New research is revealing the havoc caused by HIV and the drugs used to suppress it.

HIV/AIDS has been around for 30 years and thanks to anti-retroviral drugs, the virus no longer has to be a death sentence.

But longer lives are coming with a cruel catch; many long-term HIV survivors are ageing far too soon.

Conditions such as dementia, brittle bones, frailty and cardiovascular disease are happening to people in their thirties, forties and fifties.

Nick Scott survived HIV for 12 years before the arrival of anti-retroviral drugs in the mid 1990s.

But at 38, Mr Scott was diagnosed with dementia, a condition associated with people twice his age.

New Australian research has found that HIV gets into the brain quite early and attacks it, with HIV-related dementia emerging as a concern in the fight against the virus.

Dr Lachlan Gray is studying the life cycle of the virus at the Burnet Institute.

Dr Gray says current estimates are that up to 20 per cent of people with HIV will get dementia, and researchers are seeing that number escalate.

He says HIV compromises the brain's normal function and leads to the death of neurons and clinical dementia.

"One of the major problems is that the virus uses the brain as a sanctuary site where it can hide out from the immune system and also from the drugs that we use to treat the patients," he said.

"This poses a risk for patients developing dementia down the track."

The Burnet Institute's other research has found many of the other ageing conditions are due to HIV-induced inflammation.

Immune cells called monocytes are key regulators of inflammation and the institute's Dr Anna Hearst says HIV appears to make them hyperactive.

"What we are finding is that monocytes in a 35-year-old HIV-positive person actually look likes more of a 75-year-old."

And the older class of HIV drugs also caused premature ageing. Britain's Newcastle University has found that drugs like AZT damage DNA.

"It's likely to be a combination of things. In the past there has been a suggestion that certain anti-HIV drugs were associated with an increased risk of, say, heart disease. But this is only a very small part of the picture," says Dr Hearst.

"There's definitely something aside from the drugs which is driving these diseases in HIV positive individuals."

Constant struggle

There is still no cure for HIV, but drug therapies have extended many lives. Taking around 30 pills a day is the price to be paid.

After living with the virus for 28 years, David Polson's body is betraying him.

He says one of the drugs has given him a brain disease called superficial siderosis, which he describes as "worse than HIV".

"You lose the use of your arms and legs. You go deaf, which I have got. And speech - you start to lose your ability to talk. That is why I am slurring my words a bit today," he said.

"And this goes [on] and you are eventually bed ridden and get dementia and die. There is no treatment at present and no cure."

Some people in their thirties are developing conditions usually seen in 70 and 80-year-olds - brittle bones, cardiovascular disease, organ failure, cancer and early on-set dementia.

After years of specialist HIV care, Nick Scott has moved into a dementia unit at a nursing home.

His long-term companion, Hugh Scott, says it is a difficult situation.

"To suddenly be plucked out of [a] community, leaving behind all this friends and all that social engagement ... to be parked in a warehouse for human beings, which is essentially the way in which these nursing homes essentially operate, was an awful thing," he said.

Mr Polson is also facing a similar future as his condition worsens.

"The thought of being in a nursing home is just really depressing. I'd rather stay here and have home care. I am getting a little bit of help. I have a cleaner coming in," he said.

"[But] in the future, particularly if I am bed ridden with my arms and legs gone I will need a lot of care."

Rising numbers

Successes in treating HIV have led to complacency: every year more than 1,000 Australians become HIV-positive, and the number is steadily rising.

It is estimated 30,000 Australians will be living with HIV by 2020. Not all will need early aged care, but planning is needed.

The aged care sector says it does not have the resources to provide specialist care for people with HIV.

"[The sector is under] considerable strain," says Rod Young from Aged Care Association Australia.

"The system has been structured to deal with people who are frail and old. As the population has aged quite significantly over the past 35 years ... the level of dementia has risen accordingly. We need to change a lot of our focus.

"What the aged care system needs to be able to do is break out of the aged care-specific focus and really be able to provide some flexibility to address the needs of those specific groups."

A Productivity Commission report due out this week is expected to recommend greater flexibility in the aged care sector and encourage smaller, more focussed facilities, perhaps similar to the gay and lesbian centres in the United States.