kearns to LA city council: a 2-minute tour of my personal HIV/AIDS & aging-related frailties & multimorbidities (long play) (038)

richardkearns.awo.atomic-moi-0504090915a

[september 30, 2009, ryan white CARE act sundown day] good morning president garcetti, distinguished council members. i have given the clerk copies of my prepared remarks.

my name is richard kearns. i am a 58-year-old gay man living with AIDS in los angeles for more than 20 years. i am a long-term survivor & AIDS activist, a medical cannabis advocate, a poet and journalist. i’m here today to talk with you about HAVVACC, the online HIV/AIDS Volunteer Virtual Assisted Care Community that began publishing last week with the city’s proclamation of National HIV/AIDS & Aging Awareness Day (NHAAAD). Our aim is to assemble a body of both anecdotal & scientific knowledge to help prepare the demographic surge of HIVers over 50 to enter & reform the assisted care system in los angeles. in five years our 50+ segment will represent 60% of the national HIV-infected population.

HAVVACC just published jules levin’s at NATAP’s notes & links to recent abstracts from studies on frailties & multimorbititiies in HIVers & PWAs. it’s dry reading, but since i’ve got a good number of them myself, i thought i would show you how it works in a real-life person. (me.)

HIV infection is associated with, & is a predictor of, diverse impairments that resemble frailty, a state of decreased physiologic reserves that increases patient risk of morbidity and mortality. frailty includes such conditions as

  • myopathy (me),
  • loss of muscle mass & weight (me),
  • fatigue & exhaustion (me),
  • cognitive dysfunctions (which includes AIDS-releated dementia, which i have),
  • motor abnormalities (me again), &
  • neuropathies (of course),
  • osteoporosis (me),
  • physical shrinking (me) &
  • rheumatoid problems (not yet)

The estimated prevalence of frailty in 55-year-old white, non-Hispanic, college-educated men HIV-infected for 4 years or less is equivalent to the estimate that in uninfected men of the same ethnicity & education at age 65 years or older. frailty risk increases 3 fold after having HIV for 10 years. (remember: i’ve been doing this for more than 20)

The presence of multimorbidities, including

  • medical,
  • psychiatric, and
  • substance use comorbidities,

is more common in HIV-infected patients than in uninfected patients, but primary care guidelines rarely account for comorbid conditions. few HAART drug trials have involved aging populations

protease inhibitors, while saving our lives, triggered diabetes in many of us. (me too) insulin 4 times a day & all that. the diabetes makes it difficult to stick to the 3,000 calories/day intake i need to maintain to keep my weight steady.

Kidney function is low both in elderly patients and in HIV-infected patients (mine’s waning), affecting drug clearance, risk of drug toxicity, and mortality associated with cardiovascular events.

& then the big C, cancer. after adjusting for age, race and gender, the incidence of non-ADMs (non AIDS-defining cancers) is significantly higher among HIV-infected persons than among HIV-uninfected patients in the HAART era. this includes, from  the top of the list down, increased incidence of

  • · anal cancer (15 times greater) (not me)
  • · hodgkins lymphoma (not me)
  • · prostate cancer (not me)
  • · skin cancer (me — i have this — they’re the red things you see on my face. they’re not karposi’s, not KS, though)

so this has been my little 2-minute tour of what the whole comorbidity & frailty package looks like. something to think about next time you run across more statistics: “does richard have that too?” probableeeeee. ask me.

namasté

—richard kearns

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