Growing Old with HIV
Life expectancy has increased remarkably in HIV+ people. This is due to the improved efficacy of antiretroviral drugs. However, according to a recently published article, “Inflammatory Co-morbidities in HIV+ Individuals: Learning Lessons from Healthy Ageing” by lead authors Dr Anna Hearps and Professor Suzanne Crowe at the Burnet Institute in Australia, this comes with a price [1].
“Increased life expectancy in HIV+ individuals has uncovered an increased risk of acquiring age-related conditions such as cardiovascular diseases, neurocognitive decline, osteoporosis and frailty.”
The authors linked these conditions to inflammation that causes premature ageing of the immune system. The immune system of young HIV+ people resembles that of uninfected elderly people.
Where Does Inflammation Come From?
Damage to the lining of the intestine during HIV infection is thought to cause leaking of bacterial products into the blood stream and this contributes to inflammation. Chronic Inflammation is a feature of ageing and is recognised as the driving force behind many age-related diseases. HIV infected individuals have high levels of inflammation even in those receiving anti-retroviral therapy (ART) and who have undetectable viral load. In fact, as shown in the Data collection on Adverse events of Anti-HIV Drugs (DAD) study [2], a non-smoking HIV+ person on ART and a long-term smoker face the same health risk of developing heart disease.
Therapies
Preventing or treating inflammatory diseases by reducing inflammation seems an obvious approach. Unfortunately, as there is no “magic bullet” pill, healthy lifestyle choices remain the most effective way to control inflammation. Low-dose aspirin (baby aspirin) is commonly used as a preventative strategy for heart attack in the general population. The medical world holds its breath for results from a large Australian study (ASPREE) that has been evaluating the efficacy of low-dose aspirin treatment over a 5 year period, in preventing age-related conditions in 19,000 elderly individuals. Other drugs such as statins and hydroxychloroquine have been evaluated, but adding yet another drug to the already complex HIV regimen is not an inviting prospect for those already on a cocktail of pills. Furthermore, the long-term effects of these drugs are unknown. Some evidence suggests that probiotics and a Mediterranean diet could be beneficial although more studies are warranted.
The Future
The majority of studies conducted examined a limited number of biomarkers that consistently show a strong relationship with several age-related co-morbidities and therefore may have diagnostic potential. The main challenge that remains is to understand how these association studies can pinpoint the mechanisms involved in these clinical manifestations to engender novel therapeutics to delay the onset of pre-mature ageing in the HIV+ population. Most importantly, these novel strategies should be long lasting, perhaps once per week or once per month, to limit additional pill burden.
References
1. Hearps A.C, Martin G.E, Rajasuriar R, Crowe S.M: Inflammatory Co-morbidities in HIV+ Individuals: Learning Lessons from Healthy Ageing. Current HIV/AIDS Reports (2014).
2. Friis-Moller N, Thiebaut R, Reiss P, Weber R, Monforte A.D, De Wit S, El-Sadr W, Fontas E, Worm S, Kirk O, et al: Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology (2010), 17:491-501.
About the author
Dr Clovis Palmer heads the Immunometabolism research team at the Burnet Institute in Melbourne, Australia. He recently identified a new subset of immune cells and is the first to show that HIV affects the way CD4 T cells use energy – a discovery that could revolutionize the prognosis and treatment of people infected with HIV. He frequently speaks at The International AIDS Society/AIDS conferences and is a guest editor and reviewer for several top ranked scientific journals. He is the Founder of Natural Immunity-Health, a scientifically driven organization that promotes a healthy lifestyle in order to combat inflammatory conditions such as HIV and obesity. Dr Palmer’s work has also been featured in The Australian Sydney Morning Herald and The AGE: http://www.smh.com.au/digital-life/digital-life-news/ideas-that-could-change-your-life-20130312-2fxo6.html, and the Star Observer: http://www.starobserver.com.au/news/study-finds-new-route-against-hiv/90705.
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