Challenges of Aging With HIV
Getting old with HIV at one time seemed unimaginable. But the introduction and widespread use of antiretroviral therapy (ART) two decades ago have shifted the diagnosis of HIV-1 to that of a manageable chronic disease, and people living with HIV (PLHIV) now have a life expectancy almost equal to that of people who do not have HIV.1
The number of PLHIV over the age of 50 globally has nearly tripled since the year 2000.2 In 2016, there were an estimated 5.7 million people aged 50 and older living with HIV, and that number is expected to increase to 7.5 million by 2020. In higher-income countries, those aged 50 and older represent approximately 31% of the adult population living with HIV.3
People aged 50+ living with HIV by the year 2020, rising from 5.7 million in 20162
In many countries, the leading cause of death for people living with HIV isn’t AIDS. They are dying because of age-related diseases, referred to as comorbidities.4 One 2015 study of PLHIV estimated that by 2030 more than 80% will have at least one age-related disease, such as cancer or arthritis, and approximately one-third will have at least three age-related diseases.5
These statistics point to a growing need for specialized research and care focused for HIV and aging and the chronic conditions associated with it for PLHIV who are 50 and older.1,5
“HIV infection in most cases...the vast majority of people [on stable treatment] are suppressed. It's how we deal with these complex comorbidities, because that is what kills the patient."
-Dr Andrew Clark
The changing treatment needs of older PLHIV
As people age, the immune system ages too, making it more difficult for the body to fight off infection. This age-related change is more pronounced in PLHIV and is likely related in part to the chronic inflammation caused by the disease.4 Even if an individual aging with HIV is able to control their virus, chronic inflammation remains more likely among PLHIV versus those without, and scientists have yet to fully understand the mechanism by which inflammation persists.6
It’s important that the HIV community start asking questions about HIV and aging, what the evolving role is for ART, and what clinical challenges are associated with PLHIV.4,5
Not actual patients
Adapting ART to the challenge of HIV and aging
Current and future novel ART is helping PLHIV achieve a near-normal life span; however, long-term treated patients remain at a higher-than-expected risk of a number of complications typically associated with aging.4
These complications can include cardiovascular disease, cancer, osteoporosis, and other diseases in which the organs, such as the liver or kidney, are ultimately affected by chronic or progressive diseases.4,5
Current ART is helping PLHIV achieve a near-normal life span.
However, long-term treated patients remain at a higher-than-expected risk of a number of complications typically associated with aging.5
Understanding aging in HIV
A better understanding of how aging impacts HIV, and how ART may influence this phenomenon, is an important piece of the puzzle that will help address these clinical issues. The ambition is for antiretroviral (ARV) drugs to have a good safety and tolerability profile, with limited organ-related toxicities and drug-to-drug interactions.
The epidemic patterns of aging HIV patients must also be understood. Long-term follow up from large patient groups may help provide insights on care management and prevention.
Scientists are looking into multiple sources and studies to better understand aging with HIV and explore potential therapeutic treatments or inventions that could work hand in hand with ART to improve outcomes for PLHIV.
“HIV, probably mediated through inflammation, has caused people to become physiologically older at an earlier chronological age. We don’t know why that happens with any certainty.”
-Dr Charles Hicks
Mapping a new future in HIV
ViiV Healthcare is committed to helping PLHIV live long, healthy lives. ViiV Healthcare runs and supports a number of studies to build an understanding of how treatment affects older PLHIV and to provide relevant data to address their clinical needs. ViiV Healthcare also actively supports and is involved in large observational groups in aging HIV patients (cohorts such as POPPY7 and AgeHIV8).
Development programs at ViiV Healthcare focus on generating meaningful data for new medicines and treatment strategies with the aim of reducing the short- and long-term burden of ART on the lives of PLHIV. Meanwhile, through involvement in a range of activities—including close engagement with patient organizations, support through engagement programs, initiatives on aging, and data generation—ViiV Healthcare is working to help understand the clinical, scientific, and societal effects of HIV on aging.
By collaborating with the HIV community, ViiV Healthcare supports efforts that improve the care and control of the epidemic and help to map a new future in HIV, leaving no patient behind.
1. UNAIDS. The gap report. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf. Published September 2014. Accessed February 5, 2020.
2. Autenrieth CS, Beck EJ, Stelzle D, et al. Global and regional trends of people with HIV aged 50 and over: estimates and projections for 2000-2020. PLoS ONE. 2018;13(11):e0207005.
3. UNAIDS. Get on the fast-track: the life-cycle approach to HIV. http://www.unaids.org/sites/default/files/media_asset/Get-on-the-Fast-Track_en.pdf. Published November 21, 2016. Accessed February 5, 2020.
4. Guaraldi G, Orlando G, Zona S, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011; 53(11):1120–1126.
5. Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Inf Dis. 2015;15:810-18.
6. Hunt PW, Landay AL, Sinclair E, et al. A low T regulatory cell response may contribute to both viral control and generalized immune activation in HIV controllers. PLoS One. 2011; 6(1): e15924.
7. Bagkeris E, Burgess L, Mallon P, et al. Cohort profile: The Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. Int J Epidemiol. 2018;47(5): 1391-1392e.
8. Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individual: the AGEhIV cohort study. Clin Infect Dis. 2014;59(12): 1787-97.
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