Facing the Challenges of HIV and Aging
Aging 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 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 cause of death for PLHIV isn’t AIDS. They are dying because of age-related diseases, referred to as comorbidities.4 One 2015 study of PLHIV estimated 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 do 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 are yet to fully understand the mechanism by which inflammation persists.6
It's important that the HIV community begins to ask questions about HIV and aging, what the evolving role is for ART, and what clinical challenges are associated with people aging with HIV.4,5
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 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
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
Understanding aging in HIV
A better understanding of the process of how age 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 the potential therapeutic treatments or inventions which could work hand in hand with antiretroviral therapy 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 Kicks
Mapping a new future in HIV
ViiV Healthcare is committed to helping PLHIV live long, healthy lives. ViiV runs and supports a number of studies to build an understanding of how treatment affects PLHIV who are older and to provide relevant data to address their clinical needs, and 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 – from close engagement with patient organizations and support through educational programs and initiatives on aging to data generation – ViiV 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 August 26, 2019.
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 August 26, 2019.
4. 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.
5. 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.
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.
HVUWCNT190033 October 2019