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 people with HIV are at higher risk of myocardial infarction, ischemic stroke, and several non-AIDS-defining cancers compared with the general population.
DOR researchers have contributed to research highlighting the high risk of cancers in people with HIV, particularly cancers with a known infectious cause. The also led studies evaluating cancer risk and a study showing that starting ART quickly after diagnosis may reduce the risk of certain cancers.
Section members have been active in exploring increased risk of cardiovascular disease in people living with HIV, including work showing a higher risk of heart failure, and that people with HIV can benefit from statin therapy.
Ongoing work includes a study using a syndemic approach to investigate combinations of social and biological conditions that may act synergistically to increase the risk for of cardiovascular disease in people with HIV.
HIV and Aging
DOR researchers have examined trends in life expectancy for people with HIV, and found significant increases since the introduction of ART, but a continuing gap compared with people without HIV. In other work related to HIV and aging, section investigators found that older adults living with HIV have nearly double the rate of dementia of people without HIV.
Ongoing work includes optimizing identification of frailty among older adults with HIV and predicting neurocognitive impairment and dementia in this population.
Substance Use, Mental Health in HIV
Research from DOR’s HIV group also explores substance use and mental health issues specific to people with HIV, such as screening for unhealthy alcohol use, and trends in smoking and smoking cessation in this population. Other work explored ways to reach people with HIV who may have unhealthy alcohol use through the screening, brief intervention, and referral to treatment (SBIRT) model in primary care.
DOR investigators and their clinical partners have made significant contributions understanding trends around HIV-prevention drug therapy, known as pre-exposure prophylaxis (PrEP). They were among the first to evaluate PrEP use in clinical practice. This work also included developing an electronic health record based HIV risk score to identify patients who might benefit from PrEP, along with important studies of PrEP patients identifying factors that could influence who might stop taking the medication and feasibility of alternate dosing regimens.
Ongoing initiatives on prevention include a randomized clinical trial investigating the effectiveness of a clinical decision support intervention to increase PrEP uptake in primary care, leveraging the EHR-based HIV risk score. Infectious disease section members also contribute data to the America’s HIV Epidemic Analysis Dashboard (AHEAD), a key resource maintained by the Centers for Disease Control and Prevention to monitor U.S. progress in ending the HIV epidemic.