HIV, ageing and the eye

Sophia Pathai examines a participant in the HIV, ageing and the eye study

Caption: Sophia Pathai /LSHTM with a patient.


Examining the eye to investigate age-related eye disease and the biological mechanisms of ageing

The number of people living and growing older with HIV infection is increasing in sub-Saharan Africa. These people may also be at risk of ‘accelerated biological ageing’ – that is, at risk of age-related conditions at an earlier chronological age compared to uninfected people of similar age. The eye provides an excellent model for the investigation of not only age-related eye disease, but also the biological mechanisms of ageing in general.

Measuring biological ageing in the body (from blood samples) and comparing them with ocular markers of ageing may provide insight into accelerated ageing mechanisms in HIV infection and ultimately may enable age-related eye disease to be detected earlier, or enable detection of populations most at risk of developing age-related eye disease. It may also help us to understand general mechanisms of accelerated aging in HIV infection.

A recent ICEH study has focused on the use of non-invasive, non-painful, objective measurements of the eye that change with age, as well as assessment of general health and cellular aging. We investigated this in a population of HIV-infected people living in Cape Town, South Africa and compared the findings in a group of HIV-uninfected individuals of similar age and gender and living in the same area (‘controls’).

HIV-infected individuals in South Africa display greater biological ageing

We found that HIV-infected individuals in South Africa display greater biological ageing than their uninfected counterparts of similar age and socio-economic background. In addition, we found that markers of aging in the eye, such as the amount of opacity in the lens and the width of blood vessels at the back of the eye showed greater levels of biological ageing in HIV-infected individuals compared to controls. These findings suggest that the eye is a valuable tool to evaluate biological ageing in the rest of the body.

This study provides novel data about accelerated biological aging in sub-Saharan Africa and a platform for addressing future research questions related to accelerated aging mechanisms. As the HIV-infected population continues to age in sub-Saharan Africa, accelerated biological aging may have wide-ranging implications for the management of HIV in this region.


We would like to thank the Wellcome Trust for funding this study.


  • Sophia Pathai, Stephen D. Lawn, Helen A. Weiss, Colin Cook, Linda-Gail Bekker, and Clare E. Gilbert. Friedemann Paul, Editor Retinal Nerve Fibre Layer Thickness and Contrast Sensitivity in HIV-Infected Individuals in South Africa: A Case-Control Study. PLoS One. 2013; 8(9): e73694. Article
  • Pathai, S; Shiels, PG; Weiss, HA; Gilbert, CE; Peto, T; Bekker, LG; Wood, R; Wong, TY; Lawn, SD; Ocular parameters of biological ageing in HIV-infected individuals in South Africa: Relationship with chronological age and systemic biomarkers of ageing. Mech Ageing Dev. 2013 July; 134(7-8): 338–345. Article
  • Pathai S, Lawn SD, Gilbert CE, McGuinness D, McGlynn L, Weiss HA, Port J, Christ T, Barclay K, Wood R, Bekker LG, Shiels PG. Accelerated biological aging in HIV-infected individuals in South Africa: a case-control study. AIDS. 2013 Jun 6. Article
  • Pathai S, Gilbert CE, Lawn SD, Weiss HA, Peto T, Cook C, Wong TY, Shiels PG. Assessment of candidate ocular biomarkers of ageing in a South African adult population: Relationship with chronological age and systemic biomarkers. Mech Ageing Dev. 2013 May 20. pii: S0047-6374(13)00061-4. Article
  • Pathai S, Shiels PG, Lawn SD, Cook C, Gilbert C. The eye as a model of ageing in translational research – Molecular, epigenetic and clinical aspects. Ageing Res Rev. 2013 Mar;12(2):490-508. Abstract
  • Pathai S, Lawn SD, Shiels PG, Weiss HA, Cook C, et al. Corneal Endothelial Cells Provide Evidence of Accelerated Cellular Senescence Associated with HIV Infection: A Case-Control Study. PLoS ONE 8(2): e57422. Article
  • Pathai S, Lawn SD, Weiss HA, Cook C, Bekker LG, Gilbert CE. Increased ocular lens density in HIV-infected individuals with low nadir CD4 counts in South Africa: evidence of accelerated aging. J Acquir Immune Defic Syndr. 2013 Feb 11. Abstract
  • Pathai S, Gilbert C, Weiss HA, Cook C, Wood R, Bekker LG, Lawn SD. Frailty in HIV-Infected Adults in South Africa. J Acquir Immune Defic Syndr. 2013 Jan 1;62(1):43-51. Article
  • Pathai S, Weiss HA, Lawn SD, Peto T, D’Costa LM, Cook C, Wong TY, Gilbert C. Retinal Arterioles Narrow with Increasing Duration of Anti-Retroviral Therapy in HIV Infection: A Novel Estimator of Vascular Risk in HIV? PLoS ONE 7(12): e51405. Article
  • Pathai S, Lawn SD, Gilbert C. Cytomegalovirus retinitis associated with HIV in resource-constrained settings: systematic screening and case detection. International Health – June 2012 (Vol. 4, Issue 2, Pages 86-94,). Abstract

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