Premature Aging and Premature Age-Related Comorbidities in HIV-Infected Patients: Facts and Hypotheses.

Although even recently human immunodeficiency virus (HIV)–infected patients have mainly encountered AIDS-defining morbid events and early AIDS-related mortality, at present, in Western countries, most of these patients are efficiently treated and their infection can be considered to be in remission. However, many patients encounter the early occurrence of several common age-related comorbidities [1–3], leading to early mortality [4]. In the Swiss HIV Cohort Study [3], the incidence of diabetes, coronary angioplasty, myocardial infarction, osteopororosis, and non–AIDS-related cancers was increased among patients aged .50 years, compared with those aged ,50 years, and was not further increased among patients .65 years, suggesting that HIV-infected patients .50 years of age can be considered to be old. In the present issue of Clinical Infectious Diseases, Guaraldi et al [5] analyze the important cohort of patients followed up at the Metabolic Clinic of Modena (Italy) who underwent a complete set of clinical, biological, and imaging investigations, allowing investigation of comorbidities. The authors analyzed diseases with clear clinical or biological diagnoses, both in HIV-infected patients and in the general population; these diseases included cardiovascular events, fractures, diabetes, renal failure, and hypertension. First, they found the early occurrence of these age-related comorbidities in HIV-infected patients. Second, they were able to compare these patients with persons from the general population who were part of a large Italian observational database, CINECA ARNO, that records health information. At a given age, HIV-infected patients had a greater likehood of comorbidities than did control subjects paired for age, sex, and ethnicity. A possible bias acknowledged by the authors is the more careful examination of HIV-infected patients because of their routine care, compared with control subjects who generally do not undergo any investigation if they do not feel sick. There is also a possible selection bias among the patients specifically referred to the metabolic clinic of Modena, compared with the unselected HIV-infected population, even if the authors report a similar occurrence of comorbidities in these 2 groups. Nevertheless, these data are of clinical relevance. Other age-related comorbidities were also found to be more prevalent in adult HIV-infected patients than in the general population: neurocognitive disorders, non–AIDS-defining cancers, sarcopenia, and frailty [1, 2]. It is now frequently considered that HIV-infected patients are aging prematurely, considered to be old when .50 years of age, compared with 65 years of age in the general population.