Effective antiretroviral therapy (ART) for people living with HIV (PLWH) has dramatically reduced mortality resulting in many surviving into middle and old age. Despite this success, PLWH experience high rates of comorbidities, multimorbidity (>1 major chronic illness), and functional decline at ages 10-15 years younger than uninfected controls. Geriatric syndromes, such as frailty and falls, are becoming more prevalent in PLWH. Thus, there is an urgent need to focus on the healthspan of PLWH rather than just mortality. Healthspan, in contrast to lifespan, is defined as the time someone is healthy not just alive. The Claude D. Pepper Older American Independence Centers (OAlCs) were established to help define aging phenotypes and advance research into the causes, prevention and treatment of functional decline with age. OAlCs have developed and validated functional assessments in aging, but lack depth and breadth of HIV expertise. In contrast, Centers for AIDS Research (CFARs) have unparalleled expertise in HIV-related basic, clinical and social/behavioral research, but lack robust resources and expertise in aging biology, geriatric clinical phenotypes and functional assessments. Our R24 project, ?Developing Research At The Interface Of HIV And Aging? was in response to PA-12-064 Network and Infrastructure Support for Development of Interdisciplinary Aging Research. Through this R24 we successfully linked CFARs and OAICs to support pilot projects in high-priority focus areas and mentor researchers at the interface of HIV and Aging. Our vision for this proposal is to build on this success deepening the ongoing linkage of CFARs and OAICs and expanding the network to include Nathan Shock Centers of Excellence in the Basic Biology of Aging (NSCs) and the McKnight Brain Institutes (MBIs). By bringing together OAICs expertise on functional decline in aging, with NSC expertise in aging biology and the mechanisms underlying function decline, with MBI expertise on age-related cognitive decline, and CFAR expertise on HIV, we create an integrated approach to advancing and accelerating investigation at the interface of HIV and aging via the following Aims:
Aim 1. Provide specific training models and a brief inventory of tools to efficiently collect data to improve HIV clinical care and outcomes research.
Aim 2. Using a geroscience approach, provide a platform for pilot studies to determine the links between molecular hallmarks of aging with functional decline, and the development of common comorbidities among aging PLWH.
Aim 3. Develop infrastructure for evaluating interventional approaches and their application to HIV care.
Aim 4. Provide educational support, implementation advice and mentoring for emerging investigators to establish/advance research programs in HIV and aging. These synergistic aims leverage and expand the infrastructure and close ties built in the R24 of HIV expertise from CFARs with the gerontology and functional assessment expertise within the OAlCs and expand them with inclusion of NSCs and MBIs to enhance and accelerate investigation at the interface of HIV and aging.
Antiretroviral therapy for people living with HIV (PLWH) has dramatically reduced mortality resulting in many surviving into middle and old age. Despite this success, PLWH experience high rates of comorbidities, multimorbidity (>1 major chronic illness), and functional decline at earlier ages than those without HIV. This proposal addresses this high priority area and is responsive to goals outlined in PAR-18-644 to advance the science of aging building infrastructure and interdisciplinary collaborations. We will efficiently leverage the interdisciplinary resources of the NIH to develop and support emerging investigators researching HIV and aging and to enhance and accelerate investigation at the interface of HIV and aging.
