CATIE News

10 December 2020 

Studying patterns of healthy aging among HIV-positive people in Canada

  • HIV-positive people are getting older and can develop health issues associated with aging
  • Finding clues to healthy aging can help make HIV-positive people more resilient
  • A study called CHANGE HIV is underway in three Canadian cities to study healthy aging

The widespread availability of HIV treatment (ART) in Canada and other high-income countries has made AIDS-related infections much less common than 25 years ago. Scientists increasingly predict that HIV-positive people who achieve viral suppression and who continue to take ART as directed will have a near-normal life expectancy.

Despite the use of ART and good adherence, HIV-infected cells persist in the body and some abnormalities in the immune system remain. For instance, multiple studies have found that the immune systems of HIV-positive people have persistent activation and inflammation. As many cells of the immune system are distributed throughout the body, cells of the immune system can release chemical signals that incite inflammation in multiple organ-systems. Chronic inflammation of organ-systems could cause them to slowly degrade. In turn, this degradation could increase the risk for a range of chronic health conditions, including heart disease, diabetes, chronic obstructive pulmonary disease, thinning bones, kidney injury, stroke and so on. It is plausible that the inflammation that accompanies chronic HIV infection may also contribute to an acceleration of the aging process. Therefore, it is important to better understand how the aging process interacts with HIV infection. Such knowledge could lead to timely interventions to improve health and quality of life.

Healthy aging and HIV

A team of scientists in Toronto has used a validated aging assessment system called the HAS (Rotterdam Healthy Aging Score). This scoring system has previously been used in several thousand HIV-negative people in the Netherlands and was found useful. The HAS takes data from different assessments to help put together a numerical picture of a person’s health, emphasizing the following issues:

  • mental health
  • cognitive function
  • physical functioning (including pain)
  • social support
  • quality of life

In a pilot study with 101 HIV-positive people (81% men, 19% women) aged 44 to 69, the Toronto team found that the HAS scores were linked to health issues such as frailty. Furthermore, poor HAS scores were linked to increased use of health services, including hospitalization.

An important clinical trial called CHANGE HIV is now underway in Canada to better capture data from hundreds of HIV-positive people and monitor them over time. This will reveal the usefulness of the HAS over the long-term. Doctors could then find HAS scores that predict ill health and propose HAS scores for which interventions could be made to help HIV-positive people.

Results of pilot study

Participants underwent extensive analysis and HAS scores were calculated for each person based on their health information. Here are how the HAS scores grouped people in the study:

  • healthy – 39%
  • intermediate health – 32%
  • poor health – 30%

(Percentages do not total 100 due to rounding.)

Depression and pain

The scientists looked for trends within the data they collected and found the following:

  • People under the age of 60 were more likely to have some degree of depression.
  • Women were more likely to report a greater extent of pain.

Frailty

The scientists assessed participants for frailty and classed them as follows:

  • frail – 10%
  • pre-frail – 79%
  • not frail – 10%

(Percentages do not total 100 due to rounding.)

People who had low HAS scores were more likely to be frail.

Hospitalization

The proportion of people with the following HAS categories were hospitalized in the six months prior to the study:

  • HAS scores suggesting good health – 5%
  • HAS scores suggesting poor health – 17%

Bear in mind

The HAS scoring system has previously been used only for HIV-negative people, so the Toronto team was not sure if it would be useful for classifying HIV-positive people until they did their study.

The scientists stated that HAS may have some drawbacks, as it does not take into account issues that can affect the health of HIV-positive people, such as “stigma, trauma and discrimination.” They also stated that HAS does not take into account other issues such as food security, housing and income, which also affect a person’s health and quality of life.

The original Rotterdam study that gave rise to HAS found a link between low HAS scores and the risk of death. The Toronto team only studied people at one time point in time, so they were unable to make predictions. However, by monitoring more HIV-positive people for longer periods, the scientists can find out if HAS scores can predict which people will develop serious outcomes such as illness and hospitalization.

CHANGE HIV

Based on the pilot study, scientists in three Canadian cities—Montreal, Toronto and Vancouver—are cooperating and conducting a clinical trial called CHANGE HIV. It seeks to monitor HIV-positive people aged over 65 years to find patterns for healthy aging. The study will use the previously mentioned Healthy Aging Score. Participants will need to make a visit to the study clinic three times over the course of five years. The study is supported by the Canadian HIV Clinical Trials Network (CTN).

There are many clinical trials underway in Canada and it is important for HIV-positive people to consider enrolling in research. The findings from CHANGE HIV can be used to ultimately improve the care of HIV-positive people as they get older. To learn more about the clinic sites for CHANGE HIV and the many interesting studies completed or recruiting volunteers under the aegis of the CTN, visit the links in the resource section below.

–Sean R. Hosein

Resources

CHANGE HIV trial

Canadian HIV Trials Network (CTN)

CTN clinical trials

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REFERENCES:

  1. Walmsley SL, Ren M, Simon C, et al. Pilot study assessing the Rotterdam Healthy Aging Score in a cohort of HIV-positive adults in Toronto, Canada. AIDS. 2020 May 1;34(6):859-867.
  2. Sehl ME, Rickabaugh TM, Shih R, et al. The effects of anti-retroviral therapy on epigenetic age acceleration observed in HIV-1-infected adults. Pathogens and Immunity. 2020; in press.