Background: Life expectancy has markedly increased among HIV-infected persons. By 2017, it is estimated that more than half of HIV-infected persons will be at least 50 years. Thus, determining the indicators of successful aging in this population is critical.
Methods: We conducted a cross-sectional study among HIV-infected persons engaged in care at the Washington University HIV Clinic who were ≥ 50 years. Successful physical aging (SPA) was defined as absence of cardiovascular disease (CVD) (i.e. myocardial infarction, stroke, peripheral vascular disease, or heart failure), malignancy, fracture, cirrhosis, and chronic kidney disease (CKD) stage IV/V. We also used the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equation (PCE), which estimates 10-year CVD risk, and the Veterans Aging Cohort Study (VACS) Index, which estimates 5-year all-cause mortality risk among HIV-infected persons.
Results: Of 464 participants included (74% male, 63% non-Hispanic black, median age 56 years, median CD4+ cell count 546 cells/mm3, 89% with HIV RNA < 200 copies/mm3, median duration of HIV infection 15 years), a significant majority did not have CVD (84%), malignancy (83%), fracture (91%), cirrhosis (95%), or CKD stage IV/V (95%). There were 280 (60%) participants who meet the SPA criteria (“successful agers”). On multivariate logistic regression analysis, participants who did not meet the SPA criteria (“unsuccessful agers”) were more likely to have older age, diabetes, hypertension, current CD4+ cell count < 500 cells/mm3 and hepatitis C infection. Only 28% and 35% of the successful agers had low risk PCE and VACS Index scores, respectively. Among those with available data, the proportions of participants with unemployment, annual income of < $10,000, and without a college degree were statistically similar between successful and unsuccessful agers.
Conclusion: Our study suggests that immunologic recovery plays an important role in promoting successful physical aging in the HIV-infected population. Our finding that only one-third of successful agers have low morbidity/mortality risk profile is compelling. It stresses the need for closer monitoring and more comprehensive preventive interventions for the aging HIV-infected population.
J. Wu, None
M. Tang, None
R. Presti, None
W. Powderly, None