Some 30 researchers from the University of California-San Francisco and the Gladstone Institute of Virology and Immunology have come together to investigate why HIV-positive patients, who are now living longer lives thanks to anti-retroviral drugs, seem to be aging faster than their uninfected peers.

"There's a long list of concerns that people have raised about the effects of chronic HIV infection on different health outcomes," says Dr. Paul Volberding, who as a co-chair of San Francisco's Center for AIDS Research is bringing together this group of scientists. UCSF/San Francisco General Hospital cardiologist Priscilla Hsue, for example, has found that HIV-positive patients (the patients she sees in San Francisco are mostly men) have heart attacks when they're around 50 years old. That's 10 years earlier than when your average, uninfected, man has a heart attack.

Other researchers have found that HIV-infected patients develop dementia younger and kidney failure at a faster rate than their uninfected peers. Volberding says that these patients are also showing accelerated bone loss and accelerated loss of their kidney function. These are all ways in which our bodies normally decline as we age. But in patients with HIV, the decline seems to be faster.

At the beginning, researchers believed that anti-retroviral drugs were causing the aging, but as research has progressed, the thinking has shifted. "The more nuanced recognition now is that maybe some of that was from the drugs," says Volberding, "but maybe some of it was because the drugs were working and patients were living longer and allowing us to see these other effects of chronic viral infection." Even though anti-retroviral drugs can bring the amount of virus in the body down to almost undetectable levels, there is always a tiny amount of HIV replicating inside a patient's body. And Volberding and others believe that this virus could be responsible for the sped-up aging.

UCSF molecular biologist Elizabeth Blackburn, another member of this new group, has spent her life studying the tips of our chromosomes, called our telomeres (pronounced TEAL-oh-meres), and the role they play in aging. Blackburn has found that as we age, our telomeres wear away and shorten. She has studied the telomeres in patients with heart disease and cancer, and now she wants to look at HIV patients' telomeres.

Listen to the Graying of HIV radio report online.

People with the delta 32 version of the CCR5 gene are more
resistant to HIV infection.
Doctors announced in Berlin that a man who received a bone marrow transplant for leukemia was now also free of his HIV infection. Looks like this patient's luck is finally turning around!

Both leukemia and AIDS are diseases of the blood. Bone marrow transplants cure leukemia by permanently replacing the patient's blood with the donor's. This eliminates the cancerous blood cells and so cures the cancer.

One "side effect" of a bone marrow transplant is that the patient's blood cells now have donor's DNA. This sometimes makes for problems at crime scenes (and interesting CSI episodes). But here the doctor used it to the patient's advantage.

Scientists have known for a long time that people with two copies of a certain version of the CCR5 gene, the delta 32 version, are much more resistant to HIV. Their AIDS symptoms also tend to progress much more slowly.

So the doctors reasoned that if the patient were going to receive a bone marrow transplant anyway, why not give him one from a donor with two copies of delta 32? And that’s just what the doctors did.

Over 20 months later, there is no sign of the patient’s leukemia. And no sign of HIV either.

We'll still need to wait and see if this result holds up. But even if it does, this cure isn't for everyone. It is expensive and very risky.

Around 1 in 4 patients dies from bone marrow transplants. I'm no M.D., but I would guess that patients at the later stages of AIDS would do even more poorly.

But if the result does hold up, then maybe scientists can figure out how to do something similar without the bone marrow transplant. Maybe they can find a medicine that can shut down the CCR5 gene and so get the same effects as the delta 32 version. Another possibility is gene therapy.

The idea would be to change the patient's CCR5 gene into the delta 32 version. This would be really hard.

Gene therapy is pretty good at adding a working gene to a cell. It is not very good at changing a patient's gene. This means it would not be easy to turn a CCR5 gene into the delta 32 version in a patient's bone marrow cells.

But maybe there is another way. The CCR5 gene is not the only way to be resistant to HIV. Another way is by having extra copies of the CCL3L1 gene. Perhaps scientists could add extra copies of this gene to a patient's bone marrow cells and help at least slow down HIV. This seems doable with gene therapy.

Although African Americans represent one eighth of the U.S. population, they make up half of the people living with HIV in the country, according to the Los Angeles-based Black AIDS Institute's 2008 report Left Behind – Black America: A Neglected Priority in the Global AIDS Epidemic." An African American woman is 23 times more likely to get infected with HIV than a Caucasian woman. And the overwhelming risk for black women is unprotected sex with men.

The reasons why African Americans are so burdened with HIV are complicated, says doctor Edward Machtinger, director of the Women's HIV Program at UCSF. The high rate of incarceration of African American men plays an important role, with men carrying HIV back to their female partners when they get out of prison.

HIV/AIDS is a disease of poverty. "Sexually transmitted diseases, in general, disproportionately afflict the poor," says Ruth Greenblatt, who is the founder of the Women's HIV Program and the principal investigator of the Northern California site of the Women's Interagency HIV Study. "If you have poor access to health care, you're less likely to see a doctor early on in your HIV infection, and thus you may be more likely to transmit infection, and you may be less likely to be able to afford condoms and medication."

HIV is now the leading cause of death for African American women between 24 and 35 years old. "Women tend to get sicker and die faster and more often than their male counterparts with HIV," says Machtinger. "One reason is that women don't perceive themselves to be at risk."

In its report, the Black AIDS Institute says that turning the tide is possible, but that it will require better planning and more funding from the federal government, and a stronger commitment from African American leaders. And the report calls for people to get tested. "Knowing your HIV status early can save your life," it concludes.

For patients who have access to drugs, infection with the virus ceased to be a death sentence in 1995, when combinations of drugs called highly active antiretroviral therapy (HAART) were developed. For some patients, drugs can reduce the amount of virus to undetectable levels.

But some virus always hides in the body's immune cells and attacks again if the patient stops taking their medication. Researchers are working on developing a drug to wipe out this latent virus, which could mean the end of AIDS.

Find out more about new research into HIV treatment and a possible cure by watching our HIV Research: Beyond the Vaccine television story report online.