CAHR2017 - Clinical Sciences Plenary

Inflammation and Aging in Treated HIV Infection

Presenter: Dr. Peter Hunt, Associate Professor of Medicine in
Residence, University of California, San Francisco, California

While HIV-infected individuals with access to modern
antiretroviral therapy (ART) have experienced a dramatic
improvement in life expectancy, they remain at higher risk than
the general population for morbidity and mortality, particularly
from non-AIDS complications typically associated with aging.
While lifestyle factors and ART toxicities likely play a role, it
is now well recognized that abnormal immune activation and
inflammation persist in many ART-suppressed individuals and
that the extent of these immunologic defects strongly predicts
morbidity and mortality from non-AIDS conditions. Interestingly,
while some of the immunologic predictors of morbidity and
mortality overlap with those of aging, many are unique to HIV
infection, suggesting distinct interventional targets. Multiple
causes of the persistent inflammatory state in treated HIV
infection have been proposed including HIV persistence,
microbial translocation, CMV, and other prevalent co-infections,
some of which may be more relevant in individuals who start
ART late in the course of disease. While earlier ART initiation
appears to reduce the inflammatory state and some morbidities,
infectious and neoplastic complications remain abnormally high
even in individuals treated very early. While some commonly
used medications with anti-inflammatory properties (e.g.
statins) have shown some promise in pilot studies and are
now being investigated in clinical outcomes studies, there is a
need for effective interventions to reverse persistent immune
activation in this setting. These issues will become increasingly
important as the HIV epidemic gets older, particularly in
resource-limited settings, where most HIV-infected individuals
live.