Alan Winston, of Imperial College London, spoke to us at the HIV Endgame conference and answered questions about clinical challenges and research opportunities in HIV and aging.
The HIV Endgame logo appears on screen. Text reads: Alan Winston answers questions about HIV and aging. Alan Winston sits in front of a wood-paneled wall and asnwers questions from off screen interviewers. The text of each question appears in between clips.
Alan Winston: Hi there, my name is Alan Winston I’m a professor of HIV medicine at St. Mary’s Hospital in London and Imperial College in London. So, I’m a clinician. I look after people living with HIV, in the out patient and in the in patient setting, and I also run a several clinical research studies.
Q: How worried should we be about aging with HIV?
Winston: We mentioned at the plenary, are we setting on a time bomb? So, are things going to get worse and worse and worse for people living with HIV? And are we going to see more and more comorbidities and problems as people age? I think we also have to talk about the reassuring data that the risk factors for these comorbidities are probably changing over time as people with HIV are aging.
So we now have, when someone is now diagnosed with HIV, they start antiretroviral therapy at a much higher CD4 count, if they’re in a healthcare system. They start antiretroviral therapy with a much less toxic treatment. And the number of people presenting with AIDS-defining illnesses is a lot lower, thankfully, than in years gone by. So, these are all also important risk factors for complications, non-infectious complications. And, as these risk factors decline over the next decades, there’s also hope that the number of comorbidities or the age of onset of comorbidities in people living with HIV may also go down. So, I think there’s there’s reassuring data out there as well, that a lot of the risk factors, with HIV treatments improving, will actually decline.
Q: Do you see opportunities to collaborate in HIV care?
Winston: Yeah, I think that’s completely fundamental. That we have to be working with other healthcare professionals and other researchers with other areas of expertise. So, I am an HIV clinician. I can’t do everything myself. And I’m not the best person to see if you want to talk about cancer or how your kidneys are working. So, both on the clinical side it’s really important that we work with other specialists.
At our centre, at St. Mary’s, we do joint clinics. So, I run a joint HIV neurology clinic with one of the neurologists. So we have the HIV expertise and the neurology expertise, and we do this for many organs. So we have an HIV renal clinic, we have a metabolic clinic — and that really allows the patients coming through our services to get this joint expertise. I think, on the research side, we have been a little slow to engage in this approach, and it’s fundamental as well. We are working with geriatricians, with public health physicians, and within our network. But, yes, we need to be working with researchers from a whole host of different backgrounds.
Q: What are some good research opportunities in HIV and aging?
Winston: So, I think there’s several exciting areas to focus research on. So, a lot of work regarding HIV dementia or mild cognitive impairment and HIV disease has focused on antiretroviral therapy, and, historically, has focused on not enough drugs getting into the brain to prevent the virus from turning over. I think nowadays, with the modern antiretrovirals that were using, for the main — for the main part, most of the the treatments that we’re using, they do seem to suppress the virus in the nervous system. So the focus is moving a little bit towards, could the drugs actually have some toxicities on the nervous system?
Another interesting aspect, is the immune system affecting the brain and could thus lead to dementia or mild cognitive impairment? And there’s evolving work on biomarkers. So, measuring markers from lumbar puncture fluid, and also markers from imaging from MR and PET scanning, looking at inflammation in the nervous system.
Another important aspect are the other peripheral or peripheral comorbidities or medical problems outside the brain and the rest of the body, and how they could contribute to brain health and to cognitive function. So, we know that heart disease and kidney disease can affect that — can affect the brain. And there’s mounting evidence that these conditions affect the brain in people living with HIV as well. And studies looking at modifying risk factors and treating these peripheral diseases may have implications on brain health and cognitive function.
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Note on content: Interview questions have been edited for brevity.