Infectious and Parasitic Diseases Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo - Avenida Dr. Eneas de Carvalho Aguiar 255, 4° Andar do Instituto Central, Sala 4028 - 05403-000-Sao Paulo, SP, Brazil.
Ageing Res Rev. 2011 Jan;10(1):163-72. doi: 10.1016/j.arr.2010.10.004. Epub 2010 Oct 23.
Population aging has become a global phenomenon, and HIV infection among older individuals is also increasing. Because age can affect the progression of HIV infection, we aimed to evaluate the present knowledge on HIV infection in older patients.
Literature review of the last 20 years.
Older HIV-infected patients have lower CD4(+) T cell counts, higher viral load and are more frequently symptomatic at diagnosis. The infection progresses more rapidly, with higher morbidity and lethality rates. However, older patients are more compliant to antiretroviral treatment; they experience a better virologic response, and treatment represents a positive clinical impact. Aging affects the complex interaction between HIV infection and the immune system. Both conditions contribute to the dysfunction of immune cells, including a decrease in the phagocytes' microbicidal capability, natural killer cells' cytolytic function, expression of toll-like receptors and production of interleukin-12. Chronic immune activation responsible for the depletion of CD4(+) and CD8(+) T cells in HIV infection appears to worsen with senescence. Older patients also exhibit a less robust humoral response, with the production of less avid and specific antibodies.
Both HIV and aging contribute to immune dysfunction, morbidity and mortality. However, highly active antiretroviral therapy (HAART) is beneficial for older patients, and treatment of older patients should not be discouraged.
人口老龄化已成为全球现象，老年人群体中的 HIV 感染也在增加。由于年龄会影响 HIV 感染的进程，我们旨在评估目前关于老年患者 HIV 感染的知识。
对过去 20 年的文献进行回顾。
老年 HIV 感染者的 CD4(+)T 细胞计数较低，病毒载量较高，且在诊断时更常出现症状。感染的进展更快，发病率和死亡率更高。然而，老年患者对抗逆转录病毒治疗的依从性更高；他们的病毒学反应更好，治疗对临床产生积极影响。衰老会影响 HIV 感染与免疫系统之间复杂的相互作用。这两种情况都会导致免疫细胞功能障碍，包括吞噬细胞的杀菌能力下降、自然杀伤细胞的细胞溶解功能下降、Toll 样受体的表达以及白细胞介素-12 的产生减少。慢性免疫激活会导致 HIV 感染中 CD4(+)和 CD8(+)T 细胞耗竭，而这种情况似乎会随着衰老而恶化。老年患者的体液免疫反应也较弱，产生的抗体亲和力和特异性较低。
HIV 和衰老都会导致免疫功能障碍、发病率和死亡率增加。然而，高效抗逆转录病毒治疗（HAART）对老年患者有益，不应劝阻对老年患者进行治疗。
