Confronting Challenges of HIV and Aging

Nearly half of the people living with diagnosed HIV in the United States were at least 50 years of age in 2016.¹ While new HIV diagnoses are declining, by 2016 new diagnoses among people aged 50 to 54 accounted for 43% of new diagnoses among people 50 years of age and older. Because both age and HIV increase the risk for many health conditions, aging with HIV presents unique challenges for preventing neurocognitive disorders and other diseases.

As effective antiretroviral therapies (ART) become more available, people with HIV are living longer and experiencing fewer HIV-related medical conditions. However, this longer life expectancy means that people with HIV now face more aging challenges such as chronic diseases, the need for multiple medications, and physical and cognitive decline. Additionally, both HIV and its treatment affect the brain. At the same time, few studies have examined interactions between neurodegenerative processes in HIV and Alzheimer’s disease in the era of ART.

OAR and the National Institute on Aging (NIA) believe it is critical to understand the neurodegenerative processes contributing to central nervous system impairment in older adults, including those with HIV.

For example, in September 2018, the NIA announced funding awarded for cross-disciplinary research projects that will increase understanding of the similarities and differences between the mental and physical declines observed in Alzheimer’s disease and HIV-associated neurocognitive disorders. The awards include annual workshops that will focus on assessing the initiative’s progress and contribute to the development of a core of researchers from different disciplines.

The OAR remains steadfast in its commitment to stimulate research in this area and to work collaboratively across the NIH and with other partners. NIH/OAR supports additional activities on HIV and aging, including the following:

• In 2011, OAR’s HIV and Aging Working Group of experts in HIV and/or aging began developing recommendations for research priorities in the field.
• The Veterans Affairs Aging Cohort Study conducts critical longitudinal research to identify conditions and complications associated with aging with HIV.
• Two long-standing longitudinal cohort studies, the Multi-Center AIDS Cohort Study (MACS) and the Women’s Interagency Study (WIHS) recently were renewed and expanded into a combined cohort study (CCS) supported by 12 NIH Institutes. This CCS will launch in early 2019, providing unparalleled resources for studying the effects of HIV infection and aging.
• Individuals older than 50 years of age are included in HIV clinical trials managed through the AIDS Clinical Trials Group and the HIV Prevention Trials Network.
• An initiative to fund collaborative research between early-stage investigators from the Claude D. Pepper Older American Independence Centers (“Pepper Centers”) and the Centers for AIDS Research will work to leverage the multidisciplinary expertise of these organizations.

We look forward to sharing scientific progress on HIV and aging with stakeholders in research, medicine, policy, industry, and—most important—the people and communities living with and affected by HIV.

Maureen M. Goodenow, Ph.D.
Associate Director for AIDS Research and
Director, Office of AIDS Research
National Institutes of Health

¹ Centers for Disease Control and Prevention. Updated September 2018. “HIV Among People Aged 50 and Older.” www.cdc.gov/hiv/group/age/olderamericans/index.html