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The Immune System, Aging, and HIV


Little more than a decade ago, it was almost inconceivable that the issue of aging with HIV infection would emerge as an important concern. But it has now become clear that antiretroviral therapy can suppress virus replication for many years--likely for life--in most people who can access the drugs, and the opportunistic infections that were once the primary causes of illness have largely evanesced everywhere treatment is available. Morbidity and mortality from HIV infection has plummeted, and the survival of HIV-positive individuals is edging ever closer to that of comparable HIV-negative people. With the specter of AIDS having finally been chased from the near horizon, attention has turned to health problems that may lie further down the road.

HIVAgingcover_1-1.jpgLooming largest are illnesses typically associated with aging. Examples include cardiovascular, kidney, and liver disease; bone loss and increased fracture risk; frailty; cognitive impairment; and cancer. Evidence is accumulating that the risk of these conditions is elevated in HIV-positive individuals and, in some cases, they may be occurring at a younger age, on average, than is typically observed among comparable HIV-negative populations. As the proportion of older individuals living with HIV grows, there is an urgent need to understand how a broad array of factors may be contributing to this phenomenon; these factors include inflammation, immune dysregulation, polypharmacy, long-term drug toxicities, and coinfections and comorbidities that are disproportionally prevalent among people with HIV, such as hepatitis B and C, current or former substance-use disorders, stress, and depression.

It is important to emphasize that the reported elevations in risk for aging-associated diseases among people with HIV (compared to their HIV-negative counterparts) are typically relatively small. There are also inconsistencies between studies and as yet unresolved controversies regarding the extent to which HIV infection is an independent risk factor for specific illnesses. So while there is cause for vigilance and concern, there is no reason to panic, and it is likely that many HIV-positive people will not face a significant additional hazard of aging-associated conditions. As a general recommendation, HIV-positive individuals should consider the lifestyle factors that are now known or expected to maximize health once a person reaches old age; these include daily exercise, a healthy diet, maintaining low blood pressure and cholesterol, and avoiding substance abuse and excess fat gain.

In a new report published by the Treatment Action Group, Richard Jefferys and I outline current scientific knowledge regarding the immunologic connections between HIV and aging, and provide an introduction to some of the unresolved questions that are being addressed--or need to be addressed--by research.

Have a look, give it a read, and let us know your thoughts!


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Comments on Tim Horn's blog entry "The Immune System, Aging, and HIV"

As one who has been living with HIV/AIDS, for just over 23 years now, and, having taken meds for it from the very beginning, at age 51, I am experiencing some of the mentioned health issues.
Blood pressure, cholesterol, especially kidney disease, and cardio related issues, are things that are of concern for me. Whether it is HIV related, or, just an aging issue, it nonetheless, compounds my HIV/AIDS situation.
I was given a 5-7 year prognosis, when I learned I was infected with HIV, so, I never thought I'd live long enough to face other health issues, although, even with the additional concerns, I am glad I am still around.
One other thing of concern, not mentioned in the piece, for me at least, is the wasting, and/or facial and muscle loss, which makes me look older, I feel, than I actually am.
I am grateful to be a long term survivor however. There have been so many, who were not given that.

Infected in late 70s, and diagnosed in 85. And sero converted from Hep B the same year. Have had one hip socket replaced, and despite on-going and routine dental care, there's signs of both receding gum and bone loss in jaw as well. Then there was lypodistraphy (?sp) w/leg swelling followed by 90% blocked heart artery after the leg clot splintered which necessitated a angioplasty. And seems there's a bit of mental deterioration in spite of intense neuro- linguistic exercise.

Am simply thankful to alive and moving along a bit more sedately though active at 66.5years!?! Lost many hundreds of chums, friends, a lover and a family member to the early disease and mega treatment w/AZT. May all continue taking their meds, and find support group that works to keep them informed and motivated to further contain additional infections.

Now I am 43-years old and I have servived HIV infection for now over 20-years. The issue of us aging faster is of concern.
I now realize that when I began to read, The Diolauges of Plato", hair began to grow on my ears...

I was 27 when I was diagnosed HIV+. This year I turned 54 which means that I have been poz as long as I've been neg. I live a happy and healthy life that includes regular and frequent exercise, and a diet that includes many different foods - always in moderation.

I don't smoke nor do drugs, but I do drink occasionally in social settings. I work hard but make sure I allow myself time to enjoy life with my partner and family.

I recommend this lifestyle to anyone who is HIV+.

Oh, and most other people too...

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About this Entry

This page contains a single entry by Tim Horn published on June 4, 2013 12:33 PM.

Preparing for Generics in the U.S. was the previous entry in this blog.

TAF: Will an Exciting New Gilead Drug Achieve its Full Potential? is the next entry in this blog.

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