HIV and Aging – Perhaps Not as Dramatic as We Feared?

Abstract

Ever since the introduction of highly active antiretroviral therapy (ART) in 1995, HIV infection has been linked to “metabolic” complications (insulin resistance, dyslipidemia, osteoporosis, and others). Studies suggested increased rates of myocardial infarction, renal insufficiency, neurocognitive dysfunction, and fractures in HIV-postitive patients. Even long-term suppression of HIV seemed to be accompanied by an excess of deleterious inflammation that could promote these complications. The aims of this viewpoint paper are to summarize recent data and to examine the possibility that the problem of aging-related morbidity in HIV might not be as dramatic as previously believed.

Frailty in medically complex individuals with chronic HIV

“…Median plasma HIV RNA was undetectable (77% of the sample). There was a significant burden of medical comorbidities, with an average of 2.7 medical conditions per person (median 3, IQR [1][2][3][4]). Almost one-half of the sample smoked, had hypertension, and hyperlipidemia, and over one-half displayed DSPN.…”

“…Other factors significantly associated with FFI components after multivariable analysis were for the most part conceptually congruent: for example, weight loss was associated with smoking and cancer, worse physical activity and exhaustion with increased BMI, and worse physical activity with COPD. 4 AIDS 2019, Vol 00 No 00…”

“…Frailty is a phenotype that accounts for some of this variability; within each stratum of disability, frailty predicts survival [1,2]. Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4].…”

“…Adults living with HIV exhibit frailty more frequently than HIV-negative individuals of similar age, but whether this increase is a consequence of HIV itself or of its comorbidities is debated [3,4]. Some also question the validity of frailty measurement tools in populations with mean ages under 50 [3,4]. As combination antiretroviral therapy (cART)-era HIV populations enter decades for which common frailty measures were designed, determinants of frailty will be important to identify in order to optimize clinical management.…”

Ageing with and without HIV: will advanced age bring equity or greater disparity?

“…We also began to talk about “accelerated ageing” and “frailty,” but these concepts may have been a bit exaggerated in a largely middle‐aged, ambulatory population with suppressed HIV‐1 RNA who were living independently. Once differences in the underlying distribution of ages in the population with HIV versus the general population and higher rates of smoking are accounted for, people ageing with HIV do not appear to develop specific age‐associated conditions such as cancer, cardiovascular disease or renal disease at substantially earlier ages than the general population.…”