Is HIV a model of accelerated or accentuated aging?

Abstract

Background: Antiretroviral therapy has reduced the incidence of adverse events and early mortality in HIV-infected persons. Despite these benefits, important comorbidities that increase with age (eg, diabetes, cardiovascular disease, cancer, liver disease, and neurocognitive impairment) are more prevalent in HIV-infected persons than in HIV-uninfected persons at every age, and geriatric syndromes such as falls and frailty occur earlier in HIV-infected persons. This raises a critical research question: Does HIV accelerate aging through pathways and mechanisms common to the aging process or is HIV simply an additional risk factor for a wide number of chronic conditions, thus accentuating aging?

Methods: Extensive literature review.

Results: The purpose of this review is to briefly outline the evidence that age-related clinical syndromes are exacerbated by HIV, examine the ways in which HIV is similar, and dissimilar from natural aging, and assess the validity of HIV as a model of premature aging. Specific biomarkers of aging are limited in HIV-infected hosts and impacted by antiretroviral therapy, and a high rate of modifiable life style confounders (eg, smoking, substance abuse, alcohol) and coinfections (eg, hepatitis) in HIV-infected participants.

Conclusions: There is a need for validated biomarkers of aging in the context of HIV. Despite these differences, welldesigned studies of HIV-infected participants are likely to provide new opportunities to better understand the mechanisms that lead to aging and age-related diseases.

Keywords: AIDS; Biomarkers of aging; HIV; Immunosenescence; Multimorbidity.

Figure 1.

Hypothetical age-at-diagnosis distributions of cancer in the AIDS and general populations. (A) Accentuated: cancer occurs at the same ages but more often among HIV-infected participants than among HIV-uninfected comparators. (B) Accelerated and accentuated: cancer occurs earlier among HIV-infected participants compared with HIV-uninfected comparators and there are more cancer events. Reprinted from reference (38) with permission.

Figure 2.

Comparative risk of hypertension, diabetes mellitus, renal failure, cardiovascular disease, and fracture, by age, among HIV-infected participants versus control participants. Modified from reference (6).