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.1,2

Comorbidities and HIV

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 include3,4:

Cardiovascular disease

Chronic obstructive pulmonary disease

Frailty

Liver disease

Many non-AIDS cancers

Neurocognitive dysfunction

Osteoporosis

Renal disease

Type II diabetes

Managing comorbidities as a multidisciplinary team

Screening and treatment of comorbidities in people living with HIV (PLHIV) 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.4

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.4

In situations where PLHIV are seeing multiple HCPs, is important to ensure some level of shared-care arrangement.5

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.4,5

Agreement about the best course of action with realistic goals can be facilitated with other members of the care team, including dieticians and exercise physiologists.5

The key to successful lifestyle changes, and indeed HIV infection, is empowerment of the central figure in the process – the person living with HIV.

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, and might be less likely to respond positively to ART.4

They 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.6

By discussing these risks associated with smoking, PLHIV may feel determined to quit – even more so if they’re already considering stopping.

Educating your patients

It is important for PLHIV to know what health conditions are associated with living with HIV.

PLHIV can take control of their health by learning more about common comorbidities and their risk factors by visiting HIV IS: JUST A PART OF ME.

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