New studies on HIV and the diseases of ageing
Richard Jefferys, TAG
The December 1st issue of Clinical Infectious Diseases contains a raft of papers addressing the issue of HIV and ageing.
A report from the Swiss HIV Cohort Study documents that illnesses typically associated with ageing are now the most common causes of morbidity in their cohort, which contains an increasing proportion of individuals aged 50 or older.  In contrast, opportunistic infections make only a minor contribution in the current era of effective antiretroviral therapy (ART). An accompanying editorial by Mike Saag highlights the implications for providing appropriate multidisciplinary care to people with HIV as they age. 
While there are ongoing debates about whether HIV infection is linked to premature ageing – some studies have suggested the risk of ageing-associated diseases is increased among HIV-positive people compared to age-matched HIV-negative individuals, while other studies have disputed these findings – the Swiss HIV Cohort Study paper emphasises that whether or not they are occurring sooner, these morbidities are now the main concern in the long-term care of people with HIV. In discussing their findings, the authors note that the incidence of cancer, heart attacks and diabetes among members of their cohort aged 50-64 was higher than described in studies of somewhat comparable HIV-negative cohorts, but they also stress that “a comparison of our results with an age-matched HIV-uninfected population with similar comorbidity or behavior is difficu
Giovanni Guaraldi and colleagues from the University of Modena and Reggio Emilia in Italy attempted to address this issue in their study, which compared the occurrence of non-infectious co-morbidities (NICMs) and polypathology (the presence of more than one NICM) among HIV-positive people on ART and a matched HIV-negative control group from the general population (from 2002 through 2009). 
The NICMs captured in the study included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. The results revealed that prevalence of NICMs and polypathology was higher in HIV-positive individuals across all age categories. The prevalence of polypathology among people with HIV aged 41-50 was similar to the prevalence among HIV-negative controls aged 51-60.
Interpretation of the findings is complicated by the fact that the data from HIV-positive individuals was all derived from a metabolic clinic at Modena. Part of this population is comprised of local people from main HIV clinic at Modena who are automatically referred to the metabolic clinic if they are on ART. However, the population also includes a large proportion of HIV-positive individuals who are referred to the Modena metabolic clinic from neighboring centers due to metabolic issues such as lipodystrophy, and this would appear to account for the unusually high prevalence of this condition among the study cohort (74%). To assess whether this over-representation of people with metabolic issues had biased their results, the study authors compared the incidence of NICMs and polypathology among the local referrals to those from the neigh
The authors conclude: “our findings suggest that an aggressive approach to the screening, diagnosis, and treatment of NICMs is warranted as part of routine healthcare for HIV-infected patients. Furthermore, our data suggest that onset of such screening should commence at a substantially earlier age for HIV-infected persons, compared with HIV-uninfected persons, possibly at least a decade in advance. Additional studies are needed to further evaluate the impact of convergent age-related NICMs on age-related functional status, frailty, and disability among ART-experienced HIV-infected persons and to provide insights into accelerated ageing processes that may be associated with chronic HIV infection.”
Source: TAG Basic Science web log. (1 November 2011).
- Hasse B et al for the Swiss HIV Cohort Study. Morbidity and ageing in HIV-infected persons: the Swiss HIV Cohort Study. Clin Infect Dis. 2011 Oct 13. [Epub ahead of print]
- Saag MS. Editorial commentary: HIV now firmly established in the Middle Ages. Clin Infect Dis. 2011 Oct 13. [Epub ahead of print]
- Guaraldi G et al. Premature age-elated comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011 Oct 13. [Epub ahead of print]
- Capeau J. Editorial commentary: Premature Aging and Premature Age-Related Comorbidities in HIV-Infected Patients: Facts and Hypotheses. Clin Infect Dis. 2011 Oct 13. [Epub ahead of print]