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Ahead of World AIDS Day on 1 December, we highlight research underway at Burnet to improve age-related problems for people living with HIV. In Australia, there are an estimated 27,000 people living with HIV (as of 2014).
In Burnet Institute’s latest edition of IMPACT magazine, our researchers describe their work on the new frontier of HIV – improving the ageing process for people living with the virus.
HIV is no longer a death sentence, but people living with the virus experience early development of diseases commonly related with ageing. Cardiovascular disease, kidney disease, cognitive disorders and physical frailty can strike people with HIV in their thirties and forties, instead of the fifties and sixties in the non-HIV population.
Head of the Palmer Laboratory and the HIV Immuno-metabolism Group at Burnet, Dr Clovis Palmer said he had seen people as young as 38 living with HIV and ageing diseases, including arthritis and cognition difficulties.
“It really is devastating for them.”
While HIV treatment can decrease the viral load in a person’s blood, the virus continues to multiply in organs such as the brain, testes and adipose tissues, where it triggers inflammation. Inflammation is the main cause of these ageing diseases, occurring when immune cells such as monocytes and T cells recognise infection in the body and respond by becoming over-reactive.
Inflammation in HIV is a result of three main causes:
Burnet is targeting the two main comorbidities: cardiovascular disease (CVD) and frailty, with research projects in these areas examining their relationship to inflammation at various stages.
In the field of CVD research, the Palmer Laboratory is collaborating with the world renowned Professor Alan Landay at the US-based Rush Medical Centre in Chicago, to look at two separate groups of women living with HIV.
“We have evaluated metabolic markers in each group and we have preliminary data suggesting we can use these markers on immune cells to identify who is at risk of CVD,” Dr Palmer said.
“We can then use interventions, such as these drugs identified in our own labs that can modify metabolic activities of immune cells to treat CVD.”
This work, inspired by tests developed in the Palmer Laboratory, is also being done in collaboration with Dr Joshua Anzinger at the University Hospital of the West Indies, in Kingston, Jamaica.
The test is a quick and sensitive way to detect inflammation in people living with HIV and was recently published as a video demonstration in the journal JOVE. Other work in this field, headed by Burnet’s Associate Professor Anthony Jaworowski, aims to understand how inflammatory processes damage blood vessels in the heart, to help improve diagnosis and treatment of heart disease in high-risk groups.
Frailty is another age-related condition being investigated by Burnet researchers. Frailty includes concepts such as the ability to recover from infections, cognitive function and handgrip strength.
Burnet is working on new laboratory tests to identify frailty and predict how quickly people who are borderline frail (pre-frail) will become fully frail within a certain amount of time.
“We have started a study cohort and recruited more than 100 men aged over 55,” Dr Palmer said.
“We found a significant proportion were frail, much higher than the normal population. About half were pre-frail.”
Rather than measuring inflammation, the researchers are investigating ‘the root of the evil’ and measuring the metabolism of immune cells, in collaboration with Burnet’s Professor Suzanne Crowe AM and The Alfred hospital, Melbourne’s Professor Jenny Hoy and student Dr Hui Ling.
“The higher the activity of immune cells, the more inflammation, which makes sense because cells need energy to produce all those toxic chemicals,” Dr Palmer said.
So what does the future hold for HIV research? Dr Palmer believes safe, long-acting treatment is the next goal for people living with HIV.
“The future of treatment is drugs that will suppress the virus for a long time and keep inflammation at bay.”