20th International AIDS Conference (AIDS 2014)


AIDS 2014: Untangling HIV and Aging

August 1, 2014

As people with HIV live longer, issues of aging are gaining more attention from HIV/AIDS researchers, clinicians, and advocates. Although by no means a focus of AIDS 2014, HIV and aging-related illnesses did take center stage in a mid-week "bridging session" that featured an in-depth presentation on the intersection of HIV, HIV treatment, and aging.

Peter Reiss, co-principal investigator with the AGEhiv Cohort Study in Amsterdam, was tasked by session organizers to disentangle biological aging, the inflammatory effects of long-term HIV infection, and the adverse effects of antiretroviral therapy (ART). To this end, Reissreported on his research team’s comparison of comorbidities -- simultaneously ocurring illnesses and health conditions -- in people with HIV vs. their HIV-negative counterparts.

"Across the board, the prevalence of a wide range of comorbidities is higher in those with HIV," Reiss shared. Many chronic diseases of aging, such as hypertension (high blood pressure) and chronic obstructive pulmonary disease (COPD, a disease of the lungs that makes breathing difficult), are more common in the study’s HIV-positive participants, even after adjusting for lifestyle factors and use of antiretrovirals.

"What we also found in this study," Reiss added, "is that especially the prevalence of multimorbidities -- people having three or more comorbidities at the same time -- is strikingly higher, especially in those individuals who are 60 years or 65 years and older."

Multiple factors likely contribute to these higher rates of comorbidity and multimorbidity in older people with HIV, including host-related factors (like lifestyle and genetics), ART toxicity, and the persistent immune dysregulation and chronic inflammation that accompanies even well-treated HIV disease.

Researchers with the AGEhiv study found that a number of factors are independently associated with having more comorbidities. Not surprisingly, Reiss noted, known risk factors such as age, smoking, family history of disease, and waist-to-hip ratio played an important role. While having HIV was not associated with greater comorbidities, the duration of immunodeficiency (having a CD4 cell count below 200 cells/mm3) was linked with increased risk. Markers of immune activation were also associated with higher number of comorbidities, as was longer duration of exposure to high-dose ritonavir, an antiretroviral drug that today is primarily taken at smaller doses to "boost" levels of other drugs.

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