Global Health Research Fellow
As successful treatments prolong the lives of HIV positive individuals, researchers question whether they could be facing a “double hit to the immune system” from a combination of the disease and normal aging, UCLA HIV researcher Judith Currier said Friday at the final plenary session of AIDS 2012. The effects of HIV, even when adequately treated, combined with the decline of the immune system as people age, could be making those living with HIV more susceptible to non-communicable diseases (NCDs).
By 2020, Currier noted, half the population with HIV in the U.S. will be over 50 years of age. In addition, all countries are facing a tremendous rise in NCDs, which now cause the majority of deaths worldwide. “The HIV and NCD epidemics are colliding on a global scale,” Currier noted.
Life expectancy for those on treatment for HIV is similar to that for people without infection, Currier said, but in many studies, a gap still exists. Life spans are especially improved for those who start ARVs earlier and prior to developing AIDS, she added, and the drugs go a long way toward tempering immune system disorders created by the infection. Nonetheless, studies have found that even those on treatment are at higher risk than the general population for cardiovascular disease, non-AIDS related cancers, osteoporosis, diabetes and other health conditions. In addition, some ARVs have been shown to exacerbate certain conditions, including bone loss and renal disorders.
Complicating the picture is a lack of information on how different antiretroviral drugs affect the body over the long term and how they might interact with other drugs needed to control conditions such as heart disease and diabetes. “Here we are in 2012 planning to treat millions of people with HIV for decades to come. We’d better figure out how to do it right,” Currier said.
In a later session focused on HIV and NCDs, Suzanne Crowe, head of the Centre for Virology at the Burnet Institute in Melbourne, said those with HIV face a two-fold increase in cardiovascular disease, a risk similar to those who smoke or have high blood pressure. Her research shows that HIV positive individuals --whether or not they are on treatment--have signs of premature aging of their immune systems. She said further research needs to be done to determine whether that effect makes HIV positive individuals susceptible to chronic diseases at earlier ages.
The researchers all called for more study of how to maintain the health of those living with HIV around the globe as world also prepares for an epidemic of chronic disease. Despite the difficulties, Currier reminded the audience that the problems are the result of tremendous successes in HIV treatment. “Do not regret growing older—it’s a privilege denied to many,” she said. “And we now have the privilege to face this challenge of providing HIV treatment for people over a long life span.”