Aging and non-AIDS morbidity in HIV: The Stanford HIV Aging Group

Andrew Zolopa
Stanford University
Clinical Sciences

Advances in HIV therapy have dramatically extended life expectancy. Now, almost all patients who reliably take medications are able to control HIV and do not develop AIDS-related complications. With this success, Californians with HIV are aging, but people with HIV suffer from increased rates of many common age-related complications such as problems with thinking, problems with their hearts, and frailty. As these problems also increase with normal aging, HIV is often described as leading to “early” or “accelerated” aging. To best try to reduce rates of these age-associated diseases, a better understanding of the effect of age and the effects of various risk factors (including both HIV-related and more general risk factors) on the development of these problems is needed. In younger patients, we believe factors related to HIV such as dividing virus or medication toxicities likely are driving the increased disease rates. In older individuals, especially those with optimal control of HIV, the factors causing the increased rates of non-AIDS morbidity likely are similar to factors that lead to these conditions in people without HIV. We believe HIV likely leads to irreversible damage in many tissues, but aging and other non-HIV-related risk factors add to this damage and lead to increased rates of these problems.

Funding from the California HIV Research Program will allow us to define the rates of problems with thinking, frailty, and heart problems in a group of aging HIV-infected patients who are doing well on HIV medication. We will study the risk factors for the development of these conditions, specifically comparing the differences in the risk factors in older and younger patients. Later grant funding will support comparisons of immune function between individuals with disease and those without using stored blood samples from study patients . We plan on enrolling a group of 300 HIV-infected individuals, with half of the patients over the age of fifty, from the Stanford Positive Care Clinic. In addition to testing for problems with thinking, frailty, and heart problems, we will give the patients surveys to relate their quality of life, diet, and level of exercise. We will also ask patients about their social connections and how actively they use their brains, as these factors have been shown to be important in the development of brain problems in HIV-uninfected patients. Study nurses will also gather information on the patient’s HIV disease history such as the status of their immune system currently and in the past. We will then evaluate the importance of both HIV-related and non-HIV-related factors to the development of non-AIDS morbidity.

While other studies have also looked at the contributors to problems with the brain, frailty, and heart problems in HIV, previous studies have not looked broadly at non-HIV-related risk factors and the development of these conditions. By studying a large group of older patients who are doing well with HIV medications, our study will provide an important look at the future of the HIV epidemic in California. Our broad evaluation of potential risk factors will provide a comprehensive look at the physical, mental, and social functioning of aging HIV-infected Californians, as well as pave the way for efforts to try to reduce the rates of these important illnesses that substantially impact the quality of life of HIV-infected Californians.