Table 1.

HIV and Aging Priorities of the NIH

NIA

With the growing population of aging individuals living with HIV on cART, many studies on HIV/AIDS are relevant to NIA's mission to support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging. Example topics include: Interactions among aging-related genetic, molecular, and cellular changes with HIV risk, infection, and pathogenesis; Interactions among HIV/AIDS, other diseases, social structural variables, and population aging (including in low-income areas to understand how individual, interpersonal, social, structural, and other factors contribute to physical, psychological, and economic well-being); interactions among HIV infection, treatment, and development or progression of cognitive decline, dementia, and other disabilities in older adults; and interactions of HIV infection and treatment with other aging-related diseases, conditions, and syndromes and “geriatric” approaches to assessment and management of older adults with HIV. The NIA also described a significant interest in support for early clinical investigators offered through the Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) program for junior faculty physicians or dentists interested in a research career bridging their specialty and aging, which can be applied to HIV studies.

NCI

NCI as a participating institute seeks to foster research studies to help understand how aging in the presence of chronic HIV infection affects the risk, spectrum, and biology of cancer (AIDS-defining and non-AIDS-defining cancers). Recent data indicate an increase in the non-AIDS-defining cancers that is driven to a large extent by the growth and aging of the HIV/AIDS population. Aging is by itself a key factor promoting the development of many cancers, and there are a lack of data on the interplay between aging, HIV, long-term exposure to antiretroviral drugs, and other factors promoting cancer development in the aging population. In addition, there is little understanding of the interplay between host factors and immune perturbations that occur in aging and how these interactions affect cancers that are mostly seen in older people (e.g., Kaposi's sarcoma and Merkel cell carcinoma).

NIAAA

Patterns of alcohol use among HIV-infected individuals are associated with increased morbidity and mortality from multiple causes. Research priorities for NIAAA include the impact of alcohol use and its interaction with HIV and antiretroviral medications in both causing and adapting to accelerated disease progression. Alcohol may cause increased inflammation, and the accumulation of toxicities results in organ and tissue damage impacting the gut, liver, and brain. Research should address the development of interventions for health care providers to screen for early signs of these conditions, and preventive interventions should be developed, tested, and implemented to ameliorate the interaction of current or past acute and chronic use of alcohol on patient frailty and associated health outcomes over the life span.

NIAMS

NIAMS is interested in studies that investigate the effects of HIV infection and/or antiretroviral therapy on musculoskeletal and skin tissues and diseases. Proposed research should focus on chronic diseases and conditions in older adults and/or arising in the context of long-term HIV infection and/or antiretroviral therapy. Mechanistic ancillary studies that leverage existing HIV/AIDS cohorts and clinical trials are encouraged.

NIDCR

NIDCR is interested in research that investigates the effects of HIV infection and treatment on dental, oral soft and hard tissues, and salivary glands. Specifically, changes in these tissues with relation to aging adults and premature aging of oral tissues in chronic and acute HIV infections are of high priority.

NIDA

NIDA strongly encourages new interdisciplinary collaborations on a wide range of issues focused on HIV in aging high-risk, substance-abusing populations, including those with multiple infections (e.g., HIV and HCV).

NIMH

NIMH's overarching angle in HIV and aging is interdisciplinary, conceptually grounded HIV research studies in behavioral/clinical science research, and basic/clinical neuroscience research of older adults.

NINDS

CNS. Research to define and elucidate novel mechanisms of pathogenesis that are driving neurocognitive decline at the intersection of HIV-associated neurodegenerative processes and aging-associated CNS diseases.

NHLBI

NHLBI supports research on the prevention and treatment of heart, lung, blood, and sleep disorders. As the population of individuals living with HIV/AIDS ages, the interplay of the viral infection, antiretroviral therapies, and complicating chronic conditions becomes increasingly important. For this initiative, NHLBI is interested in basic, epidemiologic, clinical translational, and interventional studies, as well as implementation science research on topics such as, but not limited to: Elucidating the impact of accelerated senescence, HIV, and antiretroviral therapy on the pathogenesis of HIV associated cardiovascular (e.g., heart failure) and lung diseases (e.g., chronic obstructive pulmonary disease, pulmonary hypertension, and pulmonary fibrosis); Understanding the changes in hematopoiesis that occur with HIV infection, including changes in the hematopoietic stem cells and the stem cell niche; Developing stem cell strategies as a means to cure HIV infection; Understanding the impact of disordered sleep and sleep-disordered breathing on cardiovascular and pulmonary disease risks and exploring strategies to reduce these risks; Investigating interventions aimed at reducing HIV-related heart, lung, and blood diseases by modifying or eliminating more traditional risk factors such as smoking, metabolic disturbances, hypertension, and coagulation abnormalities; and Developing strategies for novel biomarkers or other measures to detect subclinical HIV-related heart, lung, and blood diseases and strategies to mitigate the manifestation of clinical disease.

cART, combination antiretroviral therapy; CNS, central nervous system; NCI, National Cancer Institute; NHLBI, National Heart Lung and Blood Institute; NIA, National Institute on Aging; NIAAA, National Institute on Alcohol Abuse and Alcoholism; NIAMS, National Institute of Arthritis and Musculoskeletal and Skin Diseases; NIDA, National Institute on Drug Abuse; NIDCR, National Institute of Dental and Craniofacial Research; NIMH, National Institute of Mental Health; NINDS, National Institute of Neurological Disorders and Stroke.