2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Possible Reasons for “Unsuccessful Aging” among PWH

ART Toxicity

Unsuccessful Aging

Persistent Inflammation

Genetics and Lifestyle

Adapted from Deeks and Phillips, BMJ, 2009

Slide19of43FromSGianellaWeibel,MD atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

SMART Study: Interrupting ART Increases the Risk of Heart Disease

10

DC

VS

7.5

Death fromCVD

7

4

Intermittent ART

Non-fatalclinicalMI

12

12

5

Non-fatalsilentMI

11

5

2.5

Non-fatalstroke

8

3

ContinuousART

0

CAD requiringsurgery for invasiveprocedure

22

14

0

0.5

1

1.5

2

2.5

3

3.5

4

% with a Major CVD Event

Years from Randomization

No. at Risk

2752 2720

1306 1292

713 696

379 377

10 10

All majorCVD events

48

31

El-Sadr, NEJM, 2006

Slide20of43FromSGianellaWeibel,MD atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.

T Cell Activation Declines with ART

Hunt et al, JID, 2003; PLoS One, 2011

Slide21of43FromSGianellaWeibel,MD atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICAL CONFERENCE, IAS  USA.