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AIDS

National HIV/AIDS & Aging Awareness Day: The Nutritional Implications of the Evolution of Treatment

By Kana Ogaki, MPH

September 18 is the National HIV/AIDS & Aging Awareness Day, which raises awareness of the challenges faced by aging populations with HIV/AIDS (1). Human Immunodeficiency Virus (HIV) is the virus that causes HIV infection, which was first recognized among homosexual males by the Center for Disease Control (CDC) in 1981 (2). HIV attacks and destroys the infection-fighting white blood cells, CD4 T-lymphocytes, and gradually destroys the immune system. If untreated, HIV may cause health decline and onset of acquired immunodeficiency syndrome (AIDS), which is the most advanced stage of the infection (3).

In the 1980s-1990s, azidothymidine (AZT), which was first developed as a potential cancer therapy in 1964 and approved as HIV treatment by the U.S. Food and Drug Administration (FDA) in 1987, was the first breakthrough in HIV treatment (2). However, AZT had significant side effects, such as nausea, vomiting, diarrhea, headaches, myalgias, insomnia, bone marrow suppression, peripheral myopathy, lactic acidosis, elevated liver enzymes, and hepatotoxicity (4). During the early stages of the HIV epidemic, malnutrition was common among patients with HIV due to the high energy demands of the body fighting the virus, poor appetite, and malabsorption caused by the side effects of AZT (5). Nutritional interventions were mainly focused on preventing wasting at that time.

The introduction of Highly Active Antiretroviral Therapy (HAART) in 1996 marked a significant advancement in HIV treatment (2). HAART involves a combination of three or more antiretroviral drugs, which significantly reduce the viral load in patients, improve immune function, and thus reduce the incidence of AIDS-related illnesses and deaths(6). This emergence has dramatically increased life expectancy, improved the quality of life for people with HIV, and shifted the focus to early diagnosis and treatment, marking the transformation of HIV from a fatal disease to a manageable chronic condition for many people with HIV. According to the latest data from the CDC, of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas in 2021, over 53% were aged 50 and older (7). As people with HIV live longer, older adults with HIV face a unique set of challenges, both from the virus itself and medication and from the aging process, including more frequent side effects from HAART, complications from drug interactions between HAART therapy and their prescribed medications for other chronic disease, such as cardiovascular disease, diabetes, and cancer (7). From the nutritional perspective, with the advent of HAART, the incidence of wasting syndrome has decreased. However, HAART can cause side effects such as lipodystrophy (abnormal fat distribution), insulin resistance, and changes in lipid profiles, leading to an increased risk of cardiovascular disease. Thus, nutrition interventions among patients with HIV have shifted towards managing these side effects, maintaining a healthy weight, and addressing metabolic issues (8).
As nutritional professionals, it is important to educate patients with HIV about managing/preventing metabolic complications and other diet-related chronic diseases and addressing micronutrient deficiencies through healthy eating and lifestyle from a young age.

References

1 National HIV/AIDS & Aging Awareness Day | National Institutes of Health. Accessed September 11, 2024. https://www.oar.nih.gov/about/directors-corner/national-hivaids-aging-awareness-day
2 Timeline of The HIV and AIDS Epidemic. HIV.gov. Accessed September 11, 2024. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline
3 HIV and AIDS: The Basics | NIH. Accessed September 11, 2024. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-aids-basics
4 Edwards Z, Ingold CJ, Azmat CE. Zidovudine. In: StatPearls. StatPearls Publishing; 2024. Accessed September 12, 2024. http://www.ncbi.nlm.nih.gov/books/NBK554419/
5 Babameto G, Kotler DP. MALNUTRITION IN HIV INFECTION. Gastroenterology Clinics of North America. 1997;26(2):393-415. doi:10.1016/S0889-8553(05)70301-01.
6 Eggleton JS, Nagalli S. Highly Active Antiretroviral Therapy (HAART). In: StatPearls. StatPearls Publishing; 2024. Accessed September 12, 2024. http://www.ncbi.nlm.nih.gov/books/NBK554533/1.
7 HIV and Older People | NIH. Accessed September 12, 2024. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-older-people
8 Grinspoon S, Carr A. Cardiovascular Risk and Body-Fat Abnormalities in HIV-Infected Adults. New England Journal of Medicine. 2005;352(1):48-62. doi:10.1056/NEJMra0418111.

Author’s Bio

Kana Ogaki is a recent graduate from the University of Washington’s MPH in Food Systems, Nutrition and Health program with the Graduate Coordinated Program in Dietetics and a research associate at the Center for Nutrition and Health Impact. She has been serving as a diversity committee chair at the GSDA and a diversity liaison at the Washington State Academy of Nutrition and Dietetics. Her biggest interest lies in building a regional food system where all the people regardless of race, sex, gender, and age are accessible to sustainable, locally-grown, nutritious foods and to decrease health inequity among disadvantaged populations including people of color, immigrants, and refugees through local food policies and federal nutrition assistance programs.