Aging with HIV infection: A journey to the center of inflammAIDS, immunosenescence and neuroHIV

• In the last decade the number of aged HIV+ individuals has been dramatically increasing.
• HIV infection is characterized by a persistent immune activation.
• Immunosenescence contributes to a chronic inflammatory status called inflammaging.
• Despite successful HAART, the persistence of latent virus in the CNS leads to cognitive impairment and neurodegeneration.

In the last years, a significant improvement in life expectancy of HIV+ patients has been observed in Western countries. The parallel increase in the mean age of these patients causes a parallel increase in the frequency of non-AIDS related complications (i.e., neurocognitive, cardiovascular, liver and kidney diseases, metabolic syndrome, osteoporosis, non-HIV associated cancers, among others), even when antiviral treatment is successful. Immune activation and persistent inflammation characterizes both HIV infection and physiological aging, and both conditions share common detrimental pathways that lead to early immunosenescence. Furthermore, HIV-associated neurocognitive disorders represent important consequences of the infection. The persistent systemic immune activation, the continuous migration of activated monocytes to the central nervous system and progressive patients’ aging contribute to develop neuronal injuries, that are in turn linked to HIV-associated neurocognitive disorders, which can persist despite successful antiretroviral treatment.