World AIDS Day 2020 Reflection–Frailty, Resilience, and Impact.

On December 1st 1988, the first World AIDS Day was observed to support people living with HIV (PLWH) and remember those who died during the initial phase of the AIDS epidemic.  Now, 32 years later, HIV has been transformed into a chronic disease with the widespread use of effective combination antiretroviral therapy. The goal of ending the HIV epidemic, while aspirational, is increasingly achievable with the widespread test and treat efforts and very effective prevention strategies.

 With survival of PLWH approaching that of peers without HIV, the HIV population is aging and the majority of PLWH in the US are now over 50 years old. Over the past 10 years, we have seen many reports documenting that aging-related comorbidities occur at an earlier age in PLWH and some have posited that HIV may represent an accelerated aging phenotype, which is driven by chronic immune activation.  There is much work to be done to understand the pathogenesis of comorbid diseases in PLWH and determine the extent to which this is the same or different than people without HIV.  We also need to understand the drivers and manifestations of physical frailty in this vulnerable population.  Here’s a link to an introduction to this area of HIV and Frailty. 

 While potentially vulnerable to the impact of aging-related conditions, older PLWH are also extremely resilient.  They know exactly the devastation that this disease caused and how to face its challenges.  As we face another viral epidemic, I am struck by the perspective of PLWH and their strength in the face of adversity and uncertainty.   The theme for World AIDS Day 2020 is “Ending the HIV/AIDS Epidemic: Resilience and Impact.”   For older PLWH, improving health span is essential, and their resilience forged from their lived experience in the early days of the HIV epidemic will be instrumental to achieve this goal.