HIV and Aging: HIV seen as a Chronic Inflammatory Intestinal Disease.

Abstract

After the introduction of successful antiretroviral therapy (ART) HIV has become a chronic infection with significantly increased survival. However, even HIV-infected patients who are considered “optimally treated” have a high prevalence of non-AIDS defining illnesses (cardiovascular, respiratory, neurologic, metabolic, renal, and liver disease) along with different types of solid and hematologic malignancies which led to the concept of “Accelerated aging” due to persistent inflammation and immune-activation “Inflammaging”. This review emphasizes the importance of the dysfunctional GI mucosa on the genesis of systemic inflammation and provides insights about possible future clinical trials to reach a functional cure along with ART. Microbial translocation, the Th17 and MAIT cells, the “Warburg-like” immunophenotype switch of immune cells, the indoleamine 2,3-dioxygenase (IDO-1) activity, the alteration of the microbiome (Dysbiosis), and the central role of Short Chain Fatty Acids (SCFAs) are all important parts of this model of inflammaging. Future studies focused on the tight junction alterations at the GI mucosa level will be essential to develop strategies in order to reach a functional cure.