As a result of the global response to the HIV/AIDS pandemic, particularly the successful use and scale-up of antiretroviral therapy (ART), the spectrum of HIV disease has dramatically changed in the last several years. With good adherence to ART, many HIV-infected persons can expect to live to an older age. The CDC estimates that by 2015, half the people living with HIV infection in the United States will be 50 years of age or older. CDC also reports that a significant proportion of new infections are occurring in older adults.
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 (PDF) has made AIDS and aging a research priority. To identify specific research gaps and strategies, in 2011 the NIH established a working group comprised of scientists, clinicians, community representatives and other experts on areas related to HIV/AIDS and gerontology. The HIV and Aging Working Group prepared a Report to the NIH Office of AIDS Research, “HIV and Aging: State of Knowledge and Areas of Critical Need for Research,” 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.
In response to the recommendations of this Working Group, the NIH has launched a number of new initiatives to support research in this area. The report will continue to help shape the NIH research agenda to address the medical implications of aging with HIV and to develop more sophisticated treatment strategies so these older adults can live longer, healthier lives.