Comorbidities and HIV

With the effectiveness of antiretroviral therapy (ART) over the past few decades, the management of HIV has moved from treating progressive HIV infection and declining immune function to managing HIV as a lifelong condition in an aging population with various comorbidities.

Regular screening for common comorbidities is essential as they can occur earlier in the HIV-positive person’s life than would otherwise be expected. Most comorbidities are not specific to HIV itself but are associated with ageing. These include:1, 2

  • Cardiovascular disease
  • Chronic obstructive pulmonary disease
  • Frailty
  • Liver disease
  • Many non-AIDS cancers
  • Neurocognitive dysfunction
  • Non-AIDS infections
  • Osteoporosis
  • Renal disease
  • Thromboembolic disease
  • Type II diabetes

Managing comorbidities as a multidisciplinary team

Screening and treatment are usually no different than that for HIV-negative individuals. However, a multidisciplinary approach, with relevant expertise from specialist colleagues, should be considered when managing multiple comorbidities in people living with HIV (PLHIV).3

Healthcare professionals (HCPs) who are unfamiliar with ART, should seek guidance from HIV specialists before any new treatment is prescribed as medications for some chronic comorbidities like diabetes and hypertension, may invoke adverse drug–drug interactions. In situations where PLHIV are seeing multiple HCPs, is important to ensure some level of shared-care arrangement.3

A healthy lifestyle

Lifestyle changes can help to decrease the risk of developing a comorbidity and reduce the impact of existing comorbidities. This may involve improvements to diet, giving up smoking or introducing an exercise regime.

Agreement about the best course of action with realistic goals can be facilitated with other members of the care team, including dietitians and exercise physiologists. The key to successful lifestyle changes, and indeed HIV infection, is empowerment of the central figure in the process – the PLHIV.

 

Benefits of smoking cessation intervention

The smoking rate in PLHIV is two to three times higher than in the general population. PLHIV who smoke face a higher risk of contracting serious illness compared with non-smokers but they might be less likely to respond positively to ART.2 PLHIV who smoke may also face an increased risk of death from cardiovascular disease and cancer compared with non-smokers, as well as an increased risk of AIDS-related death.4

By addressing the risks associated with smoking; discussing how it may affect chances of successful treatment and the benefits of quitting to overall health, PLHIV may feel determined to quit – even more so if they’re already considering stopping.