HIV infections can cause patients to age faster than others

This is sparking new approaches to treating this wave of pioneers, who survived what was once a deadly disease, only to shoulder a heavy burden of other illnesses before their time.

“HIV is their least active thing. They are all virally suppressed and undetectable, and their HIV is fine,” said Dr. Matthew Russell, Duffy’s physician and co-director of the Age Positively program at Massachusetts General Hospital. The program pairs geriatricians, like Russell, with infectious disease specialists to provide more comprehensive care to a rapidly aging HIV-positive population. Most patients are only around 50 years old.

Russell and other doctors said they suffered from numerous chronic illnesses, including heart, kidney and lung disease; stroke; fragility; and cognitive impairment a good decade earlier in many of their patients living with HV than in the general population.

Nationally, more than half of people living with HIV are over the age of 50, according to the Centers for Disease Control and Prevention. In Massachusetts, it’s 63 percent, according to the state’s latest survey, and data shows that proportion is increasing.

Russell said many patients who were diagnosed with HIV before effective treatments became available in the 1990s told him they buried so many of their friends in the HIV-positive community early on that they didn’t did not expect to live long enough to face old age.

“I have these conversations with my patients and I say, ‘What is your plan for getting older?’ and they say, ‘I don’t have one,'” said Russell, who is also interim chief of geriatric medicine at MGH.

For years, health care providers have reported that patients who have lived with HIV for a long time experience accelerated aging and more severe illness. Some have highlighted the toxicity of early HIV drugs and their potential impact. Today’s medications are gentler, but even though they lower a person’s viral load, they consistently boost the immune system, which is also thought to play a role in this phenomenon of premature aging and disease.

Some scientists think it goes even further.

More and more research has found specific chemical changes in the DNA of people living with HIV, indicating that their bodies age more quickly at the cellular level than those of people of the same age who are not HIV positive.

In one such study, a team of researchers at the University of California, Los Angles measured blood samples from about 100 men before and after their HIV diagnosis and compared those samples to 100 other men of the same age. age, the same weight and the same weight. ethnicity who were not infected. They found that before infection, several so-called epigenetic clocks – a DNA-level measurement of a person’s biological age – were similar in the two groups. But about two and a half years after infection, the epigenetic clocks of men with HIV had become excessive and accelerated, aging by up to five years. A similar acceleration in age was not observed in uninfected participants during the same time interval.

In a follow-up study in 2024, researchers found that this accelerated aging slowed after people with HIV received antiretroviral treatment, which is the standard treatment today, but that some level of accelerated aging persisted.

“The question is: Is there still underlying viral replication and inflammation that we’re not seeing? said Beth D. Jamieson, a researcher at the David Geffen School of Medicine at UCLA and co-author of the series of studies.

Jamieson said researchers now want to study whether an epigenetic clock can help identify people with HIV who are taking antiretroviral drugs but are still at higher risk of developing cardiovascular disease or other serious health problems.

“If that’s the case,” she said, “then this is a screening mechanism to maybe find these people early enough to intervene. »

At Boston Medical Center, Dr. Archana Asundi, who directs the center’s infectious disease clinical research unit, said many of her patients living with HIV and facing accelerated health problems feel too young to be treated in a geriatric clinic. So Asundi created a new location, known as the HIVE Clinic, as in HIV-Endurance, which provides specialists in geriatric and infectious diseases, as well as other health care providers, to treat patients of 50 years and over living with HIV. It is one of ten national sites funded by the federal government to develop strategies to improve health outcomes for people aging with the virus.

“The patients accepted that they were survivors. But I think we’re about to, we don’t want you to survive. We want you to flourish in your older years,” Asundi said.

Beyond managing their heart disease, diabetes and other health issues, the clinic works with patients to help them think about what they want out of life in the years ahead. would have never imagined living.

“We really try to get our patients … to think about what brings you joy in your life, and that we can help as a medical community to support them,” she said.

But now, the clinic is thinking about its own survival. Its three-year, $970,000 federal grant expires in July. Asundi said she is seeking other federal, state or private funds to help keep the popular but resource-rich clinic operating.

Among the HIVE Clinic’s champions is Marlon Wallen, a 55-year-old HIV and immigration advocate from Boston who emigrated from Trinidad to New York shortly before he was diagnosed at age 20. He arrives wide-eyed, with little money, big dreams and new memories of childhood abuse, Wallen was petrified by his diagnosis.

“People were dropping like flies (because of HIV). The air was filled with fear, people just didn’t know if you could even touch other (HIV-positive) people at the time,” he said.

“When I got my diagnosis, the hard thing you had to face was, do you want to die or do you want to live,” Wallen said. “And I was busy living. This is not what I came to America for, to get a terminal illness.

Wallen absorbed all the information he could find about HIV, followed a strict, healthy diet, didn’t smoke or drink, exercised extensively, studied meditation, and became a speaker and advocate.

Today, Wallen stands out for what he doesn’t have: age-related chronic illnesses common among people living with HIV. He even managed to avoid diabetes, a disease that claimed his mother in her early 50s and his father in his early 60s. The only medications Wallen takes are for HIV.

“Even now, to this day, I’m like, can you believe I’m still here?” he said. “I I’m even kind of thinking about old age at this point.

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Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.