NIH Research on HIV and Aging
Further, research studies have shown that HIV disease itself and/or its treatment appear to affect the process of aging or the development of illnesses associated with aging. For example, the NIH-sponsored Multicenter AIDS Cohort Study has shown that HIV disease accelerates the development of chronic diseases. Older adults with long-term or new HIV infection experience complex interactions with HIV, antiretroviral therapy (ART), age-related changes to the body, and, often, treatment for illnesses associated with aging. These conditions include cardiovascular disease, infectious and noninfectious cancers, osteopenia/osteoporosis, liver and renal disease, and neurocognitive decline. Globally, research in Sub-Saharan Africa, the geographic area where most HIV-infected people live, suggests that this trend is also occurring in resource-limited settings. These findings have many clinical, social and economic ramifications and will pose a number of challenges to provide effective health care to an increasing number of HIV-infected individuals.
The trans-NIH AIDS strategic plan released in July 2012 as a Supplement to the Journal of AIDS. The report identified the key scientific questions requiring further research and investment including gaps in basic science and challenges in diagnosis, prognosis, and clinical management of persons who are aging with HIV.
Research in this area must address:
- multi-morbidity, i.e. the development of multiple chronic conditions that complicate HIV disease;
- the complexity of distinguishing what complications are attributable to HIV, to its treatment, or to the aging process;
- the simultaneous use of a large number of HIV and non-HIV medicines;
- the inter-related mechanisms of aging of the immune system, inflammation and coagulation disorders;
- the need for accurate methods to identify HIV-infected patients who need specific interventions or are at high-risk for specific complications; and
- issues of community support, care giving and systems infrastructure.