April 29, 2013
By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.
What does the future hold for people with HIV and HIV/HCV as they get older?
These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).
Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.
Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)
As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.
That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.
And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.
In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.
And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).
NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.
We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…
To your health,
New York Buyers’ Club
February 29, 2012
NYBC’s specially manufactured antioxidant supplement, ThiolNAC, is again in stock at the nonprofit co-op. Below is the product description for this combination supplement, which is available only through NYBC, and which provides a key part of NYBC’s MAC-Pack, our LOW COST alternative to K-PAX:
ThiolNAC (NYBC) Each bottle, 90 tablets, sustained release formula. Each tablet contains 500 mg of NAC and 134 mg of alpha lipoic acid. As part of the MAC Pack, three per day provide the equivalent dose as used in the original neuropathy study published in the journal AIDS: 1500 mg of NAC and 402 mg of alpha lipoic. This is an excellent formula for those suffering from liver inflammation. It is also extremely convenient for many PWHIVs who take both NAC and Lipoic Acid since this 2-in-1 combination eliminates some pills while providing the same, generally accepted dosages. Suggested use is 2-3 tablets daily with meal or as directed. Reduce dose if headaches occur.
Note: This version of NYBC’s ThiolNAC intentionally decreases the alpha lipoic acid amounts per tablet from our original formula’s 200mg/tab to the present formula’s 134mg/tab. This change brings us precisely in line with the dosage studied in Jon Kaiser’s study, and also responds to a concern raised by our colleague Lark Lands regarding higher dose alpha lipoic and hypothyroidism.
February 28, 2012
K-PAX®, the popular multi-supplement pack, was developed following Dr. Jon Kaiser’s 2006 study that found an increase in CD4 count among HIV+ individuals using a mix of a potent multivitamin and antioxidants.* Eventually, Medicaid or ADAP formularies of many states included K-PAX®– a validation by the healthcare system welcomed by those of us who have long maintained that supplements can help to address chronic illness. Unfortunately, many people do not have access to these programs and for them, cost can be an issue. Even worse, some states, such as New York, are cutting budgets and eliminating items like K-PAX® from their formularies.
That’s why NYBC continues to offer the MAC Pack (for Multivitamin Antioxidant Combination), a low-cost alternative to the “Double-Strength” K-PAX® formula, based on products already available through our nonprofit co-op. (Unlike K-PAX®, the parts of the MAC Pack are delivered in their original bottles, so “some assembly is required”–one reason we also stock small ziplock baggies, which are great for travel, too!)
Note that the NYBC MAC Pack is based on the formula that was originally studied and published in the journal AIDS, while the current version of K-PAX®, on the other hand, has considerably less of certain micronutrients, such as vitamins B6 and B12. Nevertheless, the NYBC MAC Pack still costs HALF THE PRICE of the retail “Double Strength” K-PAX® formula. (That’s $62/month for the MAC Pack, versus $139/month for K-PAX® Double Strength.)
Subsequently, NYBC added to its MAC Pack offering by introducing the Opti-MAC Pack. This version of the MAC-Pack relies on SuperNutrition’s OptiPack (iron free), which has higher amounts of B vitamins than Added Protection, and so represents a further economy in number of bottles (no P5P or B12 needed!) and in cost (about $56/month).
For more information on NYBC’s MAC Pack or Opti-MAC Pack, or to place an order, visit us at www.newyorkbuyersclub.org, or call us at 1-800-650-4983. A comparison chart of the exact ingredients is available on our website. All the components of the MAC-Pack or Opti-MAC Pack can be ordered individually as well.
* Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42: 523-528.
August 17, 2011
We were glad to see a recent Q&A on the “Ask the Experts” forum of thebody.com, which is one of the leading online sources of information for people with HIV. The question concerned NYBC’s MAC-Pack, our low-cost, close equivalent to K-PAX, a multivitamin/antioxidant combination which has been shown in research to raise CD4 counts, and which is available thru some — but not all–formularies in some — but not all — states.
For more information, see NYBC’s entry
Here’s the exchange:
Jul 5, 2011
are you familiar with the co. NYBC and their MACPAC-combination multivitamin & antioxidant program sells for 65 dollars and they compare to KPAC for 1/2 the cost..don’t want to throw money away on useless vitamins or vitamins that are sub-par or not tested
ANSWER: Response from Mr. Vergel
Supplement quality is always an important issue. One available resource is http://www.consumerlab.com although they are a for-profit company. It would be preferable if there were a government agency that routinely tested supplements and published the results!
It will always be a bit of a crapshoot, but the good news is the majority of supplements tested by them either pass and those that do fail often do for relatively minor reasons (though some do spectacularly).
According to Jared Becker and George Carter from the New York Buyers Club, the brands used in NYBC’s MAC Pack come from companies as reputable as K-PAX and with longer histories. NYBC has assessed Jarrow, Douglas Labs and Montiff, the providers used to make the Mac Pack. A few years ago, NYBC sent Montiff’s acetylcarnitine for testing and it came back fine. NYBC also uses consumerlab’s reports to verify quality of our big suppliers like Jarrow and Douglas.
Entry posted at: http://www.thebody.com/Forums/AIDS/Nutrition/Q216051.html?ic=700101