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Carl Dieffenbach Highlights Aging & Comorbidities for PLWH, Frailty & Research & the Need for Better Care: "care of people living with HIV has NOT kept up with the reality of this aging population"
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One of the major themes that was brought forward at the meeting was that the care of people living with HIV has NOT kept up with the reality of this aging population.
The National HIV/AIDS Strategy is to deal with the aging population.
Carl Dieffenbach says aging is a problem due to years of immune activation & chronic inflammation despite ART viral suppression, that despite success with ARTs here is still a level of immune activation that is residual, caused by all kinds of things - residual HIV production from the reservoir that's defective, other co-infections like cytomegalovirus (CMV), lifestyle choices, smoking, alcohol use, drug use, all contribute to activation of the immune system - resulting in increased risk for heart disease & other comorbidities resulting in higher rates of pre-frailty (40% in PLWH 50-55) & frailty (10%) in PLWH. ……. And - that is driving the appearance of chronic inflammation driving the appearance of accelerated aging, there is no reason it has to be so accelerated - AND - care has not kept up with the aging population, - we need to do on the research that we are doing what we can to prevent these diseases & prevent the emergence of frailty. So how can the health systems step up and deal with the needs of these people and integrate a different level of care into the process of treating people living with HIV, and he makes reference to the new HRSA $10 3-year funding for HV geriatric clinics & the new National HIV/AIDS Strategy, which for the 1st time has language on aging, as ways to help advance efforts to address these problems. He says " dealing with aging in this population is one of the cornerstones of that program".
Watch the video: https://www.niaid.nih.gov/news-events/hiv-research-update-croi-2022-dr-carl-dieffenbach?utm_campaign=+51177461&utm_content=&utm_medium=email&utm_source=govdelivery&utm_term=
NIAID Now | March 01, 2022
Carl Dieffenbach discusses aging & aging-related discussions at CROI.
Here are a brief summary of his comments:
HIV and Aging
Aging and HIV was a cross-cutting theme of this year's CROI. As Dr. Dieffenbach explained, this large and growing area of HIV research is the result of highly effective antiretroviral therapy (ART) that has enabled many people with HIV to live long lives. Researchers are now examining what it means to age with HIV and how the consequences of the virus, ART, or both affect the overall health of people with HIV. Scientists are also investigating which interventions effectively prevent or reduce the comorbidities, cancers, and other consequences of the long-term immune activation and inflammation caused by living with HIV for many years. One example of such research that Dr. Dieffenbach pointed to is the NIH-supported REPRIEVE clinical trial, which is studying whether a statin medication could help reduce heart disease among people with HIV.
Findings from research related to aging with HIV must move into practice in health care and other settings, Dr. Dieffenbach observed. He highlighted one way this is happening: recent funding opportunities from HRSA to support Ryan White HIV/AIDS Program sites to identify, refine, evaluate, and disseminate emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial concerns of people ages 50 years and older with HIV. He also highlighted that the new National HIV/AIDS Strategy PDF focuses on engaging both federal and nonfederal partners in multisectoral approaches to support healthy aging with HIV.Jump directly to this discussion in the video.
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at 12:34 of the video aging discussion starts…..https://www.youtube.com/watch?v=HEEA0hsz08U&t=732s
Here is Transcript of Carl Dieffenbach's comments:
"We are dealing with populations 50 & older. We're talking about cancer. One of the major themes of CRO 2022 was aging & HIV, and what does it mean t be getting older & living with HIV. The very first (Martin Delaney session) & the next to last (Aging Symposium) sessions of the CROI meeting were about that. What we learned from the SMART Study is the stopping & starting ART "was incredibly deleterious". You want to get n therapy & stay n therapy. Because overtime you stop & start you are essentially taking your body through a massive amount of immune activation.SMART study looked at the advantage of starting ARTs as early as possible, and demonstrated that its never too soon to start. The sooner you start the better. Every year or as time passes of not being on therapy there is damage being done to your immune system that you're not aware of. And one of the ways it shows up is as an increased level of cancer. BUT a the same time what we have seen is that even with ARTs there is still a level of immune activation that is residual, caused by all kinds of things - residual HIV production from the reservoir that's defective, other co-infections like cytomegalovirus (CMV), lifestyle choices, smoking, alcohol use, drug use, all contribute to activation of the immune system. And that is driving the appearance of chronic inflammation, which helps promote certain forms of diseases that are advancing & appearing as aging. And the primary of those in PLWH is cardiovascular disease (heart disease). That's where we have seen it quite significantly. We know early ART does mitigate some of the risk, but then there s accelerated the appearance of aging in people with lung disease, liver disease, and cancer. In the meantime we are trying to mitigate that kind of risk, in terms of advancing with cardiovascular disease, and NIH is participating in or performing a very large study of looking at the effect of statins on heart disease called the Reprieve study. Its been going on a long time & there is data at this CROI showing that even after a short course had an effect on certain biomarkers. So this is helpful in us looking at heart disease. But that does NOT get away from the fact that there are other changes that have occurred in your body. You have altered lipid profiles, you have changes in microbial translocations, that are helping to continue to drive this level of chronic immune activation. AND that translates into other consequences like frailty.
There is the research side, but there is also the care side
One of the major themes that was brought forward at the meeting was that the care of people living with HIV has NOT kept up with the reality of this aging population.
And there needs to be some consideration for how tp del with somebody who's moving into frailty, and moving into this status where they have multiple comorbidities and they're just slowing down & having these consequences of this level of immune activation. So we need to do on the research that we are doing what we can to prevent these diseases & prevent the emergence of frailty
care has not kept up with the aging population, there has to be some consideration of how to deal with someone who is moving into frailty where they have multiple comorbidties…..and having the consequences of having this level of immune activation, so we need to do on the research side to prevent these kinds of diseases (e.g. heart disease) to prevent the emergence of frailty but as frailty emerges there is no reason it has to be so accelerated - so how can the health systems step up and deal with the needs of these people and integrate a different level of care into the process of treating people living with HIV. To that end HRSA has made an announcement that they have a funding opportunityy to look at centers that del with questions around frailty and function in geriatric clinics. These are something we are really going to have to focus on as we think about the National HIV/AIDS Strategy. The strategy is a whole government effort to deal with the consequences f living with HIV. An a major part of the consequences of living with HIV in 2022 is the aging population. So this is a BIG step forward for the National HIV/AIDS Strategy that HRSA has taken this step. It has to become more than just pilots but there needs to be a- the community is advocating for a wholesale change in how HIV treatment is delivered as they age up. when you have a situation for PLWH who are 50 and living between 50 & 55, 10% are frail already. And another 40% are in the pre-frail syndrome/b> is a very significant difference compared to people to living with HIV. Its important that we as the whole of government address this. And this gets to the leadership we have in the National HIV/AIDS Strategy that has been so forward thinking about this so that dealing with aging in this population is one of the cornerstones of that program."
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