1. HIV and ageing: study aims Aim: to examine the effects of ageing on medical and social outcomes of people living with HIV Example research questions: - What is incidence of medical complications in older HIV- positive people; what are impacts of ARVs, co-morbidities, virological/immunological status on incidence of these? - What are outcomes of complications in older HIV-positive people; how do these compare to controls? - Do plasma concentrations of ARV drugs change with age? - How do sexual behaviours and relationship patterns differ between younger and older HIV-positive patients? - What health services are used by older HIV-positive people and do these differ from controls?

2. HIV and ageing: study group Alan Winston: study co-ordination; CNS manifestations Caroline Sabin: study co-ordination; cohort design; statistical support Frank Post: renal and CV disease Marta Boffito: pharmacokinetic studies, CV disease Martin Fisher: resource utilisation; sexual health and behaviour Jane Anderson: treatment of women; behavioural and social aspects of HIV infection Jonathan Elford: behavioural and social research Ian Williams: HIV management and models of care Alec Miners: Health economics Memory Sachikonye: community liaison Karen Walker-Bone: rheumatology Paddy Mallon: bone disease John Cason: sample storage Neil Poulter: Imperial Clinical Trials Unit

3. HIV and ageing: study design Nested cohorts within UK CHIC and demographically matched HIV-negative controls HIV-positive cases: 900 HIV-positive subjects aged >50 years HIV-positive controls: 450 HIV-positive subjects, 150 aged 20- 29, 30-39 and 40-49 years, matched to cases for sex, ethnicity, sexual orientation, geographical location HIV-negative controls: 500 HIV-negative controls aged >50 years, matched to cases for age, sex, ethnicity, sexual orientation and geographical location Five-year study – Baseline plus three annual visits

4. HIV and ageing: study design HIV-positive subjects recruited from UK CHIC clinics Use of UK CHIC infrastructure and sampling frame to identify eligible HIV-positive subjects will minimize data collection costs Eligible patients selected randomly using clinic lists Patients will be contacted by clinicians to discuss participation; interested subjects will meet with study nurse who will provide written information HIV-negative controls recruited through HIV/GUM clinics, HIV/gay press, community organisations and churches

5. HIV and ageing: monitoring of subjects Baseline visit Demographics – age, sex, ethnicity, sexual orientation, country of birth, socioeconomic status Full clinical assessment – clinical and family history, lifestyle factors, anthropometrics, medications, adherence assessment Neurocognitive function – memory and motor function testing Quality of life and depression Pain assessment Sexual behaviour DXA scan Laboratory tests – renal, liver, lipid and bone profiles, glucose, thyroid function, FBC, sexual health screen, HCV serology, vitamin D levels Blood/urine samples stored

6. HIV and ageing: monitoring of subjects Annual follow-up visits Clinical examination, changes to lifestyle and socioeconomic status Significant clinical events – CV events, renal or liver failure, diabetes, malignancies, falls, fractures, joint disease, joint replacements Access to health care services – visits to GP, hospital, counsellors, psychiatrists, psychologists, medical investigations Assessment of fracture risk, neurocognitive function, quality of life and depression Pain Sexual behaviour Laboratory tests – as baseline Blood/urine samples stored at each visit (HIV-positive subjects) and at year 2 (HIV-negative controls)

7. HIV and ageing: work packages WP1: Data collection and management (A Winston, C Sabin) WP2: Clinical manifestations (F Post, A Winston, P Mallon, K Walker-Bone, J Anderson) WP3: Antiretroviral pharmacokinetics and drug interactions (M Boffito) WP4: Sexual health (J Elford, J Anderson, M Fisher) WP5: Socioeconomic circumstances (J Anderson, J Elford) WP6: Resource utilization and service delivery (I Williams, M Fisher, A Miners) WP7: Community involvement (M Sachikonye)

8. HIV and ageing: Current status Stage 1 application for programme grant to NIHR was successful Full stage 2 application due mid-October If successful, notified in March 2011 Awards commence – October 2011