TAG report: Immune system, HIV, and ageing

Richard Jefferys and Tim Horn, TAG

On 5th June 2013, Treatment Action Group launched a new report on HIV and ageing.

This brief report outlines current scientific knowledge regarding the immunologic connections between HIV and ageing, and provides an introduction to some of the unresolved questions that are being addressed—or need to be addressed—by research.

It includes an assessment of the impact on HIV positive people of illnesses typically associated with ageing. These include cardiovascular, kidney, and liver disease; bone loss and increased fracture risk; frailty; cognitive impairment; and cancer.

As the proportion of older individuals living with HIV grows, there is an urgent need to understand how HIV-related factors including immune 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, may be contributing to risks for these conditions.

The report emphasises that the elevations in risk for ageing-associated diseases among people with HIV are typically relatively small (compared to their HIV negative counterparts). 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 this is an important cause for concern and research, the report highlights that the data do not support a current need to panic: HIV, especially with access to effective treatment, does not appear to have a significantly greater impact on ageing-associated conditions compared to similarly matched HIV negative people.

As a general recommendation, HIV positive individuals should consider the lifestyle factors that are now known or expected to maximise 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.

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