usual suspects: Better treatment, better prevention with drugs like statins and drugs for blood pressure, and less smoking, are, of course, helping drive the trend. But they are not enough, heart researchers say, to account fully for the decades-long decline.
The heart disease effect has been examined by scientist after scientist. Was it a result of better prevention, treatment, lifestyle changes?
All three played a role, researchers said.
Dr. Jones said the current explanation reminds him of the Caucus-race in "Alice's Adventures in Wonderland," in which the Dodo, officiating, declared that "EVERYBODY has won, and all must have prizes."
It's not as if the waxing and waning of diseases has never happened before. And all too often these medical mysteries remain mysteries.
Until the late 1930s, stomach cancer was the No. 1 cause of cancer deaths in the United States. Now just 1.8 percent of American cancer deaths are the result of it. No one really knows why the disease has faded - perhaps it is because people stopped eating so much food that was preserved by smoking or salting. Or maybe it was because so many people took antibiotics that H. pylori, the bacteria that can cause stomach cancer, have been squelched.
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