CHICAGO John Holloway received a diagnosis of AIDS nearly two decades ago, when the disease was a speedy-death sentence and treatment a distant dream.
Yet at 59 he is alive, thanks to a cocktail of drugs that changed the course of an epidemic. But with longevity has come a host of unexpected medical conditions, which challenge the prevailing view of AIDS as a manageable, chronic disease.
Holloway, who lives in a housing complex designed for the frail elderly, suffers from complex health problems usually associated with advanced age: chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip.
Those illnesses are not what Holloway expected when lifesaving antiretroviral drugs became the standard of care in the mid-1990s.
The drugs gave Holloway back his future. But at what cost?
That is the question, heretical to some, that is now being voiced by scientists, doctors and patients encountering a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of AIDS survivors to reach late middle age.
Experts are coming to believe that the immune system and organs of long-term survivors took an irreversible beating before the advent of lifesaving drugs and that those very drugs then produced additional complications because of their toxicity a one-two punch.
The graying of the AIDS epidemic has increased interest in the connection between AIDS and cardiovascular disease, certain cancers, diabetes, osteoporosis and depression. The number of people 50 and older living with HIV, the virus that causes AIDS, has increased 77 percent from 2001 to 2005, according to the U.S. Centers for Disease Control, and they now represent more than a quarter of all cases in the United States.
Larry Kramer, the founder of several AIDS advocacy groups and a long-term survivor, said he had always suspected "it was only a matter of time before stuff like this happened," given the potency of the antiretroviral drugs.
"How long will the human body be able to tolerate that constant bombardment?" he asked. "We are now seeing that many bodies can't. Once again, just as we thought we were out of the woods, sort of, we have good reason again to be really scared."