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1st Int. Workshop on HIV & Aging Published
REPORT pdf attached. 4 -5 October 2010, Baltimore, USA
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Download the PDF here
1st Int. Workshop on HIV & Aging Published REPORT, pdf attached
4 -5 October 2010, Baltimore, USA
Jan 11, 2011 ... Reviews in Antiviral Therapy - volume 5; 2010 - Supplement ..... Virology Education
.....when people with HIV started surviving into their late 40s, 50s, and 60s, simple clinical observation soon disclosed an unusually high propensity to heart disease, diabetes, liver failure, kidney failure, broken bones, and a conflux of "non-AIDS" cancers.1......
......Not until the 1st International Workshop on HIV and Aging, however, have HIV researchers and clinicians gathered to focus solely on pivotal questions about why AIDS survivors now often face early-onset atherosclerosis, osteopenia, and neurocognitive impairment. To address those questions, more than 160 researchers and representative of industry, government, and the HIV community gathered to consider 21 oral reports and a similar number of poster presentations selected by a scientific committee chaired by Charles Flexner (Johns Hopkins University, Baltimore) and Scott Letendre (University of California, San Diego).......
In a series of invited lectures, 11 experts offered a broad perspective on current controversies and research on aging in people with and without HIV infection. Reviewing physiological pathways to frailty, Luigi Ferruci (National Institute on Aging) defined the aging phenotype as "highly variable age-associated changes in organs, tissues, and cells that diminish functional reserve and confer vulnerability to stressors and/or disease."2
"Comorbidity rates higher in HIV group than HIV-negative controls at earlier age:
A large case-control comparison of people with and without HIV infection found that HIV-positive people in their 40s had multiple noninfectious comorbidities as often as HIV-negative controls in their 50s.58 And HIV-positive people in their 50s had multiple comorbidities as often controls in their 60s. Lower CD4 nadir and longer antiretroviral duration predicted multiple comorbidities.
Alan Landay (Rush University Medical Center) proposed that research on immunologic and physiologic alterations, along with comorbidities, in people with HIV suggest that advanced aging occurs in HIV disease
Deeks believes "extensive data indicate that inflammation during effective antiretroviral therapy predicts disease."
Douglas Wallace (University of Pennsylvania).....HIV is toxic to mitochondria, Wallace observed
T-cell senescence linked to persistent KS despite good HIV control
Immunosenescent CD4 and CD8 cells were associated with persistent Kaposi sarcoma (KS) in HIV-positive men with well-controlled HIV replication in a study at the University of California, San Francisco (UCSF).62......Recently, though, UCSF clinicians noted development of classical KS lesions in a small cluster of men responding well to antiretroviral therapy.63 The UCSF investigators hypothesized that early HIV-associated waning of T-cell function-or immunosenescence-may explain emergence of KS in this population.
Age-related comorbidity rates higher in older HIV group than matched controls
Age-related comorbidities, including congestive heart failure, renal failure, and liver disease, were more prevalent in 50-and-older people with HIV than in age- and gender-matched controls in a large database analysis.59 The 50-and-old HIV group also had higher rates of comorbidities than a gender- matched group of younger adults with HIV.
Ella Nkhoma and GlaxoSmithKline colleagues based this analysis on the Impact National Benchmark Database, a deidentified US healthcare insurance claims database of more than 82 million people cared for since 1997. This study focused on people with continuous follow-up of at least 6 months as of 1 January 2009, including 34,766 HIV-positive people 50 years old or older, 104,298 age- and gender- matched HIV-negative people, and 74,476 gender- matched HIV-positive people from 18 to 49 years old. Everyone in the analysis had full pharmacy benefits.
Three quarters of people (73.6%) in the 50-and- older groups were between 50 and 59, 22.4% were between 60 and 79, and 21.7% were women. In the 50-and-older HIV group, 55.3% had ever taken antiretrovirals, compared with 44.1% of the under-50 HIV group. In the older and younger HIV groups, 15.6% and 15% had a CD4 count under 200 cells/ mm3, 53% and 50.5% had a viral load under 400 copies/mL, and 6.2% and 7.9% had a viral load over 100,000 copies/mL.
Comparing 50-and-older HIV-positive people with the 50-and-older HIV-negative group, Nkhoma found higher comorbidity prevalence ratios for many cardiovascular, metabolic, malignant, and neuropsychiatric diseases (Table 5). The comparison between 50-and-older people with HIV and younger HIV-positive people confirmed higher prevalence ratios for many of these same diseases in the older group (Table 5). In the younger HIV-positive group, only drug abuse was more prevalent than in the older group. The older and younger groups with HIV did not differ in prevalence of psychoses.
Among HIV-positive people in the database with a CD4 count available, nearest CD4 count was below 350 cells/mm3 for patients diagnosed with metastatic cancer, lymphoma, weight loss, and coagulopathy.
Of the coinfections analyzed in 50-or-older people with and without HIV, the HIV/non-HIV prevalence ratio was 15 for HBV, 9.8 for HCV, and 6.4 for herpes simplex virus (HSV). Prevalence of CMV among 50-or-older people with HIV was 1.5%; there were virtually no cases of CMV among similarly aged HIV- uninfected people. Making the same comparison between the older and younger HIV groups, the investigators calculated older/young prevalence ratios of 1.2 for HBV, 2.6 for HCV, 0.7 for HSV, and 1.9 for CMV.
Nkhoma noted that the database does not include data on race, disease stage, or HIV transmission route. Because everyone analyzed had full pharmacy benefits and most were younger than 70 years old, the results may not apply to low-income populations or the very elderly. With those caveats in mind, the investigators proposed that "the contrast in prevalence estimates observed support the hypothesis that HIV infection and long-term exposure to combination antiretroviral therapy may lead to accelerated aging in the HIV population resulting in excess age-related morbidity."
Non-AIDS multimorbidity more frequent in IDUs with versus without HIV
Aging-related chronic health conditions proved more prevalent in HIV-positive injection drug users (IDUs) than in HIV-negative IDUs from the same cohort in Baltimore, Maryland.60 This analysis of the ALIVE cohort also found evidence that a high proportion of these conditions remained undiagnosed and untreated.
Table 5. Comorbidity prevalence ratios in 50-and-older HIV patients and two comparison groups
Source: Dr. Ella Nkhoma, GlaxoSmithKline, Research Triangle Park, USA .59
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