HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene

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GeriPal - A Geriatrics and Palliative Medicine Podcast 48 min 2 speakers 2 chapters transcribed 9 hours ago

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Who are the guests and what is their background in HIV and aging care?

Alex Smith 0:00

Welcome

Eric Widera 0:01

to the JerryPound Podcast. This is Eric Quadera.

Alex Smith 0:03

This is Alex Smith. And Alex, we got a lot to talk about today. Who are our guests? We are delighted to welcome Peter Selwyn, who is a family medicine and palliative medicine doctor and chairman of the Department of Family and Social Medicine and Director of the Palliative Care Program at Montefiore and Albert Einstein and author of Surviving the Fall, the personal journey of an AIDS doctor. Peter, welcome to the JerryPal Podcast.

Peter Selwyn 0:25

Thank you. Happy to be here.

Alex Smith 0:27

And we're delighted to welcome Meredith Green, a friend, a geriatrician researcher, associate professor at Indiana University, who was previously with us at UCSF in our division of geriatrics. And when she was here, she co-founded the Golden Compass Clinic at San Francisco General Hospital for Older Adults Living with HIV. Meredith, welcome to the JerryPal podcast.

Meredith Greene 0:48

Thank you, Alex and Eric.

Eric Widera 0:50

So we're gonna be talking about HIV and geriatrics in palliative care. Uh before we do, Meredith, I think you have a song request for Alex.

Meredith Greene 0:59

Yes, I am requesting one by U two.

Eric Widera 1:03

Why did you pick one by U two?

Meredith Greene 1:06

I picked this because there's not one song that can encapsulate aging with HIV affects so many different people, but this song was actually a fundraiser. For AIDS when it was released. And so I picked this and for the ongoing work that you two and Bono have done globally.

Alex Smith 1:28

Wonderful. I love this song. Thank you, Meredith.

Unknown 1:42

Have you come here for forgiveness? Have you come to raise the dead? Have you come here to play Jesus? To the lepers in your head. Did I ask too much? More than a lot? Gave enough and now it's all I got. We're one but when not the same when we hurt each other, then we do it again. You say love is a temple, love the higher law. Love is a temple, love the higher law. You ask me to enter, but then you make me crawl, and I can't be holding on to what you got. When all you got is hurt one love. One blood, one life, you got to do what you should. One life. with each other sisters Brothers. One life, but we're not the same. We get to carry each other, carry each other.

Eric Widera 3:33

I gotta interrupt.

Alex Smith 3:34

I'm gonna

Eric Widera 3:35

g I'm getting the hook. I gotta jump. I'm getting the hook. Peter, I heard you had maybe a different song for Alex.

Peter Selwyn 3:43

Oh, well I was hoping he might uh be able to sing the message from Grandmaster Flash and the Furious Five, which next time

Alex Smith 3:53

Yeah, that would be a good challenge. Well, I'm always up for a challenge next time.

Eric Widera 3:58

Okay. Uh we got a lot to talk about. HIV, geriatrics, and palliative care, but bef you know, to kinda ease us into it, Peter, I'm gonna start off with you. How did you get involved and interested in this topic?

Peter Selwyn 4:12

Well, I mean, uh uh my whole career really has sort of grown along with and and moved through uh the AIDS epidemic. Uh I've been uh now a care provider for people with HIV for over 40 years. And I graduated from medical school in the early eighties. In fact, the same month and the same year that the first um AIDS cases were reported by CDC, which were the clusters of cases of pneumocystis and also Capos. sarcoma in New York and California. And through my residency, became just immersed more in it was which was in the Bronx at Monifure, immersed more and more in the care of people with HIV, and then became involved as both the clinician and director of uh programs involving HIV and substance use. In the Bronx and beyond.

Peter Selwyn 4:58

Um, and so really from the very beginning, I was surrounded by by people who at that time were all dying of AIDS. And that was before we even thought about palliative care as as a specific field necessarily. It certainly hospice was something that was known about, but but in terms of training or preparation, uh, that really didn't exist. And so I so I became in some ways a palliative care specialist for people with HIV almost just by being there. And over that first uh 15 years, which was a very difficult time when there was no treatment at all available, everybody died. And usually within months or a year or two of when they were diagnosed. So it felt like it was being part of this huge

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Chapters

2 chapters

1 Who are the guests and what is their background in HIV and aging care? 0:00–22:29 2 How did Peter Selwyn’s career evolve with the HIV epidemic and palliative care? 22:29–48:58

Speakers

2 identified

Eric Widera 6 min Alex Smith 4 min

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Topics in this episode

CDC 1 USAID 1 Alex Smith 1 Albert Einstein 1 UCSF 1 Eric Widera 1 HIV 1 PEPFAR 1 John Bartlett 1 Montefiore 1 hand 1 Protease inhibitors 1

Source

Recorded01 May 2025

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524510

Show notes

Peter Selwyn, one of today's guests, has been caring for people living with HIV for over 40 years. In that time, care of people with HIV has changed dramatically. Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions. The average age at death was in the 30s. Now, more people in the US die with HIV rather than from HIV. Treatment regimens are simplified, and the anti-viral drugs are well tolerated. People are living with HIV into advanced ages. The average age at death is likely in the 60s. Nearly half of people living with HIV are over age 55. One in 10 people with newly diagnosed HIV is an older adult. Our second guest, Meredith Greene, is a geriatrician and researcher who focuses on care of older adults living with HIV, in the US and Africa. On today's podcast we discuss: Implications of aging with HIV for clinical care Loneliness and social isolation among older adults living with HIV Persistence of stigma Need to consider HIV in the differential diagnosis for older adults Screening for HIV Screening for osteoporosis in people living with HIV Dementia and cognitive impairment risk in people living with HIV When to stop anti-virals near the end of life Toward the end we speak to the moment. More older adults live with HIV in SubSaharan Africa and the global South than anywhere else in the world. Funding for research and clinical care is at risk, as USAID and PEPFAR (which is under USAID), are shuttered. Millions of lives are at stake. Meredith wore a shirt that said Silence=death. Eric gave me the hook during my live cover of One, by U2, a song released in 1992 whose proceeds went entirely to AIDS research. I couldn't help it, forgive me dear listeners, I had to do a longer than usual cut at the start! -Alex Smith Useful links: Peter's article on the evolution of HIV: https://link.springer.com/article/10.1007/s11524-011-9552-y Peter's book Surviving the Fall: Personal Journey of an AIDS Doctor PEPFAR: Global Health Policy | KFF Articles: Geriatric Syndromes in Older HIV-Infected Adults - PMC Loneliness in Older Adults Living with HIV Management of Human Immunodeficiency Virus Infection in Advanced Age https://pmc.ncbi.nlm.nih.gov/articles/PMC3684249/ About Act-up for those who might know the Silence=Death t-shirt reference: https://www.npr.org/2021/06/16/1007361916/act-up-a-history-of-aids-hiv-activism https://www.newyorker.com/magazine/2021/06/14/how-act-up-changed-america

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