Combination antiretroviral therapy (ART) has dramatically improved survival among human immunodeficiency virus HIV-positive individuals. It is estimated that over half of the HIV-positive population in the United States is now 50 years of age or older. As this population ages, aging-associated conditions increasingly contribute to morbidity and mortality. Our researchers have found that HIV-infected patients are at higher risk of myocardial infarction, ischemic stroke, and several non-AIDS-defining cancers compared with HIV-uninfected patients.
The severity of HIV disease appears to play a role in this increased risk, with researchers demonstrating that HIV-infected patients with greater immunodeficiency are at particularly high risk of these aging-associated outcomes. These findings emphasize the need for early and consistent treatment with ART to maintain immune function.
Mitigation of risk factors may also have an impact on long-term outcomes of HIV infection. Researchers have observed that the excess risk of myocardial infarction in HIV-infected patients has declined in recent years, a trend that may be attributable to increased attention to cardiovascular risk-reduction interventions in this population. Researchers have also shown that mortality rates are elevated in HIV-infected patients with substance abuse and/or psychiatric disease diagnoses even after controlling for ART and health status. Our research includes strategies to reduce the use of alcohol among HIV patients.
Researchers have also begun to focus on the prevention of HIV infection, investigating the use of daily oral preexposure prophylaxis among members of Kaiser Permanente.