Abstract
The intersection of chronic HIV infection, its treatment, and lifestyle with aging has become a topic of considerable fascination during this, the third decade of the AIDS epidemic. An understanding of the pathophysiology of this intersection may provide valuable insights into our general understanding of human aging. This review summarizes the results of recent publications that may have considerable impact on screening and management strategies in the aging HIV-infected population.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Lohse N, Hansen AE, Pedersen G, et al.: Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 2007; 146: 87–95.
United States Senate Special Committee on Aging. HIV Over Fifty: Exploring the New Threat. Available at http://aging.senate.gov/hearing_detail.cfm?id=270655. Accessed October 2010.
Centers for Disease Control and Prevention: HIV Surveillance Report, 2008. Available at http://www.cdc.gov/hiv/topics/surveillance. Accessed October 2010.
The Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008; 372: 293–299.
CASCADE Collaboration. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet 2003; 362: 1267–1274.
Althoff KN, Justice AC, Gange SJ, et al.: Virologic and immunologic response to HAART, by age and regimen class. AIDS 2010; 24:2469–2479.
Hinkin CH, Hardy DJ, Mason KI, et al.: Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 2004; 18:19–25.
• Deeks SG, Phillips AN: HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2009; 338: a3172. A concise paper outlining the authors’ conceptual model of accelerated aging in HIV-infected persons.
Appay V, Rowland-Jones SL: Premature ageing of the immune system: the cause of AIDS? TRENDS in Immunology 2002; 23:580–585.
Cao W, Jamieson BD, Hultin LE, et al.: Premature aging of T cells is associated with faster HIV-1 disease progression. J Acquir Immune Defic Syndr 2009;50:137–147.
Brenchley JM, Price DA, Schacker TW, et al.: Microbial translocation is a cause of systemic immune activation in chronic HIV infection. Nat Med 2006;12:1365–1371.
Appay V, Sauce D: Immune activation and inflammation in HIV-1 infection: Causes and consequences. J Pathol 2008;214:231–241
Kuller LH, Tracy R, Belloso W, et al.: Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med 2008, 5:e203
Neuhaus J, Jacobs DR, Jr., Baker JV, et al.: Markers of Inflammation, Coagulation, and Renal Function Are Elevated in Adults with HIV Infection. Journal of Infectious Diseases 2010; 201:1788–1795.
Hunt PW, Brenchley J, Sinclair E, et al.: Relationship between T cell activation and CD4+ T cell count in HIV-seropositive individuals with undetectable plasma HIV RNA levels in the absence of therapy. J Infect Dis. 2008; 197:126–33.
Hsue PY, Hunt PW, Schnell A, et al.: Role of Viral Replication, Antiretroviral Therapy, and Immunodeficiency in HIV- Associated Atherosclerosis. AIDS 2009; 23:1059–1067.
Grunfeld C, Delaney J, Wanke C, et al.: Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study. AIDS 2009; 23: 1841–1849.
Currier JS, Lundgren JD, Carr A, et al.: Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation 2008, 118:e29–35.
Klein D, Hurley L, Quesenberry CB, et al.: Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? JAIDS 2002, 30:471–477.
Micheletti RG, Fishbein GA, Fishbein MC, et al.: Coronary atherosclerotic lesions in human immunodeficiency virus-infected patients: a histopathologic study. Cardiovasc Pathol 2008, 17:1117–1123.
•• Giovanni G, Stefano Z, Alexopoulos N, et al.: Coronary aging in HIV-infected patients. Clin Infect Dis 2009; 49:1756–62. This paper brings home the concept that the HIV heart is 10 to 15 years older than its “owner.”
Hansson GK: Inflammation, Atherosclerosis, and Coronary Artery Disease. N Engl J Med 2005; 352:1685–1695.
Carr A, Cooper DA: Adverse effects of antiretroviral therapy. Lancet 2000; 356:1423–30.
Friis-Møller N, Reiss P, Sabin CA, et al. for the D:A:D study group: Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007, 356:1723–1735.
• D:A:D Study Group: Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008, B:1417–1425. These observations on the interplay of abacavir therapy and myocardial infarction created a storm that reverberates to this day.
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group: CD4+ Count–Guided Interruption of Antiretroviral Treatment. New Engl J Med 2006; 355:2283–2296
Tebas P, Henry WK, Matining R, et al.: Metabolic and immune activation effects of treatment interruption in chronic HIV-1 infection: implications for cardiovascular risk. PLoS ONE 2008; 3: e2021.
Khovidhunkit W, Memon RA, Feingold KR, Grunfeld C: Infection and inflammation-induced proatherogenic changes of lipoproteins. J Infect Dis 2000; 181(Suppl 3):S462–72.
Dubé MP, Lipshultz SE, Fichtenbaum CJ, et al.: Working Group 3: Effects of HIV infection and antiretroviral therapy on the heart and vasculature. Circulation 2008, 118:e36–e40.
