Schrock Joshua M
Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, United states.
Brain Behav Immun Health. 2024 Feb 5;36:100737. doi: 10.1016/j.bbih.2024.100737. eCollection 2024 Mar.
People living with HIV (PLWH) experience earlier onset of aging-related comorbidities compared to their counterparts without HIV. This paper lays out a theoretical model to explain why PLWH experience accelerated aging. Briefly, the model is structured as follows. PLWH experience disproportionately heavy burdens of psychosocial stress across the life course. This psychosocial stress increases risks for depressive symptoms and problematic substance use. Depressive symptoms and problematic substance use interfere with long-term adherence to antiretroviral therapy (ART). Lower ART adherence, in turn, exacerbates the elevated systemic inflammation stemming from HIV infection. This inflammation increases risks for aging-related comorbidities. Systemic inflammation also reduces connectivity in the brain's central executive network (CEN), a large-scale brain network that is critical for coping with stressful circumstances. This reduced capacity for coping with stress leads to further increases in depressive symptoms and problematic substance use. Together, these changes form a neuroimmune feedback loop that amplifies the impact of psychosocial stress on aging-related comorbidities. In this paper, I review the existing evidence relevant to this model and highlight directions for future research.
与未感染艾滋病毒的人相比，艾滋病毒感染者（PLWH）更早出现与衰老相关的合并症。本文提出了一个理论模型来解释为什么PLWH会加速衰老。简而言之，该模型的结构如下。PLWH在整个生命过程中承受着 disproportionately 沉重的心理社会压力负担。这种心理社会压力会增加出现抑郁症状和物质使用问题的风险。抑郁症状和物质使用问题会干扰对抗逆转录病毒疗法（ART）的长期依从性。反过来，较低的ART依从性会加剧由艾滋病毒感染引起的全身炎症升高。这种炎症会增加与衰老相关的合并症的风险。全身炎症还会降低大脑中央执行网络（CEN）的连通性，CEN是一个对应对压力环境至关重要的大规模脑网络。这种应对压力的能力下降会导致抑郁症状和物质使用问题进一步增加。这些变化共同形成了一个神经免疫反馈回路，放大了心理社会压力对与衰老相关的合并症的影响。在本文中，我回顾了与该模型相关的现有证据，并强调了未来研究的方向。 （注：“disproportionately”此处暂未准确翻译出恰当意思，可译为“不成比例地”等，需结合上下文进一步优化）
