National HIV/AIDS and Aging Awareness Day: A Perspective from the National Institutes of Health

Co-authored by Scott Proestel, M.D., Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH

On September 18, 2011, we mark the fourth observance of National HIV/AIDS and Aging Awareness Day.  The remarkable success of antiretroviral therapies in prolonging the lives of HIV-infected individuals who have access to and can tolerate these drugs has led to many more HIV-infected people living into middle and old age.  In 2008, an estimated 29 percent of HIV-infected adults in the U.S. were at least 50 years of age, and in 2009, individuals in that age group accounted for 17% of all new HIV diagnoses.  Both of these percentages have been increasing in recent years.  As the benefits of improved therapies for HIV continue to accrue, research into the complex relationship between aging and HIV becomes increasingly critical.

A major goal of HIV and aging research at the National Institutes of Health (NIH) is to achieve greater understanding of how premature aging of the immune system may be occurring in people living with HIV, and clarifying the fundamental mechanisms of inflammation.  Understanding the complex interaction between HIV and aging will require considerable effort on multiple fronts. The NIH Institutes and Centers support a broad range of research on HIV and aging.  For example, this past April, three NIH Institutes (National Institute on Aging, National Institute of Mental Health, and the National Institute of Neurological Disorders and Stroke) announced that they will fund research into the effects of HIV on the brain in aging populations taking antiretroviral therapy.  Within the National Institute of Allergy and Infectious Diseases (NIAID) programs, research on HIV and aging is ongoing in the Women’s Interagency HIV Study (WIHS)and the Multicenter AIDS Cohort Study (MACS) Exit Disclaimer. These long term follow-up studies of HIV infected women (WIHS) and men (MACS) have defined some of the important differences in HIV risk, pathogenesis and treatment response between the sexes. The International Epidemiologic Database to Evaluate AIDS (IeDEA) Exit Disclaimer provides domestic and international information about the epidemic including pathogenesis differences between HIV infected adults who are growing older and newly infected older individuals. In addition, studies conducted by the Centers for AIDS Research (CFAR), AIDS Clinical Trials Group (ACTG) Exit Disclaimer, and the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) Exit Disclaimer are pursuing HIV and aging-related scientific questions.

The NIH Office of AIDS Research, which has responsibility for overall planning and coordination of NIH AIDS research, has made AIDS and aging research a priority in the annual Trans-NIH Plan for HIV-Related Research, and has supported a number of initiatives to catalyze this area of science.  In close collaboration with a number of NIH Institutes with research portfolios in HIV/AIDS, OAR has been exploring new ways to sponsor further research on HIV and aging.  OAR has established a Working Group on HIV and Aging comprised of experts in both HIV/AIDS and geriatrics, as well as representatives from the HIV affected community to identify new scientific opportunities and priorities in this field of research.

While the NIH continues to expand research on HIV and aging, multiple other Federal agencies, foundations, and advocacy groups are also making critical contributions in this important area, as well as directly supporting the needs of older individuals living with HIV.  Only by addressing these needs can we truly achieve the vision of the President’s National HIV/AIDS Strategy:

The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.