Multidisciplinary Studies of HIV/AIDS and Aging

NIA is interested in understanding how biological, clinical, and socio-behavioral processes affect older adults with HIV (OAWH) and their caregivers, and the social, economic and health consequences of HIV. Examples include:

• Aging-related genetic, molecular, cellular, and physiological changes with HIV, including risk, infection, and pathogenesis.
• Interactions among individual-level factors and interpersonal, social, and structural factors, and their contributions to the physical, psychological, and economic well-being of individuals; and interactions among HIV/AIDS, other disease, and population aging.
• Interactions among HIV infection, treatment, and development or progression of cognitive decline, HIV-associated neurocognitive disorder, dementia, and other disabilities in OAWH at the molecular and cellular level.
• Interactions of HIV infection and treatment with other aging-related diseases, conditions, and syndromes and geriatrics-informed approaches to assessment and management of OAWH.

NCI is interested in research studies to help understand how aging in the presence of chronic HIV infection affects the risk, spectrum, and biology, of cancer in people with HIV (PWH). Recent data indicate an increase in cancer types that occur with high CD4 counts (e.g., anus, liver, oral cavity/pharynx, lung, and Hodgkin lymphoma) in PWH, which is driven primarily by the increase of the population of older PWH on highly effective antiretroviral therapy. Examples of high priority topics include:

• Interplay between aging, HIV, long-term exposure to antiretroviral drugs, and other factors promoting development of various cancers in PWH.
• Interplay between host factors and immune perturbations that occur in aging and (e.g., clonal hematopoiesis and biological aging) how these interactions affect the development cancers that are commonly seen in older people.
• Treatment outcomes, quality of life indicators, and survivorship in older PWH that have cancer.
   

NHLBI is interested in how aging-related mechanisms and pathways contribute to HIV-associated heart, lung, blood and sleep (HLBS) comorbidities. Priorities include:

• The combined effects of aging, HIV, and ART on the pathogenesis and progression of associated HLBS conditions.
• Aging- and HIV-related changes in hematopoiesis, including changes in the hematopoietic stem cells and their niche.
• The impact of sleep deficiency, sleep-disordered breathing, and other conditions on the pathogenesis of HIV-associated cardiopulmonary and cardiometabolic diseases, and contribution to cognitive impairment and dementia (VCID).
• Implementation strategies that improve uptake and sustainability of HLBS evidence-based interventions.
• Mechanistic studies to reduce the effects of HIV and aging on HLBS comorbidities, including traditional risk factors and sex differences.
• Novel biomarkers, imaging, or genomics to detect subclinical HIV-related HLBS conditions and strategies to mitigate clinical disease.

NIAAA focuses on the understanding of the complex role of alcohol use among PWH. Four research goals prioritize biological decline and integrated care implementation related to aging individuals.

• Quantify Frailty Trajectories: Determine the dose-response relationship between lifetime alcohol exposure and frailty phenotypes.
• Identify Reversibility Biomarkers: Evaluate if alcohol reduction reverses or stabilizes "inflammaging” and related organ injury biomarkers to establish if alcohol-HIV synergy are reversible through intervention.
• Optimize Integrated Care: Test implementation strategies that embed treatment for alcohol use disorder (AUD) directly into HIV clinics and to reduce stigma and polypharmacy hurdles via single-point-of-care models. 
• Mitigate Functional Decline: Assess if combining AUD treatment with geriatric interventions reduces falls and HAND, extending "healthspan" and functional independence.

NIAID is interested in supporting research to advance the understanding of aging in people with HIV (PWH). Below are examples of areas of interest:

• Clinical, immunologic, genetic and molecular factors associated with premature aging and end-organ diseases
• Diagnostic tools to identify and monitor aging risks
• Strategies and therapeutics to prevent, slow or alleviate the co-morbid conditions associated with aging
• Indicators/Factors associated with aging in older PWH and those with long-term antiretroviral exposure

NIAMS supports observational, biopsychosocial/behavioral, translational, basic, pre-clinical, and clinical research, as well as mechanistic clinical trials, that examine how aging in the presence or treatment of HIV/AIDS influences diseases within the NIAMS core mission. These conditions are more prevalent among aging populations and include rheumatologic disorders, bone fractures, osteoporosis, osteoarthritis, and skin diseases. NIAMS also encourages interdisciplinary research to elucidate factors that contribute to the development of NIAMS mission-related diseases among individuals aging with HIV/AIDS, and to better understand how the interaction between aging and HIV/AIDS may accelerate or exacerbate these conditions.

