HIV positivity and “accelerated aging”

Is it caused by HIV or the drugs used to “treat” it?

By the early 1990s, prior to the emergence of multi drug cocktails and protease inhibitors, AIDS had already begun to morph from the “proto-AIDS” of the eighties, with an average estimate of 18 months from diagnosis of HIV-antibody-positive to full blown AIDS, to something that would be more appropriately termed “long haul AIDS”; in other words, HIV-antibody-positivity had already become a “chronic, manageable condition” years before “highly active antiretroviral treatment”, or HAART, became widely available.

Indeed, concerns regarding the most common AIDS-defining conditions of the early days of the epidemic—pneumocystis pneumonia and Kaposi’s sarcoma, in particular—evolved with the observation that HIV-antibody-positive individuals also seemed to suffer from conditions that have not been traditionally associated with immune deficiency at all, such as bone loss, inflammation, arthritis, cholesterol imbalances, melanoma, and more. This laundry list of conditions, including “frailty”, defined as “a clinical syndrome characterized by multi system dysregulation and increased vulnerability to stressors,” is confusing because most if not all conditions have nothing to do with immune deficiency.

Doctors are reporting a constellation of ailments in middle-aged patients that are more typically seen at geriatric practices, in patients 80 and older.

—Smith et al.

These conditions include those listed above, as well as insulin resistance and bone loss. Is there nothing that HIV, an admittedly structurally uncomplicated pathogen, cannot do? Or could other factors be at play?

Recall the Truvada lawsuits. Plaintiffs in these suits show evidence of kidney damage, bone loss, and more as a direct result of the anti-HIV nucleoside reverse transcriptase inhibitor (NRTI) Truvada. This should not be unexpected, as NRTIs are DNA chain terminators and are known to deplete mitochondrial DNA. According to the article “Premature and accelerated aging: HIV or HAART?”, not only do NRTIs cause mitochondrial damage, protease inhibitors as well “also cause severe mitochondrial damage by increasing oxidative stress and diminishing mitochondrial function.” Considering the Perth Group’s hypothesis that AIDS is, at least in part, a manifestation of oxidative stress, this finding is not insignificant.

The article under consideration is well worth reading. To summarize the most important points, consider the following quotes.

Life expectancy for treated HIV-patients […] is estimated to be 10-30 years less than that of the uninfected. […] These observations led to the hypothesis that the HART treated HIV-infected population is aging more rapidly. […] We postulate that strong correlations exist between antiretroviral drug-induced mitochondrial toxicity and premature and accelerated aging.

This is stated as follows:

We propose here that the premature and accelerated aging of HIV-patients can also be caused by adverse effects of antiretroviral drugs, specifically those that affect the mitochondria.

Furthermore, this 2009 article from New York Magazine, “Another kind of AIDS crisis”, examines this association, and also re-emphasizes the fact that “Current life expectancy charts show that people on HIV medications could live twenty years fewer on average than the general population.” The article pays particular attention to the cognitive decline seen in many HIV-antibody-positive individuals.

Most people who showed signs of dementia while alive do not have evidence of HIV in their autopsied brain. [emphasis mine] What they do have in common is evidence of persistent inflammation, which alone could account for the cognitive damage.

In fact, the lack of culpability of HIV is emphasized by the following statement.

The inflammation might be caused as much by the patient’s emotional and psychiatric burden as the virus’s pathological course.

Given the well known, established toxicities of so-called anti-HIV drugs, as well as the strong evidence we see that they might be directly contributing to accelerated aging via mitochondrial damage and massive inflammation, it is no wonder that there is still controversy around how to optimally administer these medications. The trend lately is to start them even prior to seroconversion, due to their use in pre-exposure prophylaxis (PrEP); but this approach is far from being universally embraced. Additionally, caution ought to be warranted, considering how often and how quickly the “science” changes around HIV. Recall in the mid nineties, with the advent of HAART, Dr. David Ho famously predicted that these drugs might actually clear HIV entirely. This has not occurred, but it has not stopped researchers and activists from calling for ever more aggressive treatment modalities. This quote from the article above published in 2009 remains relevant to this day, in particular as a warning regarding where the testing and treatment propaganda are concerned.

In a dramatic move last week, the National Institute for Allergies and Infectious Disease (NIAID) upped the ante even further by announcing a massive new plan to test virtually every single adult in the Bronx and the District of Columbia […] and put everyone who tests positive on anti-HIV drugs, whether they have depleted T cells or not. Dr. Anthony Fauci, the nation’s top AIDS official, said the main goal of the program was to stem transmission of the virus. Untreated patients are extremely infectious*. […] Still, the proposal is fraught with ethical peril. Because of the stigma associated with HIV infection, advocates have long insisted that testing for HIV should only be done in combination with extensive counseling. In addition, a number of leading researchers have called for more research on the drugs’ side effects before putting more people on them. [emphasis mine]

Given the massive, overwhelming evidence that anti-HIV drugs are manifestly unsafe , even if one assumes that HIV positivity itself poses a danger, it is nearly unimaginable that proponents of the HIV theory of AIDS would want to prescribe them to HIV-negative individuals as part of PrEP. The late Dr. Joseph Sonnabend, who was known for his cautious approach to treatment, sounded the alarm in 2009 regarding the concept of PrEP:

Joseph Sonnabend, the founding force behind AMFAR and a number of other agencies, is especially incensed by a proposal, currently under consideration by the CDC, to make the drugs available to people who are HIV-negative on the theory that they will help prevent transmission. [emphasis mine] “It’s all quite bizarre, and I wonder what is driving it.”

Anti-HIV drugs are not safe, yet they are meant to be taken for a lifetime, even among those considered to be “at risk” of seroconversion yet “uninfected.” Rather than barreling full steam ahead by trying to make every member of every risk group a customer for life of the pharmaceutical industry, it is high time to pull back and reassess the risks and benefits of such a regime, especially in light of the spurious correlation between HIV positivity and AIDS. Luckily, PrEP uptake remains low. Let’s hope it stays that way, because if it does not, the long term effects are likely to eclipse The Truvada disaster.

*Untreated patients are only “extremely infectious” in the imaginations of drug manufacturers and their promoters. By contrast, HIV is known to be nearly impossible to transmit sexually, especially compared with traditional STIs. The largest, longest study of sexual transmission of HIV, the Padian study, showed zero seroconversions in ten years among 175 serodiscordant couples, and no study shows significant transmissibility, with the exception of vertical (mother to child) transmission.

The Real AIDS Epidemic is available here.