What Effect Does HIV Have On Aging?

Dr Alan Winston is an HIV and sexual health consultant in the NHS at St Mary’s Hospital, and also 50% runs the clinical trials unit. We spoke to him about a new study named POPPY designed to measure the effect that HIV and antiretroviral therapy has on aging.

By Patrick Cash


What is the POPPY study?

The POPPY study stands for Pharmicalkinectics and Clinical Observations in People Over 50. People with HIV do extremely well on antiretroviral therapy nowadays and life expectancy is reaching up for people who have HIV infection. But what we know or what we’ve observed is that for people who have HIV on treatment appear to develop other medical problems a little bit younger or prematurely to people who don’t have HIV. And there’s lots of different medical problems: heart disease, bone disease, kidney disease, brain disease, dementia, or cognitive impairment, but it’s very, very difficult to tease out what’s actually causing these problems.

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Why might we see medical problems in people with HIV who are otherwise effectively treated with a suppressed viral load?

So, that’s a really good question. One hypothesis is that although you’re suppressing the virus, does the immune system fully recover or is there slight ongoing dysfunction in the immune system and could this be leading to these medical problems? Or is it other lifestyle factors like smoking and recreational drug use and everything else? And that’s what we’re trying to look into, to answer is one area more important. But from the actual more medical HIV side it could be that their immune system doesn’t go back to functioning normally and people are talking about inflam-aging, an inflammatory condition that leads to early aging but we don’t really know if that’s true or not. That’s one of the things POPPY’s really trying to tease out.

“People who have HIV on treatment appear to develop other medical problems a little bit younger or prematurely”

Because people on antiretroviral medication are just getting to this stage, aren’t they? Who’s the oldest person on the study?

So that’s a good point as well, that twenty years ago we didn’t see so many older people with HIV, so now a lot of the people that we look after are over the age of 50, almost a third in the UK, and the reasons for that are firstly people with HIV are living many decades. So, we’re seeing people entering their 50s, 60s and 70s, but not only that, we’re also seeing a lot of new diagnoses of HIV in people who are older, so people presenting for the first time with HIV who are in their 50s and 60s and it’s probably because of the clubbing and drug use, etc, in gay men. It’s not just 20-year-olds: it’s 50 and 60-year-olds as well, so we’re seeing new diagnoses. So there’s two reasons we’re seeing older people with HIV, and also remember that what we are calling older isn’t what other doctors and geriatricians are calling older, which is 70 or 80, but it’s still ‘old’ for this disease area. And then the questions you actually asked is what is our oldest individual? Well, we have people over the age of 80 in our clinics, and we have some people over the age of 80 who have entered into the POPPY study.

If someone volunteers to take part in the POPPY study, what would it entail?

It’s a whole morning or a whole afternoon, because we go into your medical history in a lot of detail but it’s only one visit at the start and one visit two years’ later. And the actual visit involves a nurse or a trained health care practitioner to go through your medical history in detail; so when you see your GP, when you see your hospital specialist, whatever health care resources you use. Any medication you’re on, and also a questionnaire that you fill in on recreational drugs and different lifestyle aspects, and then we’re specifically looking at two organs in the body in details. We look at the memory and brain in detail, and there’s what we call cognitive testing or memory testing that’s done on a computer that’s sort of like playing card games that takes half an hour or forty minutes to do. The nurses help you do those tests and it records your reaction time and memory and gives us an assessment on your cognitive ability. And then everyone also has a DEXA scan which looks at your bone health, so it’s like how strong your bones are. There’s also some blood tests which are taken, which are just stored to be used within the study in future. There’s also a sub-study, which is just here at St Mary’s Hospital and that’s looking at the brain function in much, much more detail.

 

• To find out more about the POPPY study, or volunteer to take part, email [email protected] or telephone 020 3312 1466. 

• To read the full interview about the details of the POPPY study with Dr Alan Winston, visit: www.qxmagazine.com/blog-event/in-conversation-with-dr-alan-winston

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