HIV and Comorbidities

More and more people living with HIV and AIDS (PLHA) are accessing effective antiretroviral therapy and living longer. As they age, they develop chronic age-related illnesses, and are often at greater risk of these than HIV-uninfected people of similar age.

People with HIV are more likely to have cardiovascular disease (CVD), for example, and are at an increased risk of heart attacks, heart failure, stroke, and sudden cardiac death. Several factors are thought to contribute to this greater risk, including direct damage to the heart muscle, persistent chronic inflammation and immune activation, side effects associated with antiretroviral treatment, and behavioral risk factors such as smoking. Many PLHA also have other traditional CVD risk factors, including high blood pressure and high blood cholesterol.

Kidney disease is frequently seen in PLHA as well. HIV infection of the kidneys, some HIV medications, some medications to treat opportunistic infections, and some pain medications all contribute to this problem. High blood pressure and diabetes, the most common causes of kidney disease, also often factor in the development of kidney disease in PLHA. In addition, PLHA are more likely than their uninfected peers to experience symptoms of neurocognitive disease such as difficulties in thinking and memory, but such problems occur less frequently in people whose HIV is well-controlled.

Research also suggests that adults, children, and adolescents with HIV are at particular risk of mental health problems such as depression and anxiety. These conditions can be associated with substance use and greater HIV transmission risk, and are widely thought to contribute to the higher rates of treatment nonadherence and treatment failure seen in adolescents.

In the Asia-Pacific region, there is a need for further study of such comorbidities among PLHA, and for their associated clinical care to be better addressed. Adapting to these emerging needs, the TREAT Asia network is contributing to the regional evidence base on HIV and associated comorbidities, in order to better inform regional policy, programs, and service delivery.

TREAT Asia publications and analyses related to HIV and comorbidities can be accessed at https://www.amfar.org/treat-asia/scientific-publications/.