Aging and HIV infection.
BACKGROUND
Population aging has become a global phenomenon, and HIV infection among older individuals is also increasing. Because age can affect the progression of HIV infection, we aimed to evaluate the present knowledge on HIV infection in older patients.


METHODS
Literature review of the last 20 years.


RESULTS
Older HIV-infected patients have lower CD4(+) T cell counts, higher viral load and are more frequently symptomatic at diagnosis. The infection progresses more rapidly, with higher morbidity and lethality rates. However, older patients are more compliant to antiretroviral treatment; they experience a better virologic response, and treatment represents a positive clinical impact. Aging affects the complex interaction between HIV infection and the immune system. Both conditions contribute to the dysfunction of immune cells, including a decrease in the phagocytes' microbicidal capability, natural killer cells' cytolytic function, expression of toll-like receptors and production of interleukin-12. Chronic immune activation responsible for the depletion of CD4(+) and CD8(+) T cells in HIV infection appears to worsen with senescence. Older patients also exhibit a less robust humoral response, with the production of less avid and specific antibodies.


CONCLUSIONS
Both HIV and aging contribute to immune dysfunction, morbidity and mortality. However, highly active antiretroviral therapy (HAART) is beneficial for older patients, and treatment of older patients should not be discouraged.
Infectious and Parasitic Diseases Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - Avenida Dr. Eneas de Carvalho Aguiar 255, 4° Andar do Instituto Central, Sala 4028 - 05403-000-Sao Paulo, SP, Brazil. viviansilva87@gmail.com
Vivian Iida
VI
Avelino-Silva
Yeh-Li
YL
Ho
Thiago Junqueira
TJ
Avelino-Silva
Sigrid De Sousa
Sde S
Santos
D056704:Adaptive Immunity / Q000502:physiology; D000328:Adult; D000368:Aged; D000375:Aging / Q000276:immunology* / Q000502:physiology*; D000818:Animals; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007107:Immune System / Q000473:pathology; D007111:Immunity, Cellular / Q000502:physiology; D056724:Immunity, Humoral / Q000502:physiology; D007113:Immunity, Innate / Q000502:physiology; D008875:Middle Aged