11/18/17 1 Alan Landay, PhD Professor Department of Immunology/ Microbiology Rush University Medical Center Chicago, Illinois Mechanism of FuncEonal Decline: Role for Frailty in HIV and Aging HIV and Aging • The introducEon and success of anEretroviral therapy(ART) has led to an aging HIV+ populaEon, altering the characterisEcs of the HIV/AIDS epidemic • Within this aging populaEon, there is an increased risk for and burden of comorbidiEes typically associated with age • Examples include cardiovascular disease, chronic kidney disease, osteoporosis, and neurocogniEve disorders • Increases in age-related comorbidiEes may predispose HIV-infected persons to a parEcularly vulnerable state known as frailty Frailty • In geriatrics literature, frailty is defined as an increased vulnerability to stressors in the face of limited physiological reserve • Frailty has been associated with a range of aberrant, dynamic, mulEsystem physiological stress responses affecEng neuroendocrine, metabolic, musculoskeletal, cogniEve, and immune systems • DisrupEon of key stress response systems driven by underlying aging-related cellular and molecular pathogenesis adversely impact muscle mass and quality, strength, endurance, and efficiency of energy expenditure • Fried et al defined the original frailty phenotype involving impairment in at least 3 of five domains • Physical slowness measured by walking speed, Weakness measured by grip strength, FaEgue, Low physical acEvity, and UnintenEonal weight loss • The frailty phenotype (FP) independently predicts a number of adverse outcomes • Acute illness, falls, cogniEve decline, disability, insEtuEonalizaEon, and mortality HIV and Frailty • SimilariEes between frailty, aging, and HIV infecEon were recognized early in the HIV era • Weight loss, immune acEvaEon, and high levels of cytokines were features of untreated HIV also common in aging populaEons • AZer the introducEon of ART, focus shiZed to the effect of chronic treated HIV infecEon on health and longevity as life expectancy increased • HIV-associated non-AIDS (HANA) condiEons have become major health concerns • Frailty is increasingly being recognized as an important factor to idenEfy HIV- infected persons at high risk for adverse health outcomes
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Frailty and Aging in HIV presentation Updated 111017nursing.emory.edu/_includes/documents/sections/news-events/Landay.pdf · Role for Frailty in HIV and Aging HIV and Aging • The
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Microbiome Alterations in HIV :A Possible Driver of Functional Decline • ThemicrobiomehelpsshapetheinnateandadapEveimmunesystemwithadelicatebalanceofpro-andanE-inflammatoryresponses