In 1986, 23-year-old John Hutchison traveled 50 miles north from Farmington, New Mexico to Durango, Colorado, a relatively short trip along Highway 550, through the rocky and wooded terrain of the San Juan River Valley. The news Hutchison received in Durango put him on a far more uncertain road – one he believed would end abruptly.
The Durango Health Department tested Hutchison for the human immunodeficiency virus (HIV), which can cause acquired immune deficiency syndrome (AIDS). Hutchison tested positive for HIV.
At that time, there was no treatment for HIV. Hutchison asked what was going to happen to him and was bluntly told he could expect to get sick and die in relatively short order. Hutchison pushed the dire news aside.
“I lived in denial,” he said. He decided to live as a self-described ski bum and worked several years at Ski Cooper in his native Leadville before he suffered a severe knee injury and lapsed into poor physical condition and depression.
But more than 35 years later, Hutchison is still here, and is symptom-free. He looks back to the dark day in Durango with a dash of dry humor.
“If I’d known I was going to live this long, I’d have done things differently,” he said.
People with HIV who are 50 and older
Hutchison, who now lives in Denver, is part of a fast-growing group: people with HIV who are 50 years of age and older. Thanks to the development of antiretroviral therapies (ARTs) that began in the mid-1990s, these survivors have the chance of living long and productive lives – a prospect denied to many people with HIV who were infected before ARTs were available. That good news, however, is tempered by a new challenge: staying healthy.
“There has been a shift in mindset,” said Dr. Kristine Erlandson, associate professor in the Division of Infectious Diseases at the University of Colorado School of Medicine. “For those patients diagnosed in the ‘80s and early ‘90s, an HIV diagnosis was kind of a death sentence.”
For some, that meant living for now, without much attention paid to “healthy living characteristics,” Erlandson said. “But the concept that you might live 30 to 50 years more has caused a shift toward things that people might do to prolong their lives.” That need is especially important because the risk of cardiovascular disease is significantly higher for people living with HIV, Erlandson said.
Clinical trial focuses on exercise and HIV
One of those shifts is familiar to most people as they age: abandoning long stretches of sitting in favor of getting physical with walking, jogging, lifting and other activities. Erlandson has extensively researched the health benefits of exercise for people with HIV. Now she has sharpened her focus with a trial underway at the University of Colorado – Anschutz Medical Campus that tests two different exercise regimens for mostly sedentary people living with HIV who are 50 years and older. The aim: demonstrate the success of either approach in improving participants’ physical function, reducing their fatigue and encouraging them to stick with regular physical activity after the trial ends.
The 16-week trial, also underway at the University of Washington, randomly assigns participants to either “high-intensity interval training” (HIIT), or “continuous moderate-intensity exercise training” (CME). HIIT participants alternate short bouts of high- and moderate-intensity exercise, as measured by their maximum heart rate. The CME group completes 42 continuous minutes of moderate-intensity walking or jogging. Both groups will also complete a regimen of resistance training.
Erlandson and her research colleagues also want to understand what effects, if any, regular exercise has on processes that drive the body. The study includes blood draws and muscle biopsies from participants that could shed light on the workings of the mitochondria – structures in the cell that are essential to how the body uses energy, Erlandson said. The key question: can regular exercise boost the mitochondria’s power production, thereby reducing fatigue, diminishing frailty and making it easier to increase exercise?
“We see that many older people with HIV experience a lot of fatigue,” Erlandson said. “If we exercise people and their fatigue is improved, is part of that improvement actually an improvement in how well their mitochondria are working?”
After completing the exercise portion of the trial, participants receive 12 weeks of “biobehavioral coaching,” through either standard or motivational text messages, Erlandson said. They also work with Erlandson’s research assistant, Vincent Khuu, an exercise physiologist and certified personal trainer, to develop a personal exercise prescription and plan to help them to keep moving on their own.
Khuu said the study “provides a safe, welcoming environment where [participants] can learn the foundations of how to maintain a healthy and active lifestyle for the rest of their lives.”
Participating in the exercise study
Hutchison enrolled in and has completed the study. He said it served as a springboard away from a long stretch of inactivity that sent his weight soaring and his mental health spiraling. The lingering knee injury that kept him off the slopes and on disability proved particularly discouraging.
