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Today's Health - Wellness / Exercise / Reflections:The Lesser-Known Complications of HIV/AIDSErin N. Marcus, M.D. : Nov 29, 2010 : Huffington PostAt the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.
Then he slipped one day while on vacation and broke his wrist. He underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm elevated, and then do physical therapy for two months to get to the point where he could lift a five pound weight. "It was one of the most difficult things I've ever been through in my life," he said. "I ran, biked, lifted weights and now all of a sudden I couldn't turn the page of a newspaper. It just really got to me."
After a few simple tests, the reason for Levin's fracture became clear: His bones were weak from osteoporosis, a disease that's most commonly seen in older women, but that's also associated with HIV.
"The giddiness of the age of HAART is over," said Levin, referring to highly active antiretroviral therapy, the life-saving drug regimen prescribed to people with HIV. "We should have an aging clinic in every hospital that's serving HIV patients."
Osteoporosis is one of many conditions associated with old age that is now being seen with increasing frequency in people with HIV. Research suggests that long-term exposure to the virus, and to the inflammation it triggers, make people vulnerable to premature aging and to a host of conditions seen with aging, heart and kidney disease, dementia, and osteoporosis.
Additionally, the overall population of people with HIV is getting older, thanks to improved medical therapy. At present, 1 in 4 people with HIV is age 50 or older. The U.S. Senate Special Committee on Aging has predicted that half of all adults with HIV will be older than 50 by the year 2015. Over the past few years, the National Institute of Health has increased its funding for research on HIV and aging, and the White House hosted a conference on October 27 on HIV and aging.
"The evidence is pretty clear," said Levin, who directs The National AIDS Treatment Advocacy Project (NATAP), a New York-based HIV education and advocacy group. "We're going to see early frailty, early senescence and people are going to start dying at earlier ages."
Compared to other conditions associated with HIV and aging, osteoporosis is relatively straightforward to forestall and treat. To maintain bone strength, it's important for all people with HIV to make sure they are consuming an adequate amount of calcium and Vitamin D. A recent article in the journal Clinical Infectious Diseases recommends 1,000 to 1,500 mg of calcium and 800 to 1,000 IUs of Vitamin D daily, as well as at least 30 minutes of weight-bearing exercise, such as jogging or walking, at least three days a week. Calcium is plentiful in dairy products and sardines, and is available in supplements such as calcium carbonate and calcium citrate. The National Institutes of Health has an online information sheet listing ways to get calcium. It's also important to avoid smoking and heavy alcohol use, since these can cause osteoporosis.
HIV is thought to be associated with osteoporosis for a variety of reasons. The infection, itself, causes inflammation, which in turn impacts the cells that maintain bones. Many conditions common in people with HIV, such as Vitamin D deficiency, being underweight and low testosterone, are associated with osteoporosis. Antiretroviral therapy and other medications frequently prescribed to people with HIV, such as Prednisone, also cause bone loss.
Even though many antiretrovirals can cause bone loss, osteoporosis is not a reason to stop taking them. "Antiretroviral therapy is life-saving, and we know that stopping antiretroviral therapy is not a good strategy for preventing complications," said Dr. Todd Brown, an endocrinology specialist at Johns Hopkins University who co-wrote the article in Clinical Infectious Diseases.
Brown and his coauthors recommend that all HIV-positive men older than age 50 and women who are past menopause undergo testing for osteoporosis, since it's a condition that usually doesn't cause symptoms until the person breaks a bone. His own research has found that osteoporosis is "alarmingly" prevalent among African Americans in inner city Baltimore. "Because of the perception that osteoporosis is a white disease, people of color get short shrift for screening," he said. "This concept that African Americans are protected shouldn't be a reason to neglect them."
Once someone is diagnosed with osteoporosis, it's important to take action to prevent falling, such as removing clutter and slippery rugs from the floor. Physical therapy can help improve strength and balance, which also reduce the risk of a fall. The person also should get his or her vision checked and review his or her medication list with a doctor to try to minimize any drug side effects or interactions that might cause drowsiness or unsteadiness.
A class of medicines called bisphosphonates can improve bone strength, but do have some rare risks. "While they do decrease the risk of fracture, they're not totally benign drugs," Brown said. "On the flip side, you shouldn't not use them in the patient who is at high risk of a fracture."
Levin urges all people with HIV to be assertive about discussing osteoporosis and other age-related conditions with their doctor. "My guess is that 90 percent of patients know nothing about any of this and a lot of clinicians and case managers don't know about it either," he said. "Every patient should ask their clinician, 'are you aware, are you monitoring me for heart disease, diabetes, bone disease, cognitive impairment, kidney disease?' This is an important issue for everybody."
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This group is called "Peckers PICS." The English - slang definition of "pecker" is to pluck at the truth. Therefore, we peck at items such as Gay Men's Health, Male Fitness, Gay (LGBT) Politics & Issues. In this section you may peck at each photo in order to decide the winner of the "war of the fittest!" Whereas, you should select the guy that may inspire you to exercise and "get fit!" Warning: This may stoke you!
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Palm Springs; Leather Pride (Barracks); Nov 14, 2010
By Carlos Santoscoy / December 13, 2010 / On Top MagazineThree highly-decorated gay service members discharged under "Don't Ask, Don't Tell" have filed a lawsuit challenging the law.
The plaintiffs - Michael D. Almy, Anthony J. Loverde and Jason D. Knight - are being represented by Servicemembers Legal Defense Network (SLDN), the largest group lobbying for repeal of the 17-year-old law that bans gay and bisexual troops from serving openly.
Aubrey Sarvis, the group's executive director, said he hoped the lawsuit would increases the pressure on lawmakers to lift the ban this year.
"This filing is a shot across the bow as we prepare to pursue and sustain an aggressive far reaching litigation strategy if the Senate fails to act this month to repeal the law. This dispute can be resolved by Congress or by the courts," Sarvis said in a statement.
"With this filing we put Congress on notice that a cadre of service members and our national legal team stand ready to litigate strategically around the country," he added.
In their suit - filed Monday in U.S. District Court in San Francisco - plaintiffs, who together have served 25 years in the military, are asking for their reinstatement and for the law to be declared unconstitutional.
The Obama administration is currently appealing two federal rulings against the law. The Ninth U.S. Circuit Court of Appeals in California is preparing to hear the government's appeal to U.S. District Judge Virginia Phillips' September ruling striking down the law as unconstitutional. Following her ruling, Phillips issued an injunction ordering the government to stop enforcement of the law, but the appeals court set the ruling aside after 8 days, and the policy returned.
Defense Secretary Robert Gates has urged senators to act against the law during the lame-duck session of Congress or risk leaving the military "at the mercy of the courts and all of the lack of predictability that that entails."
Gates made his remarks last week after Senate Republicans blocked a defense bill - which included language to repeal the law - from moving forward. A group of bipartisan senators have launched a last-ditch effort to end the law with a standalone repeal bill.
Sarvis added that his group is working on two additional challenges to the law, including one on behalf of young people who have been deterred from entering the military because of the prohibition.
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