People Living With HIV at Higher Risk of Other Diseases

In just a scant few decades, HIV has evolved from an untreatable death sentence into a manageable disease that can be kept in check with antiretroviral drugs. But along with the opportunity to now live a normal or near-normal lifespan, people with HIV also are susceptible to a variety of other diseases and conditions, a large-scale umbrella review finds.

A team of investigators headed by researchers at Anglia Ruskin University in Cambridge, England, and Austria’s Medical University of Vienna examined 20 meta-analyses of studies of people with HIV. Fifty-five unique health outcomes were included in the studies, and a total of 8 health outcomes offered evidence that was either highly suggestive or suggestive of an association with HIV. The report was published in the Infectious Diseases Society of America’s Clinical Infectious Diseases journal.

According to the results, coughing was highly suggestive of a link to HIV in cross-sectional studies, although in cohort studies it was pregnancy-related deaths and ischemic heart disease that were highly suggestive of HIV infection. The 5 conditions that had suggestive evidence of association with HIV were breathlessness, elevated risk of chronic obstructive pulmonary disease (COPD), sepsis in pregnancy, higher risk of anemia, and fracture risk. These conditions exist in people with HIV even though antiretroviral therapy (ART) has been widely available for some time.

The authors acknowledge that some of the health conditions linked to people with HIV may be due not to HIV itself but to lifestyle factors. For example, a higher prevalence of smoking among people with HIV in higher-income settings may result in more people who develop COPD or cardiovascular problems. Higher rates of drinking and drug use also contribute to concurrent illnesses. Some comorbidities may be due to the toxic side effects of previous HIV therapies such as renal failure, and some may be chalked up to the aging process. But the authors acknowledged that HIV’s inflammatory properties may play a part in the greater disease burden borne by those who live with it.

Lee Smith, BSc, MSc, PhD

“HIV is a systemic disease of the immune system, and the damage on it is greater the longer the disease is not readily diagnosed,” Lee Smith, BSc, MSc, PhD, reader in physical activity and public health and director of research and income generation, Cambridge Centre for Sport and Exercise Sciences at Anglia Ruskin University, and the lead author of the study, told Contagion®. Referring to a “persistent state of generalized inflammation” caused by HIV during chronic infection, he said, “this inflammatory state, which tends to persist even in the case of effective viral suppression, can alter the immune response and [cause] over time significant damage to the cardiovascular system, renal function, and the central nervous system.”

Smith’s message to clinicians who treat patients with HIV is to not view the patient through the narrow lens of the virus. “Today it is not uncommon to have HIV-positive patients in treatment who are 70 or 80 years [old]—unthinkable up to 10 years ago,” he said. “For this reason, the role of the doctor is also to...train patients on what are the comorbidities linked to [living with HIV for many] years, such as cardiovascular diseases, diabetes, [and the like].” Smith said he hopes for further research to shed light on the best ways to prevent and treat comorbid conditions in people living with HIV.