- A new study finds that HIV may accelerate cellular aging within two to three years of initial infection.
- The study also suggests that a new HIV infection could shave almost five years off one’s lifespan, compared to those who are not living with the virus.
- While medical advances have ensured that those living with HIV can live long and healthy lives, medical experts stress that studies like this highlight that HIV is still a virus that shouldn’t be taken lightly.
More than four decades since HIV emerged, researchers are still gleaning more about how the virus affects people’s overall health.
For the researchers behind the study, this work is significant in painting an even clearer picture of the role the virus may play in the aging process compared to people who aren’t living with HIV. The study suggests that a new HIV infection could shave almost five years off one’s lifespan, compared to those who are not living with the virus, according to a press release.
While advances in medication and care that emerged in the years since the height of the global HIV crisis mean those living with HIV can live long and healthy lives, experts stress that studies like this highlight this is still a virus that shouldn’t be taken lightly.
They say preventive measures and education need to be amplified while at the same time more needs to be done to bring the best care and treatments to those currently living with the virus — especially in bridging inequities that see worse health outcomes for those in marginalized communities living with HIV.
For lead study author Elizabeth Crabb Breen, PhD, a professor emerita at UCLA’s Cousins Center for Psychoneuroimmunology and of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA, it was important that this specific study examined the years after “the initial HIV infection event.”
Breen told Healthline that data from “lots of other research” shows people who have been living with HIV for many years and who are already on treatment do “show these signs of potentially accelerated aging,” but “no one had that opportunity to look at the same person before and after their HIV infection.”
“This study uniquely gave us the opportunity to look at the virus infection itself, and at the end of the day, take the same person and look at them before HIV infection and after HIV infection,” she said.
Breen explained that “two to three years after HIV infection is a relatively short time” in the scope of the life of someone living with HIV, and that the same period of time for someone who doesn’t have the virus generally won’t show any significant “age acceleration.” It would just be the average aging one generally shows within a couple of years.
“We weren’t sure if the impact of the virus itself was going to be enough to start pushing this cellular clock forward. So, that was our hypothesis. That is what we were hoping to see,” Breen added.
“What was surprising was that after the two-to-three-year [period] after infection, one of the measures that we used told us that HIV has an impact on these cellular measures of aging and it happens very quickly. Only living with HIV for two to three years indicated that [HIV] has the potential to shorten someone’s life by five years…that’s just only after the initial infection,” she said.
For the study, Breen and her team looked at stored blood samples collected from 102 men that were taken six months or less prior to contracting HIV and then samples taken from them two to three years after infection. This was then compared against samples from the same time period from 102 men in the same age range who were not living with HIV.
The men included in this study were all part of the nationwide Multicenter AIDS Cohort Study, or MACS, that ran from 1984 to 2019, studying HIV in participants who identified as gay or bisexual men.
In 2019 that study merged with its counterpart that examined women living with HIV in the United States — the Women’s Interagency HIV Study (WIHS) — and is now the MACS/WIHS Combined Cohort Study (MWCCS).
Breen explained that key to this new study was looking at epigenetic changes, or “changes in DNA that change the behavior of genes, but not the actual DNA itself.” This study examined how HIV impacts DNA methylation, when cells essentially flip the “on” or “off” switch on genes over the course of physiological changes.
“What we are able to do is measure the places where we know this chemical modification can occur and there are some very sophisticated bioinformatics research that has created these calculations that can estimate the biological or cellular age of a person by looking at these changes to the DNA,” Breen said. “They were developed originally to be able to predict someone’s chronological age by looking at their DNA.”
In their study, Breen and her team looked at five different epigenetic aging measures. Think of four of these measures as being “clocks,” with each one assessing the acceleration of cellular biological age in years, put in comparison to the actual chronological age of the person.
The other measure examined the length of telomeres, chromosomes’ ends that shorten over time as cells divide. Eventually, the ends of these long DNA molecules get so short that this cellular division can’t continue.
