New hope for healthy aging
For HIV patients, recent study shows statin may lower heart disease risk
Americans with HIV are achieving the once unthinkable: a steady march into older age. But beginning around age 50, many people living with the virus face a host of health problems, from heart disease and diabetes to social isolation and cognitive decline.
And so the medical research community, which some three decades ago developed lifesaving drugs to keep the virus at bay, is now hunting for new ways to keep people with HIV healthier in their later years.
A recent study, for example, showed that a statin drug significantly lowered the risk of heart attacks and strokes among middle-aged and older adults with HIV, and may reveal biological insights into why this group tends to age faster than others. And a crop of academic hospitals have established specialized clinics for older people with the virus, offering medical experts as well as social workers, substance abuse counselors, psychologists and nutritionists.
“I have been unbelievably impressed at how care for the older HIV population has really exploded,” said Nathan Goldstein, who heads one such clinic at Mount Sinai in New York City. “I get emails every day about new models, new grant funding. People are paying so much attention to this.”
More than two dozen HIV and aging experts also expressed optimism, in contrast to the more grim perspective many held a decade ago.
Researchers have often referred to a looming
“silver tsunami” of older people with HIV needing better care. In 2021, there were 572,000 Americans aged 50 and older diagnosed with HIV, up 73% from 2011.
Today, two-thirds of deaths in the HIV population are from causes other than the virus. This aging group faces an increased risk of diabetes, liver and kidney disease, osteoporosis, cognitive decline and various cancers.
But perhaps their most pressing health concern is a doubled risk of cardiovascular disease compared with people who do not carry the virus. Researchers in the Netherlands
estimated that by 2030, more than three-quarters of that country’s HIV population will have cardiovascular disease, including high blood pressure, high cholesterol, heart attacks or strokes.
Seeking a bulwark against this mounting threat, the National Institutes of Health invested $100 million in a randomized controlled trial, called Reprieve, that tested a statin medication against a placebo among 7,769 people ages 40-75 with HIV.
The volunteers were relatively healthy and on stable antiretroviral treatment, so they typically would not have been recommended a statin.
But the results of that trial, published in The New England Journal of Medicine, showed that the drug
lowered the volunteers’ risk of major cardiovascular events by more than one-third.
“This is really an important study,” said
Dr. Anthony Fauci, who as the former director of the National Institute of Allergy and Infectious Diseases was among the NIH leaders who approved Reprieve’s mammoth budget. “The results, in some respects — they’re even better than I would have expected.”
Donté Smith, a health consultant from Kansas City, Missouri, is 37 but began taking a statin earlier this year. Smith, who is genderqueer and uses gender-neutral pronouns, said they were motivated to take the medication because, in addition to HIV, they had a family history of
cardiovascular disease and diabetes and had smoked on and off.
Smith also noted that the virus took an extra toll on Black and LGBTQ+ people. Of the nearly 1.1 million Americans diagnosed with HIV, 63% are gay and bisexual men, and 40% are Black.
“A lot of us don’t make it,” Smith said. “It’s important to buck that trend. The best revenge for me is being an elder and being able to share and exist and to still be here.”
Dr. Steven Grinspoon, Reprieve’s lead author and a professor at Harvard Medical School, said the clinical trial also measured many chemical markers of inflammation in the volunteers’ blood and scanned their coronary arteries. The researchers are looking
at whether these data can help explain why the statin lowered cardiovascular events. The researchers will present their findings at a meeting in November.
Fauci suspected that this analysis will likely reveal that the statin tamped down the volunteers’ chronic inflammation, and in turn prevented the plaque buildup in the arteries that can precipitate a heart attack or stroke.
But experts said the longterm care of people with HIV will depend on much more than prescription drugs. An array of social problems are especially prevalent among older people with HIV and can exacerbate the perils of aging, including poverty, loneliness, addiction, mental illness, stigma and housing insecurity.
Paul Aguilar, 60, was given five years to live when he was diagnosed with HIV in 1988. He has survived, but not without struggle. The fat has drained from his face, a side effect of the toxic early generation of antiretroviral drugs. And he has weathered waves of lost peers in San Francisco: first from AIDS and more recently from other illnesses.
Last year, he began going to the “Golden Compass” program for aging HIV
patients at the University of California, San Francisco, which provides a panoply of services, including cardiology, exercise classes and dental, vision and mental health care.
Aguilar said the psychological counseling and support he received there helped him cope with his closest friend’s death by suicide and his own subsequent mental health crisis.
The university’s program is “really a godsend,” Aguilar said, noting that he has no out-of-pocket costs, thanks to his coverage from Medicare and Medicaid.
But the vast majority of older people with the virus lack the type of high-quality care that has helped Aguilar thrive, experts said. Such programs are often prohibitively expensive and pose staffing and space demands that many clinics, especially in resource-poor areas, cannot hope to meet.
“Patients are falling through the cracks,” said Jules Levin, 73, a leading activist holding the bullhorn on behalf of HIVpositive seniors such as himself.
After learning about the Reprieve study’s findings, Aguilar asked his doctor about starting a statin.
“I’m going to be crotchety and telling kids to get off my lawn,” he quipped.