D:A:D Study Group: Association between Modifiable and Non-modifiable Risk Factors and Specific Causes of Death in the HAART Era: The Data Collection on Adverse Events of Anti-HIV Drugs Study. 16th Conference on Retroviruses and Opportunistic Infections. 2-12-2009; Montreal, Canada. Abstract 145.
Bloom FE, Rausch DM: HIV in the brain: Pathology and neurobehavioral consequences. Journal of Neurovirology. 1997; 3:102–109.
Antinori A, Arendt G, Becker JT, et al.: Updated research nosology for HIV-associated neurocognitive disorders. Neurology, 2007; 69:1789–1799
Chauhan A, Turchan J, Pocernich C, et al.: Intracellular human immunodeficiency virus tat expression in astrocytes promotes astrocyte survival but induces potent neurotoxicity at distant sites via axonal transport. J Biolog Chem 2003, 278:13512–13519.
Gonzalez E, Rovin BH, Sen L, et al.: HIV-1 infection and AIDS dementia are influenced by a mutant MCP-1 allele linked to increased monocyte infiltration of tissues and MCP-1 levels. PNAS 2002; 99:13795–13800.
Sacktor N, Skolasky R, Selnes OA, et al.: Neuropsychological test profile differences between young and old human immunodeficiency virus-positive individuals. J Neurovirol 2007; 13:203–209.
Hardy DJ, Hinkin CH, Satz P, et al.: Age differences and neurocognitive performance in HIV-infected adults. New Zealand J Psychol 1999; 28:94–101.
Valcour V, Shikuma CM, Shiramizu BT, et al.: Diabetes, insulin resistance, and dementia among HIV-1-infected patients. J Acquir Immune Defic Syndr 2005; 38:31–36.
•• Ances BM, Vaida F, Yeh MJ, et al.: HIV infection and aging independently affect brain function as measured by functional magnetic resonance imaging. J Infect Dis 2009; 201:336–340. A striking finding that shows the cerebral blood flow in the HIV-infected brain is comparable to that seen in an uninfected brain 10 to 15 years older.
Esiri MM, Biddolph SC, Morris CS: Prevalence of Alzheimer plaques in AIDS. J Neurol Neurosurg Psychiatry 1998; 65:29–33.
Kallianpur K, McMurtray A, Valcour V, et al.: Abstract #460: Reduced region-specific corpus collosum volumes correlate with low nadir CD4 and decreased cognition in HIV-infected carriers of the Apo E4 allele. Paper presented at: 16th Conference on Retroviruses and Opportunistic Infections; February 2009; Montreal, CA.
Letendre SL, Marquie-Beck J, Capparelli E, et al.: Validation of the CNS Penetration-Effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol 2008; 65:65–70.
Letendre SL, McCutchan JA, Childers ME, et al.: Enhancing antiretroviral therapy for human immunodeficiency virus cognitive disorders. Ann Neurol 2004; 56:416–423.
Marra CM, Zhao Y, Clifford DB, et al: Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. AIDS 2009 Jul 17; 23(11):1359–66.
Aukrust P, Huag CJ, Ueland T, et al.: Decreased bone formative and enhanced resorptive markers in human immunodeficiency virus infection: indication of normalization of the bone-remodeling process during highly active antiretroviral therapy. J Clin Endocrinol Metab 1999; 84 145–150.
•• Brown TT, Qaqish RB: Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS 2006; 20:2165–2174. These observations made a change in how I care for older HIV-infected patients.
Dao C, Young B, Buchacz K, et al.: Abstract 128. Higher and Increasing Rates of Fracture Among HIV-infected Persons in the HIV Outpatient Study Compared to the General US Population, 1994 to 2008. 17th Conference on Retroviruses and Opportunistic Infections; San Francisco, CA; February 16–19, 2010.
Grulich AE, van Leeuwen MT, Falster MO, et al.: Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: A meta-analysis. Lancet 2007; 370:59–67.
Smit C, Geskus R, Walker S, et al.: Effective therapy has altered the spectrum of cause specific mortality following HIV seroconversion. AIDS 2006; 20:741–749.
Sackoff JE, Hanna DP, Pfeiffer MR, et al.: Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med 2006:145:397–406.
Effros RB, Fletcher CV, Gebo K, et al.: Aging and infectious diseases: Workshop on HIV infection and aging; what is known in future research directions. Clinic Infect Dis 2008; 47:542–553.
• Shiels MS, Pfeiffer RM, Engels EA: Age at cancer diagnosis among persons with AIDS in the United States. Ann Intern Med 2010; 153:452-460. An important paper that removes non–AIDS-defining malignancies from the pantheon of “diseases of accelerated aging in HIV.” Excellent accompanying editorial.
Disclosure
No potential conflict of interest relevant to this article was reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patel, D., Crane, L.R. Growing Old with HIV. Curr Infect Dis Rep 13, 75–82 (2011). https://doi.org/10.1007/s11908-010-0146-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11908-010-0146-8