In the study’s samples, the men living with HIV showed signs of pretty stark accelerating aging by way of the four “clock” measurements.
This ranged from 1.9 to 4.8 years. When it came to the fifth measure, these individuals also displayed a shortening of the telomeres at the point of time right before HIV infection, which stopped about two to three years after infection. This was without being on robust antiretroviral treatment for HIV.
By comparison, this level of accelerated aging was not seen in the people who did not have HIV.
So, exactly how does rapidly accelerating cellular aging affect a person?
Breen said what was a “strong affirmation” of her team’s work was that acceleration was seen in “multiple measurements” and “not just in one.”
She said cellular aging by way of these epigenetic processes “should in theory” be related to specific physical outcomes. Breen said the “most obvious one” is earlier death, but also heart disease, kidney disease, and earlier onset of physical frailty.
“This is all a collection of things used to assess someone’s loss of function as they get older,” Breen added. “We haven’t done that research yet, but it is part of this project, it is part of a process we are doing now, of linking these cellular measurements to ‘do they indeed predict who is going to get heart disease sooner? Who is going to die sooner?’”
“This is laying the foundation to then go forward and do that work to link these measurements in persons living with HIV to their medical outcomes,” she explained.
One thing that is certifiable is that people living with HIV in 2022 can certainly live long, healthy, happy lives. This is a far cry from the confusion of the early 1980s-to-1990s, when the global HIV crisis was at its height and modern medications were yet to be developed.
Today, a person who adheres to their regular regimen of antiretroviral therapies can reach a viral load that is so low that it is unable to be detected. This means a person who achieves this undetectable level will be unable to transmit HIV to a sexual partner.
More advanced medications have also created a higher quality of life for people living with HIV.
All of that being said, Dr. Ronald G. Collman, director of the Penn Center for AIDS Research in Philadelphia, Pennsylvania, who was not affiliated with this study, told Healthline that research like this is a reminder to avoid complacency.
HIV is still a serious medical issue.
“Something to me that is a little bit disturbing … is there is a sense out there that there is ‘nothing to worry about’ if you have an HIV infection. You just take your medicine and it is as good as not being infected,” Collman said.
He said many people are engaged with effective interventions like pre-exposure prophylaxis (PrEP) and prevention education, but the overall discussion that HIV is more of a mild concern is a bit misleading.
“There are consequences of being infected. Of course, it’s not the same as the pre-antiretroviral therapy era, but it’s more subtle. It’s more long-term. Living with HIV and being effectively treated and having it suppressed is not exactly the same as not being infected,” he added.
Collman explained that this study comes into dialogue with other research and medical knowledge of HIV in suggesting that people living with HIV “have a higher rate of getting diseases of aging.”
“We all get old, we all get frail, the risk for heart disease and dementia is there, but we don’t know which ones we will get as we get older, but this happens sooner for people with chronic HIV infection,” he said. “This study suggests that by looking at it at the cellular level, the die is cast. That is my interpretation of this.”
“This study suggests that for anyone, just the process of having gotten infected, these changes occur or begin to occur sooner,” he added.
What this might mean potentially is that if someone who is not living with HIV is likelier to get a heart attack at 75, someone living with HIV might experience that at age 70, Collman suggested.
If someone who isn’t living with HIV experiences frailty that makes it harder for them to live independently at age 80, perhaps that might come earlier in the 70s for someone living with HIV.
“ART (antiretroviral therapy) has totally transformed how people live, but it doesn’t necessarily mean they live 100 percent as successfully as without HIV infection,” Collman said.
Breen echoed those thoughts. She said that one of the key messages she would like people to take away from when looking at the study is that “in spite of this perception that ‘oh, you get HIV, just take the meds, you’ll be fine’ ” that doesn’t mean there are no other health concerns to keep in mind.
