Age-Related Clonal Haematopoiesis in an HIV Evaluation Cohort (ARCHIVE)

The challenge

It is well-known that the ageing process in people with HIV (PHIV) differs from that in people without HIV. PHIV have accelerated biological ageing processes and also have more age-related medical comorbidities and are more frail than people without HIV. However, the reasons for this are not very well understood. As PHIV are now living longer with modern HIV treatment, HIV research and clinical care has become focused on understanding how HIV affects the ageing process and what can be done to optimise the health of ageing PHIV. This study focuses on comparing ageing-related molecular processes and clinical outcomes across HIV status.

The project

The ARCHIVE study is a longitudinal cohort study that was established to evaluate ageing-related molecular and clinical processes in older adults with and without HIV. The first study visit collected blood and clinical information from 426 individuals (220 with HIV and 226 without HIV) to compare the presence of clonal haematopoiesis (CH) in the blood of people with and without HIV. CH is a common finding in older people that develops when a genetic mutation (a small change to your DNA) is present within a small number of blood cells. Up to 1 in 10 people over the age of 60 years will have CH. CH is significant because it has been linked to increased inflammation and an increased risk of blood cancers and cardiovascular diseases.

The method

446 individuals (220 with HIV and 226 without HIV) were enrolled into the ARCHIVE cohort. The first study visit consisted of a blood sample, medical record review and a self-completed participant questionnaire. Blood was tested for CH mutations and the results of CH testing was compared across HIV status. Clinical outcomes and inflammatory biomarkers were also compared across HIV status and across those with and without CH. The second study visit is ongoing, and includes similar molecular and clinical assessments as the first study visit and additionally, a frailty evaluation.

The results

From the first study visit, our main findings were:

  1. CH was twice as common in participants with HIV than participants without HIV.
  2. Participants with HIV and CH also had higher levels of certain blood cell counts and markers of inflammation.
  3. We did not find that participants with HIV and CH had a higher rate of medical conditions such as heart problems or blood cancers, however larger studies are needed.

These results were published in Nature Medicine in June, 2021 (link in sidebar).

The impact

While more studies are required to confirm the findings in our study as well to find out why CH is more common in people with HIV, these results suggest new pathways behind the development of medical conditions in PHIV, and may identify future preventive measures to reduce CH in PHIV. Research in the area of ageing with HIV is critical to improving health outcomes in this increasing population of ageing PHIV.

Project collaborators
  • Peter MacCallum Cancer Centre
  • St Vincent’s Centre for Applied Medical Research
  • Holdsworth House Medical Centre
  • Prahran Market Clinic
  • East Sydney Doctors
  • RPA Sexual Health
  • The Alfred
  • St. Vincent's Hospital-Manhattan
  • Taylor Square Medical Practice
  • Monash Health
  • Albion Street Clinic
Project funding
  • National Health and Medical Research Council (NHMRC)
  • Department of Health and Ageing