Sunday , June 26 2022

Lisbon Patients: Meet the person living with HIV who is about to turn 100


Miguel is walking with a blast, sometimes leaning on a gun as she moves constantly down a busy urban hospital hall outside of Lisbon, Portugal. But apart from the walking support and some vision and hearing loss – no surprise to a man who will be 100 this spring – on the surface, he is the perfect geriatric health picture. However, Miguel has spent at least a quarter of a century living with HIV.

I was referred to in a case study that was published soon as "The Patient Lisbon," Miguel – that is not a real name – is also the person who has documented older with HIV in the world.

"I'm feeling happy," said the soft speaker senior at CTV News, speaking through a translator at the Portuguese hospital. "I have spent these years without hardship and without troubles."

With an inflammatory blue eyes that is set against a kind, clean face, Miguel appears as a polite, correct man in her brown blazer and her cardigan. However, Lisbon Patient does not see itself as a "special case" – but others certainly do it.

"Of course, 100 years is something special!" HIV expert Dr Giovanni Guaraldi told CTV News of an office in Modena, Italy. "This man is an icon of hope for people living with HIV."

When Guaraldi heard about the Patients of Lisbon first through one of the Portuguese doctors of Miguel, who trained at an innovative geriatric HIV clinic in Modena, he knew he had to share his story with the world.

"We need to make people know," said Guaraldi. "Many people living with HIV are still considering their disease is really terribly true … irrespective of testing and living with chronic disease, you & It's still able to experience aging and healthy. "


Miguel with a primary doctor, Dr. Henrique Santos (CTV News)

In 2004, when Miguel first reached the hospital near Lisbon, he suffered from rare types of lymphoma and calcosis as well as a low risk CD4 count, which is white blood cells that play a significant role in our immune systems. Miguel's medical team would soon learn that these were the result of AIDS: the final stage of HIV infection.

"If the treatment was not started … other infections, other maliciousness, other complications (may have appeared)," said Dr. Henrique Santos, Miguel's primary doctor, to CTV News.

Miguel carried out several perfect rounds of chemotherapy. After stabilization, doctors attacked HIV infection with an aggressive and toxic combination of eight antiretroviral drugs. At the beginning, even Santos has a sense of mind.

"When this patient came to me in this age, I had some doubts that it should be treated," says Santos. "Everything went well, but it could have gone out of place. There could be signs of toxicity. It could not have been able to handle the treatment. It could have lost the treatment. We had to consider the scenarios that. "

It is not known exactly when and how Miguel contracted HIV – he has been abusive to talk about – but his medical team estimates that he has been living with the virus for about a decade before having diagnosed at 84. Unprotected heterosexual contact, they believed, were those who were most likely to be guilty.

After being on the verge of death 15 years ago, Miguel has a strong CD4 cell count and an easily found virus viral load, which means that she does not have almost a virus in her blood and can not transfer HIV. In other words, Patient Lisbon is as healthy as it could be 99-year-old. It is almost completely independent, even living alone and receives only a very little help in its everyday life by a member of the family living in the same building flat.

"I still feel good enough that I do not bother other people," said Miguel. "I also feel fit enough to look after all my arrangements, to wear, to put my shoes on, to go to bed. I do everything in the home only. "

One of the key to the success of Miguel's treatment, said his medical team, is that he is religious taking his antiretroviral medication.

Dr Inês Pintassilgo is a medical resident working alongside Santos and has been part of Miguel's treatment team over the last three years.

Dr Inês Pintassilgo is a medical resident working alongside Santos and has been part of Miguel's treatment team over the last three years. She is also the doctor who brought Miguel to the attention of Guaraldi in Italy.

"I liked, From My God – I never met someone with an HIV!" Pintassilgo said of the first meeting of Miguel.

"The only reason that came here is that the medicine is doing its work properly – the medication keeps the virus under control … If it did not take its medication, of course it would be & Sick and not like this. "

He added his healthy lifestyle and genetics similar to that picture, Pintassilgo.

