Dr. Malcolm John: What we are seeing now today we look at HIV and Aging one of the major focus is here at our clinic, we are seeing people with lot of other complications that arise either from living longer with HIV or having a longer treatment duration complications from their medications overtime from just getting older. So we are seeing a lot of Osteoporosis for example in HIV positive man something you would think primarily in woman right lot of heart disease increased rates of lung cancer, increased rate of diabetes or kidney problem, liver problems.
So it has changed in a sense that there are less HIV specific problems and more sort of non HIV problems that are worst than HIV, say about 40% of time that's what we are seeing now.
It implies today we have more complicated patients because of aging duration of HIV infection and complications for medications. So one of the thing is it's important to have a multi disciplinary approach to HIV care for best care. What that means is you have you physicians, you also need specially trained pharmacist, nutritionist, social workers to help people who perhaps are getting burn out from years of adherence or taking their pills or getting frustrated from some of those complications and they stop using it as effectively.
So all of us have to get together and we do that once or twice a week to discuss more challenging cases how best to keep people in care or get them back into care. The other thing there isn't a lot of data or information about how best to treat the Aging HIV Positive patient and so here at 360 we have started developing an HIV Aging working group and bringing young investigators and researchers as well as commissions in a discussion about projects that we can do to help advance the field in terms of what's the cause of some of the memory loss or concentration problem some of our patients are complaining about what's the cause some of the increased HPV or pre-cancer diseases that we are seeing and what is the changes in immune or T-cells responses or defenses against HIV overtime as you get older.
So it's pretty interesting and exciting stuff for us anyway. Well I think one of the biggest concerns from patients themselves that really got me over the last four years interested in HIV and Aging is really the memory loss and concentration. So the HIV in itself can cause what's coming on is HIV Associated Dementia and that means that in advance HIV or AIDS people were having a cognitive problems behavioral changes and so forth. So we started treating people on a lot of that improved or didn't happen, but instead now as people are successfully treated overtime their still seems to be a deficit in some memory issues and concentration issues for a proportion of patients.
And it's hard to tease out what percent of that is due to just getting older, what percent of that is due to the HIV or from the medications I said before and that's a big area, that's like probably the biggest area right now for lot of research and patients and there was one investigator recently that has found that HIV has some direct toxic effect on neuronal stems cells and so perhaps that's a mechanism by which some of these complaints of problems arrives and that's interesting because it has implications for other disease state such as Alzheimer and so forth as a mechanism dimension.
I have to say that in HIV and Aging one of big possibilities is that lot of the problems increase heart disease risk, might be related to the chronic immune activation or inflammation that we see with HIV and that's important because there are a lot of Chronic diseases that have that exact same state, for example people living with auto immune diseases like Lupus and Rheumatoid Arthritis and so forth and it may be that some of the things we find out regarding HIV and Aging are actually transferable to other diseases and I think that's not only interesting but important for health care in general.
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