As Mississippians with HIV age, their health risks increase

Published on Monday, July 13, 2020

By: Ruth Cummins

Bobby is a longtime Mississippi Delta resident who spends his retirement hunting and enjoying his hobbies after a career in the military.

The cancer survivor in his 70s tries to lead a healthy lifestyle, including wearing a mask and social distancing when he ventures out of the house. “I don’t go anywhere unless I have to, and if I do, I try to kill two birds with one stone,” said Bobby, whose last name is being withheld for privacy.

Because he’s an aging Mississippian living with HIV, diseases that come with growing older can be more of a health threat to him. That makes it critical for people in that population who are middle aged or older – especially in a pandemic - to prioritize receiving regular health care and taking daily medications that keep HIV at bay.

By 2030, about 70 percent of people living with HIV will be aged 50 or older, said Dr. Leandro Mena, chair and professor in the Department of Population Health Science at the University of Mississippi Medical Center’s John D. Bower School of Population Health.

But in a largely rural state like Mississippi, with poor access to health care for many and stigma associated with HIV that leaves some providers reluctant or unprepared to treat that population, getting regular care can be a life-threatening challenge. HIV, or human immunodeficiency virus, weakens a person’s immune system by destroying important cells that fight disease and infection.

The stigma contributes to older adults with HIV feeling lonely, depressed and anxious, Mena said. If they are staying at home due to concerns over the COVID-19 virus and its rampant transmission in the state, challenges to their mental well-being can be worse.

“It’s a very isolating disease. People sometimes lack a support network,” Mena said. “There’s an increased proportion of individuals with (suicidal thoughts) and depression. There’s a tremendous need for social support and mental health services for individuals aging with HIV.”

Mena is a professor of population health science and medicine and serves as medical director of Open Arms Healthcare Center, a community based clinic in Jackson with a focus on the health needs of LGBT populations. Mena also leads UMMC’s Center for HIV/AIDS Research, Education and Policy.

UMMC’s Adult Special Care Clinic, which specializes in HIV care provided through the Medical Center’s Division of Infectious Diseases, serves more than 2,000 patients. Of that number, almost half, or 44.5 percent, are age 50 or older.

The age group with the highest proportion of undiagnosed HIV infection is 24 and under, Mena said. At the same time, he said, there’s a deep concern that aging individuals with HIV might not know they have it. It’s a time in their lives when lifestyle modifications such as exercise, diet and smoking cessation can play an increasing role in managing chronic diseases, including HIV.

Most patients living with HIV whose disease is well controlled visit about twice a year, although some might visit slightly less often.

Those confirmed with HIV or who have risk factors for the disease also can be seen at the TEAM Clinic, a multidisciplinary clinic dedicated to the LGBT population. Short for Trustworthy, Evidence-based, Affirming and Multidisciplinary Care, the clinic is located at Riverchase Medical Suites in Flowood and is one of few in the region that strive to ensure all Mississippians have access to accepting, high quality and holistic primary care, no matter their gender identity or sexual orientation.

The public can receive free HIV testing at UMMC’s Express Personal Health Clinic located at the Jackson Medical Mall. Middle-aged Mississippians frequently come to the clinic for testing, said Jennifer Brumfield, a registered nurse and manager of clinical research at Express Personal Health.

“Some are the partners of HIV-positive patients,” Brumfield said. “Others may have just left a relationship and want a comprehensive sexual health screening.”

Mena says many older adults aren't aware that HIV could be a risk to them, and miss the health benefits of testing, early detection and treatment. Older adults are more likely than younger adults to have developed AIDS by the time they are diagnosed with HIV, which makes detection and immediate treatment all the more important.

Early medical care dropped Bobby’s risk for AIDS, or acquitted immune deficiency syndrome, a life-threatening disease that can develop over time in persons who have HIV but who aren’t receiving treatment.  AIDS is considered the late stage of HIV infection that occurs when the body’s immune system is badly damaged by the virus.

Bobby, who contracted HIV from blood transfusions he received during treatment, says he’s lucky that he was diagnosed as a young man instead of decades later. “I had over 500 pints of blood transfused,” he said. “When the first tests came out for HIV, people who had received a lot of transfusions were called in to be tested.”

Today, blood transfusions are generally considered safe, although some patients can have side effects. Blood banks thoroughly screen donors and test donated blood for viruses, bacteria and parasites, but infections are still a rare possibility. The chance of contracting HIV through donated blood is considered to be 1 in 2 million.

Getting the diagnosis of HIV, Bobby said, was almost as devastating as his cancer diagnosis. “I thought, ‘I’ve been through all this, and now HIV is going to take me out?’”

Physicians in the 1990s often didn’t start patients on the first HIV medications to hit the market until they began showing symptoms of the disease. That was the case with Bobby. When he began his treatment regimen, “I wasn’t doing well,” Bobby said.

Protease inhibitors, a class of antiviral drugs used to treat HIV that’s still in use today, “turned me around,” Bobby said.

Because of stigma associated with HIV, Bobby has told very few friends or family members about his condition. “I only told those who needed to know,” he said.

Mena said he has seen older patients in UMMC’s Emergency Department sickened by AIDS who have never received therapy for HIV. “Those 50 and older who are diagnosed with HIV should have treatment as soon as possible,” he said.

An emerging area of concern is women 50 and older with undiagnosed HIV. “They might be rejoining the dating world,” he said. “They might have the same lack of education and the same lack of understanding of their sexual health risks as an adolescent. They might not know how to protect themselves.”

Studies show older adults with HIV are more prone to frailty, Mena said. Frailty is defined as age-related deficits in normal body function that come with age, such as loss of muscle, stamina, weight and the ability to regularly exercise.

“The main challenge centers on comorbidities,” Mena said. “If you have HIV infection, it can induce an inflammatory response in your organs. It’s known to cause a death rate that’s three times higher for comorbidities like heart failure that are not communicable.”

Mena urges those with risk factors for contracting HIV to be tested, and those 50 and older to recognize that they are just at risk for the infection as someone half their age.

“The most important thing is medication. Lifestyle modifications are important, but we also know how difficult those things are,” he said. He recommends older adults living with HIV “quit smoking and refine their diet. Exercise is also very important – maybe a brisk walk or training three times a week.

“The good news is that we now have medications that are not only very potent, but very safe. There are newer combinations of drugs that make it possible to take fewer drugs, but still address the many difficulties that an aging population is going to have. People also are less likely to have drug interactions than in the past.”

The advances in antiretroviral therapy include some two-drug regimens that replace the gold standard of a three-drug combination. Bobby takes Triumeq, a single pill daily that contains three different HIV drugs.

He says he’s fortunate, considering his cancer history. “I should have been dead years ago,” he said.

Bobby sees Mena for periodic checkups. “HIV has become so manageable,” he said.

“All things considered, I’m doing great. I’m in good health and good shape. Medicine is great and has its place, but no pill is going to do everything for you.

“You have to do your share.”