ABSTRACT
The world's population living with the human immunodeficiency virus (HIV) has been progressively aging due to the widespread availability of antiretroviral drugs. It has been estimated that 70% of the HIV infected people in the United States will be over the age of 50 by the year 2030. Instead of the risk of infections and tumors that characterized the early years of the epidemic, the HIV population now is increasingly faced with the challenges of aging. These include comorbidities such as cardiovascular disease, chronic renal disease, osteoporosis and fractures, metabolic abnormalities including diabetes mellitus, and neurocognitive decline. In addition, the aging HIV population will develop geriatric syndromes including falls and difficulty with the activities of daily living as well as frailty. Epidemiological data indicate that HIV positive individuals develop comorbidities, geriatric syndromes, and frailty at earlier ages than those uninfected, and that the average life expectancy of HIV+ people is shorter compared to those uninfected. One hypothesis to support these data is that HIV itself accelerates the underlying aging processes. Supportive of this idea are biological changes that occur earlier in HIV positive people including increased inflammation, epigenetic changes in DNA, telomere shortening, metabolic changes including increased insulin resistance, and mitochondrial dysfunction. Research into the causes of biological changes associated with HIV and potential therapies remains a high priority.
