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Epidemic within an Epidemic-HIV and it's Treatment Causes Premature Aging

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Mishma:
Forget the "live long and prosper," nostrums from those ill informed physicians, scientists, politicians and websites. HIV, for many us now, and many you newly infected, is far from a "manageable" disease. The disease and it's treatment are irrefutably aging a number of us prematurely with often dire consequences. If you don't believe me check out the long term survivors blog on this site and read what we've been going through. So much for "normal" lifespans for many of us, baring improvements in treatment and or a cure. 




http://www.medscape.com/viewarticle/820508?src=wnl_edit_tpal&uac=177528CX

Laboratory Investigation
Aging and HIV/AIDS: Pathogenetic Role of Therapeutic Side Effects
Rebecca A Torres, William Lewis Disclosures
Lab Invest. 2014;94(2):120-128.

Abstract

The intersection of aging and HIV/AIDS is a looming 'epidemic within an epidemic.' This paper reviews how HIV/AIDS and its therapy cause premature aging or contribute mechanistically to HIV-associated non-AIDS illnesses (HANA). Survival with HIV/AIDS has markedly improved by therapy combinations containing nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors, and protease inhibitors (PIs) called HAART ( highly active antiret roviral therapy). Because NRTIs and PIs together prevent or attenuate HIV-1 replication, and prolong life, the population of aging patients with HIV/AIDS increases accordingly. However, illnesses frequently associated with aging in the absence of HIV/AIDS appear to occur prematurely in HIV/AIDS patients. Theories that help to explain biological aging include oxidative stress (where mitochondrial oxidative injury exceeds antioxidant defense), chromosome telomere shortening with associated cellular senescence, and accumulation of lamin A precursors (a nuclear envelop protein). Each of these has the potential to be enhanced or caused by HIV/AIDS, antiretroviral therapy, or both. Antiretroviral therapy has been shown to enhance events seen in biological aging. Specifically, antiretroviral NRTIs cause mitochondrial dysfunction, oxidative stress, and mitochondrial DNA defects that resemble features of both HANA and aging. More recent clinical evidence points to telomere shortening caused by NRTI triphosphate-induced inhibition of telomerase, suggesting telomerase reverse transcriptase (TERT) inhibition as being a pathogenetic contributor to premature aging in HIV/AIDS. PIs may also have a role in premature aging in HIV/AIDS as they cause prelamin A accumulation. Overall, toxic side effects of HAART may both resemble and promote events of aging and are worthy of mechanistic studies.

mecch:
Has ANY research or any credible not "ill informed physicians, scientists, politicians and website" denied the realities of LTS's? Is anyone saying LTS's are the candidate for this "near normal lifespan" we are hearing about.
I thought it was about pretty recent infections and people locked into good care, treatment when needed, and thus also the newest drugs... 
Just saying......

leatherman:

--- Quote from: Mishma on March 04, 2014, 07:31:34 PM ---is far from a "manageable" disease

--- End quote ---
but it's certainly a sight better than still being a terminal illness.  ;)

nearly dying in my thirties (thank you aids),  and about be 52, I just happy to still be alive to suffer through whatever early aging problems are happening to me. ;)

as to your point though, to paraphrase a past POTUS, it probably all depends on what the definition of "manageable" is   ;)

and is this really a "new" idea? We've known for a while the low level reservoirs of HIV, along the long term inflammation, not to mention whatever long term effect of 20 yrs of meds will do, are still doing us all in.

Mishma:
As I post this I once again have to "lawyer up" (at the $ 1000 a pop) and prove to my long term disability company that I am permanently disabled, despite my HIV doc's recent "The patient has been regressing rapidly," letter. They have access to my medical records but once again the onus is on me to make sure they've accessed these records. And their last determination, 2 years ago,  was that I was permanently disabled. It as if in 2 years I was suppose to spontaneously get better. Miracle, miracle.

The surgeon who recently replaced my hip wasn't interested in anything but my viral burden and CD4 count. After the operation I developed full blown Lupus. 

It may be a "new" idea to some but one that has to be continuously reinforced, especially to those that continue to deliberately engage in unsafe sexual practices under the mistaken belief that HAART will allow them to live a normal and manageable lifespan-and a cure is just around the corner. I've been waiting for over 30 years now.

buginme2:
You make a good point in that HIV tends to get over simplified both by the medical community and those who are affected by it, including us here.

HIV often times is wrapped up neatly into the category of your viral load and cd4 count.  As if those are the only two measurable items that matter.  If your undetectable and have a decent cd4 count then your technically ok.  Even if your body is telling you otherwise.

We really need to get away from the notion that cd4 counts matter to the degree that people make it out to be.  You can have a high cd4 count and HIV still puts you at a greater risk of getting cancer, heart disease, lung disease, kidney disease, oesteoporosis, neuropathy, arthritis....the list is endless. 

New data is showing that extremely low viral replication increases your lymphoma risk.  So even with effective HAART if you have a viral load of 10 which will show up as undetectable on your readings hiv is still causing you damage and putting you at risk.

But, Leatherman is right.  What's the alternative?  We don't want to go back to 80's and 90's obviously.  Things are improving. But;

No one has said HIV has been cured. 

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