The State of the Science on Chronic Comorbidities and Aging in Children and Adolescents with perinatally-acquired HIV

Abstract

The availability and global scale-up of suppressive antiretroviral therapy (ART) has transformed HIV from a fatal infection to a chronic disease. While long-term survival is a positive development for people living with HIV (PLWH), the increased life expectancy comes with age-related comorbidities. These comorbidities affect PLWH at relatively earlier ages than the general population, and examples include cardiometabolic conditions, renal toxicity, lung and respiratory dysfunction, neurocognitive deficits, malignancy, and oral/dental pathology. Anticipatory management of early markers of non-communicable diseases (NCDs) can be especially advantageous for children and adolescents with perinatally-acquired HIV (CAPHIV), the vast majority of whom live in low-and middle-income countries. However, evidence for the mechanisms underlying age-related comorbidities in PLWH and implications for CAPHIV represent a still-emerging area of investigation. In this article, we review the current literature on comorbidities and age-related conditions experienced by CAPHIV, discuss the role of inflammation and chronic immune activation, and highlight accelerated biological aging and/or disruptions to the microbiome as underlying mechanisms. We recommend that HIV clinical care and health policy should reflect evidence on aging and comorbidities to optimize growth, development, and long-term health for CAPHIV globally.