“It’s so easy to sit around and watch TV all day,” he said. “I had nothing to do and wasn’t going anywhere. I thought I’m wasting my life, it’s worthless, I don’t know why I’m going on.”
With a nudge from CU infectious disease specialist Dr. Nancy Madinger – his care provider since 1991 – Hutchison joined Erlandson’s current trial. He said he’d been involved in an earlier exercise study she led, but faltered and stopped exercising after the study was over. He was determined not to have a repeat performance.
“I said I’m going to make a go of it this time and get my body back into shape,” he said. “I went in with a much better attitude.” With Khuu’s help, he’s established an exercise regimen that includes regular trips to a local gym. He’s also studying for an exam to earn his certified public accountant license.
“My mood has improved,” he said. “Exercise gives me something to look forward to.”
HIV exercise study gives participants a healthy push
Like Hutchison, a Denver woman who prefers to remain anonymous said Erlandson’s trial – and particularly the guidance and encouragement of Khuu – helped to lift her out of a morass of inactivity that began with her unexpected HIV diagnosis in 2011.
“In my mind, that was it,” she said. “I saw it as the end of my life completely. It was devastating, a death sentence.”
The diagnosis that year dovetailed with the discouragement of a layoff from a large Denver law firm, her employer for more than a decade. That was the last time she worked. But she pointed to trauma at the age of 22 caused by her mother’s sudden and unexpected death by heart attack in 1972 as a life-changing event that weighed on her heavily and changed her personality.
“I didn’t care. I was out there,” she said. After moving to Denver and securing her position with the law firm, she described herself as “kind of responsible,” but admits that “I wasn’t watching what I was doing.”
About five years after her diagnosis, the woman said, she felt better and began to think that she “might be able to live.” She took part in group therapy sessions for women at UCHealth, then learned about Erlandson’s trial through a message from Khuu on My Health Connection, the patient portal. She joined the study in March 2022 and completed all phases.
“I needed a little push,” she said. “There was no getting up and going to work, and I had succumbed to not doing anything and lying around.”
She credits Khuu and the camaraderie she developed with the entire study staff for changing that. “I didn’t have the motivation, but Vincent made a big difference for me. He was encouraging and so positive. That meant so much to me physically and mentally.”
Whatever the outcomes Erlandson and her team draw from the study, the woman’s experience points to the power of exercise to change ingrained patterns of thought and behavior and rekindle aspirations for a more productive life. She admits that she has had trouble continuing to adhere to her exercise regimen since the study ended, but said she is symptom-free, and her positive outlook remains.
“For me, joining the study wasn’t about losing weight or looking different,” she said. “I felt better. That was the key for me, especially as an older person who had kind of given up.”
Probing the power of exercise
Erlandson hopes the quality-of-life improvements enjoyed by the study participants also open the door to proven clinical benefits for older people with HIV and those with other comorbidities. For example, she noted work done by endocrinologist and researcher Dr. Jane Reusch that links age and Type 2 diabetes with decreased mitochondrial function.
Erlandson, Reusch and other colleagues also collaborated on a 2021 paper that paved the way for the current study. It suggested that HIIT should be investigated as a viable method for triggering changes in the mitochondria and muscles and boosting exercise ability in aging people with HIV. An earlier study concluded that both moderate- and high-intensity exercise could reduce frailty in all older adults and encouraged people with HIV to meet the guidelines for activity established by the Department of Health and Human Services.
“We want to see if different types of exercise produce more benefits for older patients with HIV,” Erlandson said. “With that, we could develop tools to disseminate [the findings] more broadly and to help providers counsel patients in the clinic on how to start and keep up physical activity.”
Looking farther, Erlandson said she aspires to develop clinical programs for prescribed periods of supervised exercise that providers could use to help their patients. The programs would also help older people with HIV build longer-term commitments to exercise.
“It would set participants up with an initial visit and some counseling,” Erlandson said. “I think as insurers see the benefits of physical exercise on so many outcomes, ideally, we could get coverage for these types of programs. That’s my dream down the road,” Erlandson said.
Hutchison, who continues to reap personal benefits from the study, praised the research team but emphasized that patients have responsibility for their own outcomes.
“You’ll get out of the study what you put into it,” he said. “You’ll have the habit of exercise after six months if you follow the requirements of the study.”
For more information about the trial, contact Vincent Khuu at 303-724-0836 or [email protected].