NIDA seeks research on the impact of substance use (SU) and SU disorders (SUD) on HIV acquisition, prevention, care, and clinical course in older people with HIV (PWH). Substances of interest include cannabinoids, nicotine, stimulants, opioids, and polysubstance use.

• Leveraging epidemiological data to evaluate effects of aging on SU patterns and associations with viral suppression, mortality, and comorbidities among aged PWH
• Examining long-term HIV and SU patterns on service utilization, health disparities and medical consequences
• Optimizing evidence-based prevention and care interventions and development of non-pharmacologic therapies to reduce SU in older PWH
• Genomic, metabolomic, neuroimmune studies of aging brain or human-based cellular models at nexus of antiretroviral therapies (ART), HIV, and SUD
• Assessing the impact of chronic SU on age-related cognitive/behavioral deficits in PWH
• Aging-related changes affecting drug metabolism and ART

NIDCR encourages basic, translational, and clinical research investigating how aging impacts the presence, progression, or treatment of HIV-associated dental, oral, and craniofacial (DOC) comorbidities, co-infections, and complications (CCCs) in PWH. Periodontal disease, oral candidiasis, oral mucositis, impaired wound healing, oral, oropharyngeal and salivary gland cancer are of particular concern. Examples include but are not limited to: 

• Mechanisms of DOC disease development and progression in the context of HIV, aging, and antiretroviral therapy (ART)
• Age-related compounding effects of HIV/AIDS and different HIV treatment regimen on DOC health in PWH and their quality of life
• Prevention, detection, or treatment of DOC diseases and management of other aging-related comorbidities and chronic disease risk factors in older PWH and/or elderly individuals at risk for HIV
• Development of oral-cavity-based prophylactic strategies to address DOC CCCs faced by PWH with a long-term ART

NIDDK is interested in projects on aging mechanisms that contribute to comorbidities and complications. Key topics include:

• Implementation & dissemination science strategies to overcome barriers for older adults with HIV in managing co-morbid conditions within NIDDKs mission, and deliver treatment for type 2 diabetes and obesity in HIV care.
• Understanding pathophysiology of NIDDK-related comorbidities.
• Impact of HIV or its treatment on metabolism, blood development, and gastrointestinal immune function.
• Viral reservoir dynamics in sites like the gastrointestinal tract, adipose tissue, liver, kidney, and male genital tract.
• Social determinants affecting co-occurring NIDDK-related conditions and evaluating related health programs.

Areas of interest include:

• Interactions between HIV and mental health across the aging spectrum, including depression, anxiety, and their bidirectional effects on cognition, functional capacity, and treatment outcomes.
• Behavioral, psychosocial, and structural determinants of aging with HIV, including stigma, stress, social isolation, socioeconomic factors, health behaviors, and factors that promote resilience and successful aging.
• Multilevel interactions among HIV and comorbid disease, alongside their combined effects on neuropsychiatric outcomes, disability, and long-term mental and cognitive health.

NINR emphasizes research addressing conditions of daily life that influence health and that is informed by and developed with communities.   NINR is interested in research to develop innovative community-based models of care that intervene on conditions of daily life to improve outcomes among older adults living with HIV.

OAR aims to advance interdisciplinary research and training to better understand, prevent, and address the health needs and comorbidities experienced by people aging with HIV, ultimately improving their health outcomes and quality of life.

OBSSR is interested in behavioral and social science aspects of HIV/AIDS and aging. 

ODP is particularly interested in projects that test approaches for preventing HIV infection and implementing evidence-based interventions for preventing HIV-related chronic conditions, comorbidities, and improving health outcomes in older people with HIV. 

ORWH is interested in research projects that address topics of relevance to aging, HIV, and women, including menopause 

• Projects to understand and address social isolation and loneliness in the context of HIV and aging.
• Community-led interventions to improve testing, prevention, and treatment among older populations of women.
• Comorbidity and multi-morbidity among older populations of women living with HIV.
• Understanding the influence of sex on HIV infection and pathogenesis in the context of aging.
  • Understanding the role of HIV in stress and mental health in the context of aging in women living with HIV.
• Community-centered interventions to engage older women in HIV research, including HIV cure-related research.