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HIV, or human immunodeficiency virus, is a chronic condition that attacks the body’s immune system, specifically the CD4 cells or T cells. If left untreated, HIV can progress to acquired immunodeficiency syndrome (AIDS), a life-threatening condition characterized by a severely weakened immune system. However, with the advent of antiretroviral therapy (ART), people living with HIV (PLHIV) can now achieve viral suppression and live longer, healthier lives.
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As the life expectancy of PLHIV continues to increase, so does the prevalence of comorbidities, or the presence of one or more additional conditions co-occurring with a primary condition. In the context of HIV/AIDS, comorbidities refer to chronic health conditions that are more common in PLHIV compared to the general population, such as cardiovascular disease, diabetes, chronic kidney disease, and certain cancers.
| Common HIV/AIDS Comorbidities | Prevalence in PLHIV |
|---|---|
| Cardiovascular disease | 1.5-2 times higher |
| Diabetes | 2-4 times higher |
| Chronic kidney disease | 3-4 times higher |
| Non-AIDS-defining cancers | 2-3 times higher |
Source: HIV.gov
Cardiovascular Disease.
Cardiovascular disease (CVD) is one of the most common comorbidities in PLHIV, with studies showing a 1.5 to 2-fold increased risk compared to the general population. The increased risk of CVD in PLHIV can be attributed to several factors, including chronic inflammation, immune activation, and the effects of certain antiretroviral medications. Additionally, traditional risk factors such as smoking, hypertension, and dyslipidemia are more prevalent in PLHIV.
To manage CVD risk in PLHIV, healthcare providers should regularly screen for and manage traditional risk factors, such as hypertension, dyslipidemia, and diabetes. Lifestyle modifications, such as smoking cessation, regular physical activity, and a heart-healthy diet, should also be encouraged. In some cases, medication may be necessary to manage risk factors or treat established CVD.
Diabetes.
The prevalence of diabetes is 2 to 4 times higher in PLHIV compared to the general population. The increased risk of diabetes in PLHIV can be attributed to several factors, including chronic inflammation, certain antiretroviral medications, and traditional risk factors such as obesity and physical inactivity.
To manage diabetes risk in PLHIV, healthcare providers should regularly screen for diabetes and prediabetes, and provide lifestyle counseling on healthy eating, regular physical activity, and weight management. In some cases, medication may be necessary to manage blood sugar levels.
Chronic Kidney Disease.
Chronic kidney disease (CKD) is another common comorbidity in PLHIV, with a prevalence 3 to 4 times higher than the general population. The increased risk of CKD in PLHIV can be attributed to several factors, including direct damage to the kidneys by HIV, side effects of certain antiretroviral medications, and traditional risk factors such as hypertension and diabetes.
To manage CKD risk in PLHIV, healthcare providers should regularly monitor kidney function through blood and urine tests, and manage risk factors such as hypertension and diabetes. In some cases, adjustments to antiretroviral regimens may be necessary to minimize nephrotoxicity.
Non-AIDS-Defining Cancers.
As PLHIV live longer, the incidence of non-AIDS-defining cancers (NADCs) has increased. NADCs are cancers that are not directly related to HIV infection, such as lung cancer, liver cancer, and anal cancer. The risk of NADCs in PLHIV is 2 to 3 times higher than the general population, which can be attributed to several factors, including chronic inflammation, immune dysfunction, and certain viral co-infections such as hepatitis B and C.
To manage NADC risk in PLHIV, healthcare providers should regularly screen for and manage risk factors such as smoking, alcohol use, and viral hepatitis. Age-appropriate cancer screenings, such as mammograms and colonoscopies, should also be encouraged. In some cases, vaccination against cancer-causing viruses, such as human papillomavirus (HPV), may be recommended.
Integrating Comorbidity Management into HIV Care.
Given the increased risk of comorbidities in PLHIV, it is essential to integrate comorbidity management into routine HIV care. This requires a multidisciplinary approach that involves collaboration between HIV specialists, primary care providers, and other specialists as needed.
Key components of integrated comorbidity management in HIV care include:
- Regular screening for comorbidities and risk factors
- Lifestyle counseling on healthy behaviors, such as smoking cessation, physical activity, and healthy eating
- Management of traditional risk factors, such as hypertension, dyslipidemia, and diabetes
- Adjustment of antiretroviral regimens to minimize side effects and drug-drug interactions
- Age-appropriate cancer screenings and vaccinations
- Referral to specialists as needed for management of established comorbidities
By integrating comorbidity management into HIV care, healthcare providers can help PLHIV achieve optimal health outcomes and quality of life. This requires a proactive, patient-centered approach that addresses the unique needs and challenges of aging with HIV.
The Role of Research in Advancing Comorbidity Management.
Research plays a critical role in advancing our understanding of comorbidities in PLHIV and developing effective strategies for prevention and management. Several ongoing studies are investigating the complex interplay between HIV, aging, and comorbidities, with the goal of improving health outcomes and quality of life for PLHIV.
One such study is the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study (MACS/WIHS), a long-running cohort study that has been following PLHIV since the early days of the epidemic. Recently, the National Heart, Lung, and Blood Institute (NHLBI) announced a new phase of the MACS/WIHS study that will focus specifically on chronic health conditions in PLHIV.
The new phase of the MACS/WIHS study, called the MACS/WIHS Combined Cohort Study (MWCCS), will enroll 3,000 PLHIV and 1,500 HIV-negative individuals from across the United States. The study will collect data on a wide range of health outcomes, including cardiovascular disease, lung disease, diabetes, and cognitive function, with the goal of identifying risk factors and developing targeted interventions for comorbidities in PLHIV.
Other ongoing studies are investigating the role of early screening and intervention in addressing comorbidities in PLHIV. For example, a recent study published in the journal Physicians Weekly highlighted the importance of early screening for comorbidities in older patients with HIV. The study found that older PLHIV are at increased risk for multiple comorbidities, including cardiovascular disease, diabetes, and cognitive impairment, and that early screening and intervention can help prevent or delay the onset of these conditions.
Bottom Line.
As PLHIV live longer thanks to effective antiretroviral therapy, the management of comorbidities has become an increasingly important aspect of HIV care. By integrating comorbidity management into routine HIV care, healthcare providers can help PLHIV achieve optimal health outcomes and quality of life. This requires a multidisciplinary, patient-centered approach that addresses the unique needs and challenges of aging with HIV.
Research will continue to play a critical role in advancing our understanding of comorbidities in PLHIV and developing effective strategies for prevention and management. Through ongoing studies like the MACS/WIHS Combined Cohort Study and others, we can identify risk factors, develop targeted interventions, and ultimately improve health outcomes for the growing population of PLHIV living with comorbidities.
As we look to the future of HIV care, it is clear that addressing comorbidities will be a key priority. By working together – researchers, healthcare providers, policymakers, and PLHIV themselves – we can rise to this challenge and ensure that all PLHIV have the opportunity to live long, healthy, and fulfilling lives.
Disclaimer: The information provided in this article is for educational purposes only and is not intended as medical advice. Always consult with a healthcare professional for medical advice, diagnosis, or treatment.
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