Epidemiology of ageing with HIV: what can we learn from cohorts?
The last decade has seen a dramatic change in the demographic structure of the population of people living with HIV (PLWH). The majority of PLWH who start treatment with combination antiretroviral therapy now have good virological and immunological responses and this has resulted in improvements in life expectancy. In addition, there have also been continued new HIV diagnoses (and new HIV infections) in those aged more than 50 years. The average age of those attending HIV clinics has therefore increased, with this trend expected to continue into the future. As the cohort of PLWH has aged, so the spectrum and burden of age-associated noncommunicable comorbidities (AANCCs) in the cohort has increased. PLWH are likely, therefore, to have increased healthcare needs for the foreseeable future. Although it appears that the average age at diagnosis of several AANCC is lower in PLWH, current evidence remains insufficient to demonstrate that HIV infection leads to either accelerated or accentuated aging. The results from several well designed longitudinal cohorts, with appropriately matched control groups, will provide more robust evidence to confirm a potential impact of HIV on the incidence of these AANCC. However, regardless of the impact of HIV itself, the role of other, non-HIV, factors is becoming increasingly important, with coinfection with other viral infections and lifestyle factors playing an increasing role in the development of many AANCC. It is likely that attempts to reduce smoking prevalence and obesity may be associated with important reductions in the incidence of some of these events in the future.