Longitudinal Study of HIV and Aging in Brazil

Project Summary / Abstract
This study will investigate the epidemiology, clinical implications, and immunologic and infectious determinants
of aging-related diseases and outcomes in older people with HIV (PWH) in Brazil. In part a result of the long-
term effects of HIV infection and ongoing inflammation, older PWH experience high rates of non-communicable
diseases (NCDs) and early onset of geriatric syndromes including frailty, disability, and cognitive decline.
However, HIV is not alone as a chronic infection that can cause inflammation and other immunological
changes associated with these outcomes. Our knowledge of how other chronic infections endemic to low-and
middle-income countries affect the pathogenesis and epidemiology of geriatric syndromes in is lacking. A
middle-income country with a large population of older PWH, Brazil has a history of comprehensive HIV care
as well as endemic chronic infections. This diverse, longitudinal study will recruit PWH on antiretroviral therapy
≥50 years of age in three Brazilian cities (n=360 ages 50-64years and n=340 ages ≥65 years) to evaluate the
ways coinfections such as TB, HTLV-1, Chagas disease, toxoplasmosis, and others affect the epidemiology
and immunologic pathways of aging-related morbidity. We will examine the association of syndemics of
coinfections and social determinants of health with validated NCDs. We will prospectively evaluate how
individual and cumulative burden of coinfections predict incident geriatric syndromes. We will evaluate a novel
screening tool to assess vulnerability of older PWH for adverse clinical outcomes including death,
hospitalization, and new disability. This study will also investigate how coinfections affect biologic pathways of
inflammation which contribute to development of NDCs and geriatric syndromes Building upon established and
productive collaborations in HIV observational research in Latin America, this study is uniquely positioned to
provide urgently needed, high-quality data to understand aging with HIV in a global context. It will offer novel
insights into a diversity of infectious contributions to cellular mechanisms of aging experienced by PWH around
the globe.

Grant Number: 5R01AG071439-05
NIH Institute/Center: NIH
Principal Investigator: Jessica Castilho