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Aids patients pay price for surviving
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Tue, Jan 08, 2008
The Straits Times
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CHICAGO - MR JOHN HOLLOWAY was diagnosed with Aids nearly two decades ago, when the disease was a speedy death sentence, and treatment a distant dream.
Yet at 59, he is alive, thanks to a cocktail of drugs that changed the course of an epidemic.
But with longevity has come a host of unexpected medical conditions that challenge the prevailing view of Aids as a manageable, chronic disease.
Mr Holloway suffers from complex health problems usually associated with advanced age: Chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip.
| These illnesses were not what Mr Holloway expected when life-saving anti-retroviral drugs became the standard of care in the mid-1990s.
The drugs gave Mr Holloway back his future. But at what cost? That is the question now being voiced by scientists, doctors and patients encountering a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of Aids survivors to reach late middle age.
Experts are coming to believe that the immune system and organs of long-term survivors took an irreversible beating before the advent of lifesaving drugs, and that those very drugs then produced additional complications because of their toxicity.
The greying of the Aids epidemic has increased interest in the connection between Aids and cardiovascular disease, certain cancers, diabetes, osteoporosis and depression.
The most comprehensive research has come from the Aids Community Research Initiative of America (Acria), which has studied 1,000 long-term survivors in New York City, and the Multi-Site Aids Cohort Study (Macs), which has followed 2,000 subjects nationwide for the past 25 years.
The Acria study, published in 2006, examined psychological, not medical, issues, and found unusual rates of depression and isolation among older people with Aids.
Macs will directly examine the intersection of Aids and ageing over the next five years.
The first generation of Aids patients, in the mid-
1980s, had no effective treatments for a decade and died in overwhelming numbers, leaving few patients to study.
Now, survivors such as Mr Holloway lurch from crisis to crisis. His adjustment strategy is simple: 'Deal with it.'
NEW YORK TIMES
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