"It was one of the things that took me to the conclusion that HIV itself is not enough to tell you how you're going to live or if you & # 39; no surviving or not – he takes all of the other things, "she explained. "He had a very active life, he worked late and he did not drink, he had never smoked … His parents also lived up to 100. So, I think that & # 39 ; this message to me was that if HIV was being controlled, all the other factors are the important ones. "

Dr. Inês Pintassilgo in an interview with News CTV.

Pintassilgo describes Miguel as a "survivor" in "very good" health. Simply simply, her treatment involves two antiretroviral bills every night, but Miguel is of her incredible longevity – much higher than life expectancy for healthy adults in any developed country – to something much simpler.

"The reason why I've arrived so long is that because of every day when I go to bed, I'll make a cup of lemon space," he explained. "A good slice of lemon with the spider and the pulp and everything. It would boil for five minutes and in the end we will add a teaspoon of good honey."

Although it is a potential symbol of hope to the 36.9 million people living with HIV-AIDS worldwide, however, Miguel's family asked CTV News to not show his face or use his name right in this story.

"Not as big as 10 years or 20 years ago, but stigma is still," says Santos. "Because the way people can get sexually infected by drugs, the stigma still exists."

Still, Santos and Pintassilgo think it's important to share the story of Miguel, and they will explain further in a case study that was published soon that they co-authored with Guaraldi in Italy as well as other colleagues .

"It may seem like a symbol that everyone with the infection should believe that these days do not mean death," says Santos. "If people take the medication, they can live as others and as well as other people and that is the main conclusion, I believe."

"I think that's what he's going to tell us, that you can live with HIV as long as you have all other backgrounds and lifestyle and taking under control, "said Pintassilgo. "I would say, of course, that HIV may have a role in this regard, but if it's managed well and well to control it will not be that big issue."


Recent developments in HIV treatment in what makes the story of the Patients of Lisbon possible.

Dr. Anthony Fauci is an American immunologist who has been involved in the research and treatment of HIV-AIDS through the US National Health Institutions since 1981, at the end of the HIV-AIDS epidemic, when he began stories of mystery, death and after-disease unknown digest gay men's immune systems, gay in America.

"When I was caring for patients … at the start of the epidemic, someone would bring a disease in advance and the median survival would be about a year, "said Fauci at CTV News from Washington DC, where & # 39; n still working. "I had an increasing feeling that this was going to explode. Unfortunately, I was right. "

"You could be dancing on Saturday night and by Sunday morning, feel like you would have been too much over and then by Monday, they felt that you had a bad cold, by Wednesday having breathing difficulties, find yourself in hospital by Friday and you could die before the end of the weekend – it could move fast, "Tim McCaskell, a Toronto-based actor, founded the AIDS group IMPLEMENTING NOW! in the 1980s, at CTV News. "He's like to be a warrior and have broken your friends on the other side of the other for you and thinking when the bullet is going to hit you."

Miguel's family asked CTV News not to show his face or use his real name in this story.

But today, Fauci says, thanks to "staggering developments in HIV infection," people with new HIV infections can reasonably expect to live an extra 50 years after diagnosis.

"They can almost have normal life expectancy," he said.

The most significant development came in 1996 with the introduction of a combined antiretroviral therapy: a treatment that uses two or more drugs to prevent viral reproduction, retaining the HIV virus essentially and preventing the spoil of system person immunity

"When you drop the virus to a level that can be found below, you make it inevitably impossible for that person to transfer the virus to anyone else," added Fauci.

In recent years, such drugs have become less toxic, more effective and in most cases, only one or two daily pills can be taken.

  • Fauci of our opinion is "we can eventually bring the epidemic (HIV-AIDS) tomorrow". However, there are some significant barriers. To find out more about what still needs to be done to eliminate HIV-AIDS, see this story.

