HIV and aging

Abstract

With the wider availability of antiretrovirals, the world's HIV population is aging. More than 10% of the 34.5 million HIV-positive individuals worldwide are over the age of 50 years and the average age continues to increase. In the USA more than 50% of the 1.3 million people with HIV are over 50 years old and by the year 2030 it is estimated that 70% will be over the age of 50 years. Although the life expectancy of HIV-positive people has increased dramatically, it still lags behind that of HIV-negative individuals. There is controversy about whether HIV itself accelerates the aging process. Elevated rates of inflammation seen in people with HIV, even if their viral loads are suppressed and their CD4 counts are preserved, are associated with greater rates of cardiovascular, renal, neurocognitive, oncological, and osteoporotic disease. These conditions increase exponentially in the elderly and will represent a major challenge for HIV patients. In addition, conditions such as geriatric syndromes including frailty are also seen at higher rates. Management of the aging HIV patient includes an emphasis on early diagnosis and treatment, preventative measures for co-morbidities, and avoiding polypharmacy. Finally, the issue of quality of life, prioritization of medical issues, and end of life care become increasingly important as the patient grows older.

Validation of the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) chronic kidney disease risk score in HIV‐infected patients in the USA

“…Several studies have suggested that people living with HIV infection (PLWH) are at increased risk for chronic kidney disease (CKD) with a multifactorial pathogenesis . While the use of combination antiretroviral therapy (cART) as the standard of care in HIV infection has resulted in a decreased incidence of HIV‐associated nephropathy, it has also lengthened life expectancy, accompanied by an increased incidence of age‐related diseases, such as CKD .…”

A Comparison of Comorbidities and their Contribution to Medical Resource Utilization for Matched HIV-Infected and Uninfected Individuals: A Cross-Sectional Analysis

“…HIV nephropathy has decreased with the use of anti-retroviral therapy. Yet, in populations of PLWH, compared to uninfected peer groups, risk factors for kidney disease were present in our models including diabetes for HIV uninfected patients and hypertension for HIV patients [23]. Other studies have also revealed that kidney-related comorbidities are associated with extremely high medical-related costs, as indicated in both our models as top contributors to high Charlson scores [27].…”

“…HIV patients are recognized to be at high risk for cardiovascular-related illness, with heart disease being a very common complication [23]. Interestingly, both models included cardiovascular related illnesses: hypertension (HIV+) and heart failure (HIV-) were top significant contributors in both groups [23]. Higher rates of hypertension are observed in PLWH in addition to associated illnesses [28, 29].…”

“…Future longitudinal studies should analyze HIV-related clinical indicators over time, as medications, including protease inhibitors, are linked to increase risk of cardiovascular related illness. This should also be explored in future predictive modeling studies [23].…”

Persistent EcoHIV infection induces nigral degeneration in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-intoxicated mice

“…Indeed, numbers of HIV-infected people over the age of 50 increased dramatically in recent years (Wing, 2016). Consequently, as the HIV-infected ART-treated population ages, patients will be prone to age-related neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD).…”