HIV Causes Accelerated Aging: Has AIDS Become Acquired Inflammation Disease Syndrome?

HIV Causes Accelerated Aging: Has AIDS Become Acquired Inflammation Disease Syndrome?

Inflammation is the hottest topic in HIV/AIDS research. We've known for many years that, left untreated, HIV disease produces widespread inflammation. The higher the HIV plasma viral load the more dramatic the inflammatory response. Treatment with potent combination antiretroviral therapy decreases not only HIV replication and consequently HIV viral load, but also HIV-associated inflammation. More recently we've learned that even when we drive the HIV viral load to undetectable levels, we don't completely turn off the inflammatory process.

"So what?" you may wonder. Well, glad you asked.

This ongoing HIV-related inflammation is now being linked to or at least associated with a wide array of HIV comorbidities. (That's doctor-speak for nasty HIV compilations.) These complications are far from trivial. Ongoing HIV-related inflammation is being blamed for the lack of response to vaccinations, the increased incidence of non-AIDS-defining cancers, increased neurocognitive decline, the lack of immune reconstitution (CD4 counts that don't rise as expected with treatment), accelerated bone demineralization, accelerated hardening of the arteries leading to increased incidence of stroke and heart attacks, and the rise of the Tea Party Movement!

OK, I made that last one up, but the others are true. And here's the real kicker: HIV (presumably HIV-related inflammation) causes accelerated aging! Yep! We're talking "HIV Inflammaging!" Now I know what you're all thinking: "Damn! Now that's just not fair! Haven't we got enough to deal with?" And I agree with you! I will add this whole HIV inflammaging concept is still incompletely understood but it is rapidly evolving. In fact the evidence supporting this scary concept is piling up faster than AARP notices in my mailbox. Consequently I felt we should discuss it. Besides, the prescribed mechanism underlying all this malicious geriatric-inducing mayhem is immunological. Since that's my specialité, so to speak, I thought I should try to review what we know so far. (Before the Alzheimer's kicks in.)

There is increasing indirect, as well as direct, evidence that we HIVers are at increased risk of morbidity (illness) and mortality (pushing up daisies) from a wide variety of non-opportunistic, non-AIDS-defining, serious conditions like the ones I listed above. And it has become increasingly clear that inflammation underlies this entire worrisome problem.

One piece of supporting evidence comes from the SMART trial (Strategies for Management of AntiRetroviral Therapy). Clever title, eh? In this well-designed clinical trial, a treatment interruption strategy (intermittent use of antiretrovirals to maintain CD4 count above 250) was compared to ongoing uninterrupted treatment with antiretrovirals. The question that trial was designed to answer was whether reducing overall antiretroviral drug exposure would reduce non-AIDS-related complications. We knew some antiretroviral drugs were most likely increasing the risk of heart disease, stroke and liver failure in some patients. So we hoped that decreasing overall drug exposure would decrease these related problems.