“The study shows from a very early stage of being infected with and living with this virus, it is already taking a toll and setting a person up for a shortened lifespan or a period of time at the end of their lifespan that is going to be complicated by these diseases of aging,” she said.
Collman added that he hears many people say “HIV is not that big of a deal.” He said they often compare it to managing diabetes, believing they can “just take medicine every day” and they’ll be fine.
However, he stressed that, like diabetes, HIV can affect a person’s health in multiple ways that aren’t visible on the outside and that taking daily medication to manage a disease “doesn’t make it better than not having the disease in the first place.”
While both Collman and Breen emphasize the importance of education and prevention, they both said now is the time for us all to be as supportive as possible of those living with HIV — to make sure the resources, health interventions, education, and access to quality care are available and robust.
That is especially true for Black and brown communities, who are disproportionately affected by HIV, of nonbinary, transgender, and gender-expansive people, and women living with HIV.
These are groups of people who haven’t always been given as much attention as white, cisgender gay men when it comes to access to care and public health messaging.
Breen said the original MACS study provided a treasure trove of data, presenting a rare opportunity in a research study to have samples of people before and after contracting HIV, tracing their health data over decades.
“That is the beauty of the design of this study and the unbelievable dedication of the men who have been participating in this study and likewise the women,” she said.
That being said, by focusing on the more comprehensive, unique data of the longer-in-existence, MACS study, it limits this specific work to looking solely at men who have sex with men, and predominantly white, cisgender men at that.
Back when the initial study was put in place, the people who volunteered were coming from populations of “mostly college-educated white men,” Breen said.
“This has always been a challenge for any of us who are utilizing resources from the past. The MACS [study] recognized that and around the year 2000 they enrolled additional men, focusing on non-white men, but there aren’t enough of those non-white men in our study to be able to tease that out,” she said.
The women studied in WIHS, by comparison, are predominantly women of color, something Breen said could offer a more comprehensive look outside of the narrower white, male-centric data that comes from the original MACS study.
When it comes to transgender, gender-expansive, and nonbinary people, Breen said all of the men who enrolled back in the 80s identified as “male and men who have sex with men,” but that she has no idea if some now identify as trans or nonbinary.
“It’s entirely possible, we don’t have access to that data, and I’m not sure if that question has been asked recently,” she said, adding that the initial researchers at the time weren’t asking that question in the mid-1980s, but it’s possible the gender identities of some of the participants have changed.
What isn’t in question is that minority communities — from gender to racial and ethnic minorities — have higher rates of health disparities, driven by inequities and inherent biases in our healthcare system and society at large.
Breen said the higher rates of negative health outcomes as people age that are found at large in these communities, certainly present themselves in those who are living with HIV.
The broader questions about combatting inequity and health disparities that were magnified during the COVID-19 pandemic and social justice conversations in 2020 and beyond, filter down to HIV as well.
While more needs to be done in order to look at the full scope of how accelerated aging presents itself in the wide, diverse spectrum of people living with HIV in the U.S. and around the globe, Breen said this study is just the start of more to come.
Another key area she’ll be looking at is exactly what is causing this accelerated aging.
Is it due to medications? Would someone who is 20 and starting a regimen of modern HIV treatments today age differently than someone on older forms of ART? Is it due to other environmental factors?
One question Collman brought up was how hormone therapies in transgender people could “interface with the effects of both HIV infection itself and antiretroviral therapy?”
Breen said one thing she’s investigating is looking at how antiretroviral therapies play a role in some of the MACS participants.
“In the same time period that we looked at after infection, what happens within the same person, how does this cellular aging manifest itself with treatments? Are the drugs making it worse? Do these drugs ‘reset the clocks’ back to essentially ‘normal’ — to the same as a non-HIV-infected person?’ ” Breen questioned.
There are more questions to be asked, and Breen said she and her team are excited to continue to get a more comprehensive picture of what living with HIV means for a person’s cellular and physical aging in the years to come.