Abstract
Women with chronic HIV infection (WWH) living in the United States, experience a disproportionately high rate of obesity compared to uninfected populations. Both overweight and obesity, particularly central obesity, are major contributors to insulin resistance, hypertension, and dyslipidemia—the major components of metabolic syndromes, including type 2 diabetes, and leading to increased cardiovascular risk, including coronary heart disease, and cerebrovascular diseases. Notably, declining physical performance and frailty co-occur with vascular morbidities as well as changes in bone. These factors tend to exacerbate each other and accelerate the aging trajectory, leading to poorer quality of life, cognitive impairments, dementia, and eventually, death. In WWH, persistent HIV infection, sustained treatment for HIV infection, and concomitant obesity, may accelerate aging-related morbidities and poorer aging outcomes. Furthermore, health disparities factors common among some WWH, are independently associated with obesity and higher vascular risk. The purpose of this review is to describe the constellation of obesity, cardio- and cerebrovascular diseases, bone health and frailty among aging WWH, a 21st century emergence.
Highlights
The human immunodeficiency virus (HIV) epidemic, in its fourth decade, is a treatable chronic condition affecting an increasingly older population [1]
Advances in Geriatric Medicine and Research circumference; WHR, waist-to-hip ratio; NHLBI, National Heart, Lung and Blood Institute; FFP, Fried Frailty Phenotype; AIDS, Acquired Immunodeficiency Syndrome; VACS, Veterans Aging Cohort Study; CES-D, Centers for Epidemiologic Studies—Depression; FINDRISC, Finnish Diabetes Risk Score; CaMos, Canadian Multicentre Osteoporosis Study; IGFBG-1, Insulin Like Growth Factor Binding Protein; IGF-1, Insulin Like Growth Factor-1; r, correlation coefficient; OR, odds ratio; 95% CI, 95% Confidence Interval; TBS, trabecular bone score; %, percent; CSVD, Cerebral Small Vessel Disease; WMH, white matter hyperintensities; MRI, magnetic resonance imaging; FSRP, Framingham Stroke Risk Profile; PrEP, Pre-exposure prophylaxis
We address the obesity that is associated with HIV infection in aging women and its role in vascular diseases, bone health and frailty
Summary
The HIV epidemic, in its fourth decade, is a treatable chronic condition affecting an increasingly older population [1]. In the WIHS, among WWH who were on average obese and adherent to ART, one report suggested that older age, White (vs Black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture, a marker of low BMD, over 10 years follow-up [63] When these women were evaluated over 5.4 years during premenopause only, there was no association of HIV status with fracture risk; and traditional risk factors such as White (vs Black) race, hepatitis C virus infection, and higher serum creatinine were associated with fracture [64]. Given that WWH present for the first time at older ages when late-life cognitive impairments and dementias occur, with lifetimes of exposure to high vascular and cardiometabolic risk, the threat of adverse brain events and vascular cognitive impairments with aging is high
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