Aging with human immunodeficiency virus: Related immunological and metabolic changes and associated clinical presentation

Abstract

Aging is a progressive and inevitable process that varies among individuals and entails a deterioration of all physiological systems, including the immune system. This deterioration is even greater if it is associated with HIV infection. Therefore, in these individuals, the definition of older adult is established from the age of 50. With the advent of antiretroviral therapy, associated diseases such as diabetes mellitus, high blood pressure, and neoplasia have emerged. Some changes in older adults with HIV infection include a persistent inflammatory state, either due to the virus itself or due to intestinal bacterial translocation. A decrease and dysfunction of CD8+ and CD4+ T lymphocytes is also observed. Metabolic alterations such as insulin resistance, coronary artery disease, and dyslipidemia may also occur; there is a significant risk of cognitive decline; it induces increased osteoclastic activity and decreased osteoblastic activity, which favor the development of osteopenia, osteoporosis, and fractures. In addition to these factors, these patients are associated with increased postoperative complications, frailty syndrome, and mortality. Therefore, it is essential to understand the impact of HIV in older adults to achieve early diagnosis and optimize a multidimensional approach to treatment.