Managing HIV‐associated inflammation and ageing in the era of modern ART

Objectives This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians. Methods Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesis...

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Bibliographic Details
Published in:HIV medicine 2020-10, Vol.21 (S3), p.2-16
Main Authors: Bloch, M, John, M, Smith, D, Rasmussen, TA, Wright, E
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Activation
ageing
Aging
Aging (natural)
AIDS
Antiretroviral agents
Antiretroviral drugs
antiretroviral therapy
Chronic illnesses
Complications
co‐morbidities
Demographics
Demography
Drug resistance
Epidemics
Highly active antiretroviral therapy
HIV
HIV infection
Human immunodeficiency virus
immune activation
Immune response
Impact resistance
Infections
Inflammation
Management
Public health
resistance
Toxicity
Viruses
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Summary:Objectives This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians. Methods Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesised. Results The changing natural history and demographics of human immunodeficiency virus (HIV)‐infected individuals means new challenges in contemporary management. In the early years of the epidemic,management was focussed on acute, potentially life‐threatening AIDS‐related complications. From initial monotherapy with first‐generation antiretroviral therapy (ART), the development of combination highly active ART (HAART) allowed HIV control but ART toxicities, treatment adherence and drug resistance emerged as major issues. Today, the availability of potent and tolerable ART has made viral suppression achievable in most people living with HIV (PLHIV), and clinicians are confronted with managing a chronic condition among an ageing population. The combination of diseases of ageing and the co‐morbidities associated with HIV‐infection, even when well controlled, results in a complex set of challenges for many older PLHIV. There is a growing appreciation that many non‐AIDS‐related co‐morbidities are caused, at least in part, by persistent, low‐grade immune activation, inflammation, and hypercoagulability, despite suppressive ART. Conclusions In order to further improve HIV management, it is important to understand the enduring effects of chronically suppressed HIV infection, the potential contribution of these factors to the ageing process, the possibility of drug resistance, and the impact of different treatment strategies, including early ART initiation.
ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.12952