"It does not eliminate the disease, but it's taking a death sentence and it's transformed into a chronic, can be controlled," explained Dr. Neil Rau, a Ontario-based infectious disease specialist that oversees care of about 200 people with HIV. "Now, I'm telling a lot of patients … You're dying with this disease, but not from that. & # 39;"

McCaskell is now the activist in 67 and has been living with HIV for almost four decades. The advent of a combination therapy, he says, "is significant for many of us that the crisis is over."

"People stopped dead, they literally give the best to die," McCaskell explained. "After 15 years of the decline of our community … suddenly there was a possibility of living a normal life again."


Due to rapid advances in antiretroviral therapy, the 100-year-old Lisbon Patient case, Fauci says, "is unusual, but not surprising."

In addition, experts predict, if there are no others like Miguel already there, there will be much more in the years ahead. Miguel, they say, in the face of a emerging trend: the patient of geriatric HIV.

"The average age of people living with HIV in Canada is now more than 50," said Dr Sharon Walmsley, a senior HIV scientist and a specialist at the Toronto General Hospital Research Institute, at CTV News.

Those numbers are similar across the developed world, and thanks to combined antiiretroviral therapy, that average age is expected to continue to increase in the years ahead.

"There were not a cohort of patients with HIV with them," added Walmsley. "A big question is, aging (for them) different from what the population is in general?"

That is why Fauci and a team of NIH researchers in the United States are studying comorbidities: the presence of one or more additional conditions that occur at the same time as a basic disorder, which is in this case in HIV.

"Because we make them living longer with drugs, they then end up to develop other diseases that we would never realize they were going to have years ago since they were never live long enough, "explained Fauci. "They have a higher rate of cardiovascular disease, a higher rate of liver disease, a higher rate of kidney disease. They have aging features in their tissue that make their body look physiologically so it's aging as soon as certain years, so we do a lot of studies to try to find out what special issues are related to people who have been infected for 30 and 40 years. "

Similarly, Walmsley also produces a study group of 750 Canadians over 65 who live with HIV to see how they age and help provide the HIV-positive HIV-positive population. ; n grow with better healthcare. She also establishes a clinic for such people in Toronto.

"We have geriatrists on our team because we have not had to face geriatric HIV from before," he explained. "The other issue that we have never had to face is that patients with HIV are older, they will also look at the need for long-term care and our long-term care facilities are not ready to deal with HIV."

He is also largely unknown, Walmsey added, how HIV medicines interact with other drugs.

Dr. Sean Rourke is a neuropsychologist based on Toronto specializing in neurro-complicated HIV complications. People with HIV, he says, prove "fast aging" of the brain.

"The tsunami is waiting to happen," he said about the aging HIV demographic and unhealthy healthcare system. "The HIV (s) was built when people died. It needs to be redesigned to help people live and flourish."

HIV expert Dr Giovanni Guaraldi talks to News CTV at his office in Modena, Italy. (CTV News)

Yet another similar project is already underway in Modena, Italy. It is known as the HIV Modena Metabolic Clinic, this one-stop shop for geriatric HIV patients is run by Guaraldi, the Italian HIV specialist, and is staffed by other experts such as nephrologists, dieticians and geriatricians.

"I believe that the message is not to give more years to life, but to give more life to years – this is what we want for the future to & # 39; n patients, "said Guaraldi, who also works as an associate professor of infectious disease at the University of Modena. "I believe that the Lisbon patient is a sign of hope for people living with HIV saying that you still have the ability not only to live longer but to live in health, to prove aging and healthy … We have a proof of principle for researchers and doctors to say that we can provide better care for people. "

Given the good condition of the Patients of Lisbon when others experience a weak immune system, Guaraldi thinks he could maintain clues on how to age healthy with the HIV virus. That is why he now analyzes the blood of Miguel and compared to other centenaries.

"I believe that the Patients of Lisbon will tell us a lot about how HIV's people are becoming an immunologically aging," said Guaraldi. "This patient is a tip of ice."

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