Growing Old with HIV
By Lena H. Sun, The
July 26, 2012
Photo Credit: Jabin Botsford/For The
Washington Post - Rayford Kytle, 65, has been
living with HIV for more than 30 years and is
attending the International AIDS Conference to
“find out what the latest developments are in
AIDS prevention, research and care and how I can
help with the epidemic.”
person living with the AIDS virus once had
no hope of growing old. But within the
next eight years, more than half of all
Americans with the disease are likely to
be over 50.
Rayford Kytle, in other words, could soon
be a typical person living with HIV.
At 65, he is a gay man who has been
HIV-positive for more than 30 years. He
exercises regularly, watches what he eats
and doesn’t smoke. But he also has had his
hips replaced. And every 18 months, a
surgeon gives him injections to compensate
for fat loss in his face, he said, “so I
don’t look like a walking skull.”
The hip surgeries are related to his
disease. The injections, which cost about
$1,500, are fillers to counteract the
facial wasting that is a side effect of
the early, more toxic anti-HIV drugs.
The HIV/AIDS epidemic in the United States
is often perceived as something that
mostly affects young adults. But nearly 11
percent of the 50,000 new infections each
year are in people 50 or older. The
federal Centers for Disease Control and
Prevention estimates that this group makes
up 33 percent of all people living with
HIV — a percentage that will increase to
more than 50 percent by 2020.
As HIV-infected adults live longer, they
are increasingly affected by such chronic
illnesses as heart disease, diabetes,
kidney disease and osteoporosis, common
problems among many older people.
But studies suggest that those with HIV
may be at higher risk for some of those
illnesses and may get them earlier than
HIV causes the immune system to fight the
virus, and that inflammatory state
continuously damages organs, even when
antiretroviral medications are taken,
researchers said. HIV-infected people are
more likely to have hepatitis C or
hepatitis B and are much more likely to
smoke than the general population.
People with HIV are living into their 50s,
60s and beyond because of highly effective
antiretroviral therapies that became
widely used in the mid-1990s. At the same
time, experts say, some people over 50 are
engaging in sexual behaviors that put them
at high risk for contracting the AIDS
virus, resulting in new infections.
Some older Americans have a poor
understanding of their risk and don’t use
condoms. Doctors also don’t do as good a
job collecting sexual histories of
patients 50 and older, because they
consider them lower risk and fear angering
or insulting them, according to a recent
study in the American Journal of Public
The challenges of managing as well as
preventing HIV among older Americans were
a major theme at the 19th International
AIDS Conference in Washington this week,
which closes Friday with a speech by
former president Bill Clinton.
“It’s only fairly recently that we’ve come
to appreciate that even in people with
suppressed virus, there are continuing
effects of being infected with HIV,” said
Amy Justice, a professor of medicine and
public health at Yale University who
oversees an ongoing study on HIV and aging
HIV does not exist in a vacuum, Justice
said in one presentation. Smoking and
infections such as hepatitis C contribute
to the inflammation triggered by the
virus. And like everyone else who is
aging, older people with HIV are grappling
with “the physiological burden of those
things acting in concert,” she said in an
Researchers are trying to tease out the
connections: How much can be traced to the
drugs, how much is the actual virus
stimulating the immune system, how much is
the virus’s impact when the person was
Someone like Kytle, who works and has
private health insurance, is far better
off than a 55-year-old man who has the
virus and hepatitis C, high blood pressure
and depression, and is overweight and
experiencing erectile dysfunction — and
lacks health insurance. For doctors, the
tendency might be to treat the person for
each of the conditions.
may end up on 15 medications,” she said.
For sure, people would need to take
their antiretroviral medications. After
that, Justice questions whether taking
more drugs would do more harm than good.
Older Americans living with HIV drew
plenty of attention at the conference.
In the Global Village, which is open to
the public, a project called “The Graying
of AIDS” installed a temporary portrait
studio to allow anyone 50 and older who is
aging with HIV to pose for a photograph.
In the official conference area,
organizers for the session “HIV and 50+”
turned away dozens of people after the
1,000 seats were filled. When panelists
asked for a show of hands of those older
than 50, most of the hands shot up,
Kytle grew up in the South and moved to
Washington in 1980. He thinks he was
infected before 1979 but knew for sure he
had the virus in 1984, when tests became
“I was one of the first people to be
tested,” he said.
The early experimental drugs helped save
his life. But they also led to a cascade
of side effects. In addition to the hip
surgery and facial injections, he also
battles depression, a side effect from an
earlier drug, he said.
Until about seven or eight years ago, his
entire focus was staying alive, or trying
to keep his partners alive. One died in
1986, the second in 2002. Then he was
treated with the better, newer drugs. The
virus has been undetectable in his
bloodstream for four or five years.
And his outlook has changed.
“I stopped worrying about dying. I was
able to think about other things. I felt
relaxed enough to do that,” he said. He’s
reading, something he hadn’t had the time
or energy to do since the epidemic began
30 years ago.
Like other older Americans, he is facing
his own mortality.
“It scares me,” he said. “I want to make
the best use of my time to be as good a
person as I can be.”
At this week’s conference, Kytle had
thumbed through the 409-page program book
and planned out which sessions to attend.
Many dealt with homophobia and the
continuing stigma surrounding the disease.
On Wednesday, he went to a panel
discussion about the U.S. response to the
global epidemic that featured Sen. Marco
Rubio (Fla.), who has been mentioned as a
possible Republican vice presidential
The panel was interrupted several times by
There was no question-and-answer session,
and as panelists hurried off the stage,
Kytle stood up to make the point that
homosexuality should not be criminalized.
He shouted: “You can’t treat gay people as
sick, criminal, second-class citizens and
end this epidemic.”
“Homophobia kills,” he said.