Abstract
The world is now well into the third decade of use of effective anti-retroviral therapy (ART) that provides sustained control of HIV-1 viremia (viral loads <200 copies of HIV RNA/microliter). With few exceptions, control of HIV in individual patients is predictable and long lasting. Only a short time ago, the prevailing opinion was that HIV infection ‘physiologically aged’ an individual by ten years or more compared to uninfected subjects and could lead to premature frailty.1-4 Whereas these findings may have accurately characterized the untreated HIV-infected individual, they do not apply to those on ART. We discuss these concepts and show why they have not held up to scrutiny since clinical and cellular evidence contradict these statements. Theories about aging in HIV-positive patients arose in the early 2000’s5 about the time we began to study the course of HIV infection in our clinics, measuring frailty as well as obtaining and preserving blood samples from HIV- and healthy, age-matched control patients that allowed us to study cellular aging and immunity as well as the molecular features of HIV genes in viral quasispecies suppressed by ART.