The diseases of ageing develop earlier in patients with HIV
than in the general population, Italian investigators report in the online
edition of Clinical Infectious Diseases.
“Our findings suggest that an aggressive approach to the
screening, diagnosis, and treatment of non-infectious comorbidities is
warranted as part of the routine healthcare for HIV-infected patients,” comment
the investigators. “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.”
Effective antiretroviral therapy can significantly improve
the life expectancy of patients with HIV. However, even with treatment
mortality rates are still higher than those observed in the general population.
Non-infectious conditions such as cardiovascular disease,
hypertension, diabetes, renal failure and liver disease are increasingly
important causes of illness and death in patients with HIV. These illnesses are
often associated with ageing.
This has led some investigators to suggest that patients
with HIV experience premature ageing. Doctors from the Metabolic Clinic of
Modena University, Italy, wanted to examine this theory. They therefore
designed a study comparing the prevalence and risk factors for several common
age-related conditions in their HIV-positive patients, compared to age, race
and sex-matched controls.
Preliminary findings from this study were presented at the 18th Conference on Retroviruses and Opportunistic Infections in March 2011.
A total of 2854 patients who received care at the clinic
between 2002 and 2009 were included in the analysis. All had experience of HIV
therapy. Their mean age was 46 years, 37% were women and three-quarters had
lipodystrophy – the body fat changes associated with some antiretroviral
drugs. The patients were matched with 8562 controls.
The non-infectious comorbid conditions included in the
analysis were cardiovascular disease, hypertension, diabetes, bone fracture,
and renal failure. Data were also gathered on the prevalence of multiple
Rates of cardiovascular disease were higher among
HIV-positive patients than the controls for individuals aged below 40 (0.91%
vs. 0.24%, p = 0.049), as well as those between the ages of 41 and 50 (2.26%
vs. 0.64%, p < 0.01), and the ages of 51 to 60 (6% vs. 2.6%; p = 0.02).
There was also a higher prevalence of hypertension in the
HIV-positive patients aged over 51 compared to the controls (ages 51 to 60, 20%
vs. 17%; p = 0.18; age 60+, 39% vs. 32%, p = 0.007).
In all age groups, there was a significantly higher
prevalence in the HIV-positive patients of renal failure, bone fracture, and
diabetes (all p < 0.001).
Moreover, across all age strata the HIV-infected patients
were more likely to have multiple diseases of ageing. Strikingly, the prevalence
of two or more comorbid conditions in HIV-positive patients aged between 41 and
50 was 9%, similar to the 7% prevalence observed in HIV-negative controls in
the 51 to 60 age bracket.
“The prevalence…was approximately equivalent to prevalence
observed in members of the public who were 10 to 15 years older,” write the
authors. “We believe that, in this report, by showing the premature onset of
polypathology among HIV-infected patients, we have contributed to the
characterization of an emerging description of an HIV-specific aging
Across the entire cohort, the factors associated the
presence of multiple diseases of aging were age (per 1 year increase, OR =
1.11; 95% CI, 1.10-1.12, p < 0.001), male sex (OR = 1.77; 95% CI, 1.44-2.17,
p < 0.001), a lowest ever CD4 cell count below 200 cells/mm3 (OR
= 4.46; 95% CI, 3.73-5.34, p < 0.001), and length of exposure to HIV therapy
(OR = 1.01; 95% CI, 1.001-1.019, p = 0.001).
Further analysis also showed an association with
lipodystrophy (p = 0.048).
“At any given age, HIV-infected patients had a greater
likelihood of comorbidities than did control subjects,” Dr Jacqueline Capeau,
the author of an editorial accompanying the study notes. “Why? Is the entire
aging process accelerated in these patients? Are all HIV-infected patients
aging too rapidly? What can be done?”
She suggests that the chronic inflammation and immune
activation accompanying HIV infection means “patients will be more prone to
develop, in advance, age-related diseases.” A low nadir CD4 cell count could
further contribute to inflammatory process.
Dr Capeau also notes that the study population comprised
patients treated at a metabolic clinic with a high prevalence of lipodystrophy.
She suggests that these patients are likely to have been severely immune
depressed when they initiated antiretroviral therapy. Moreover, their treatment
would have been based on more toxic anti-HIV drugs.
“These…patients have accumulated deleterious conditions and
are now affected by comorbidities,” writes Dr Capeau.
Life-style factors such as smoking, a poor diet, and drug
use are also proposed as possible causes of possible causes.
“It is important to diagnose and treat these comorbid
conditions,” Dr Capeau emphasises, and she proposes the wider use of
anti-inflammatory drugs such as asprin and statins. In addition, “early
treatment of HIV-infected patients may help to delay aging.”