Accelerated biological aging in HIV-infected individuals in South Africa: a case–control study

<br>Objectives: Little is known about the impact of HIV infection on biological aging in sub-Saharan Africa. The study aimed to assess biological aging in South African HIV-infected adults and HIV-seronegative individuals using two validated biomarkers, telomere length and CDKN2A expression (a mediator of cellular senescence).</br> <br>Design: Case-control study</br> <br>Methods: 236 HIV-infected adults aged >=30 years and 250 age- and gender frequency-matched HIV-seronegative individuals were recruited from clinics in township communities in Cape Town. Biological aging was evaluated by measurement of telomere length and CDKN2A expression in peripheral blood leukocytes.</br> <br>Results: The median ages of the HIV-infected and HIV-seronegative participants were 39 years and 40 years respectively. Among HIV-infected participants, 87.1% were receiving anti-retroviral therapy (ART), their median CD4 count was 468 cells/[mu]L and 84.3% had undetectable viral load. Both biomarkers were validated against chronological age in HIV-seronegative individuals. Telomere length was significantly shorter in HIV-infected individuals compared to HIV-seronegative individuals (mean relative T/S ratio+/-SE:0.91 +/- 0.007 vs. 1.07 +/- 0.008, p < 0.0001). CD2NKA expression was higher in HIV-infected participants compared to HIV-seronegative individuals (mean expression: 0.45 +/- 0.02 vs. 0.36 +/- 0.03, p = 0.003). Socio-economic factors were not associated with biological aging in HIV-infected participants. However, in participants on ART with undetectable viral load, biomarker levels indicated greater biological aging in those with lower current CD4 counts.</br> <br>Conclusions: Telomere length and CDKN2A expression were both consistent with increased biological aging in HIV-infected individuals. Prospective studies of the impact of HIV on biological aging in sub-Saharan Africa are warranted.</br&gt