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HIV and getting older

Since the introduction of HIV inhibitors, mortality from HIV/AIDS has fallen sharply. HIV has changed in recent years from an always deadly disease to a chronic disease with which one can live for many years to come. It is therefore expected that the number of people over 50 with HIV, which now represents 30% of the total group of HIV-infected people, will double in the coming years. The average life expectancy of someone with HIV is approaching that of an uninfected person.

The process of aging is seen as a slow decline in cell functions and the accumulation of various degradation products that are no longer cleared by the body. In particular, persistent threat of infection and the immune system's response to it (chronic inflammatory response) are associated with the aging process. This aging process in the cell affects all organs and is irreversible.

In an untreated HIV infection, the immune system declines faster than in normal aging. There is a persistent chronic inflammation at the cell and tissue level that leads to a reduction in function of the relevant organ.

There seems to be a persistent inflammation not only in the blood, but also in the cerebrospinal fluid. Treatment with HIV inhibitors almost completely stops the inflammatory response.

Living longer with a chronic condition such as HIV also means that there is a greater chance that other health problems will occur in addition to the HIV infection. This is referred to as co-morbidity. These include heart disease, high blood pressure, diabetes, osteoporosis, kidney and liver disease, depression, certain cancers and forgetfulness. Having a chronic physical illness also has consequences for psychological and social well-being.

The difficulty with HIV infection is that both the inflammation caused by the HIV virus and the side effects of the HIV inhibitors can have a negative effect on the aging process and the development of co-morbidity. Much more research is needed to determine exactly which factors are most important in accelerated aging due to HIV infection. What is the role of CD4 cell count? What influence does persistent virus replication have? What is the role of HIV inhibitors?

An important aim of the pharmaceutical industry is to design new HIV inhibitors that have fewer side effects on the heart and blood vessels, bones and kidneys. For the future, this means in any case that an increasing group of older HIV-infected people with complex co-morbidities must be taken into account. These disorders will partly determine the quality of life.

For practitioners and nurses, this means that more attention is being paid to the factors that influence the aging process.

In addition to good regulation of HIV infection, the Jan van Goyen Medical Center has developed guidelines for identifying factors that influence the risk of co-morbidity, and a more extensive study into existing co-morbidity is also carried out every year.

In our center there is also a lot of attention and time for specific problems associated with aging; such as dependence, loneliness, social isolation, unemployment or financial problems.

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