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Review
. 2019 Dec 2;9(4):198-210.
doi: 10.18683/germs.2019.1178. eCollection 2019 Dec.

Consensus statement on the assessment of comorbidities in people living with HIV in Romania

Anca Streinu-Cercel  1 , Oana Săndulescu  1 , Cătălina Poiană  2 , Maria Dorobanţu  3 , Gabriel Mircescu  4 , Voichiţa Elena Lăzureanu  5 , Irina-Magdalena Dumitru  6 , Odette Chirilă  7 , Adrian Streinu-Cercel  8 ; Extended Consensus Group
Collaborators, Affiliations
Review

Consensus statement on the assessment of comorbidities in people living with HIV in Romania

Anca Streinu-Cercel et al. Germs. .

Abstract

Introduction: The life expectancy of HIV-infected patients has been increased by highly effective therapies. People living with HIV (PLWH) in Romania are exposed to age-related comorbidities occurring earlier than in uninfected individuals. Multidisciplinary care is required to maintain the general health and quality of life in these patients. Currently, the communication among different specialties needs to be enhanced and formalized.

Methods: A panel consisting of 8 Romanian experts in infectious diseases, cardio-metabolic, bone, and kidney diseases and psychology met in May 2019 in Bucharest Romania to discuss the need to evaluate and monitor the most prevalent comorbidities in PLWH. The meeting resulted in practical guidance on the management of several non-infectious associated diseases. The algorithms were endorsed by the Society for Infectious Diseases and HIV/AIDS, Romania.

Results: The consensus statement offers practical guidance on how to assess and monitor associated diseases in adult PLWH. The recommendations are grouped for each cluster of comorbidities and are based on international guidelines and clinical experience, including landmarks for referral of PLWH to cardiology, endocrinology, nephrology specialist or clinical psychologist for additional investigations and adequate treatment. Specific indications for diagnosis or treatment were beyond the scope of this consensus.

Conclusions: Screening for associated diseases and adequate management are required to maintain the overall health status of PLWH. When implemented in clinical practice, the recommended algorithms should be used in addition to diagnosis and treatment guidelines and protocols. The infectious diseases specialist plays a key role in coordinating the overall treatment strategy and working within the multidisciplinary team.

Keywords: HIV; PLWH; comorbidities; consensus statement; monitoring.

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Conflict of interest statement

Conflicts of interest: AnSC reports being sub-investigator in clinical trials by Merck and Gilead, principal investigator in an investigator sponsored research study funded by a Gilead grant, speaker for Gilead and participating in advisory boards for Gilead and ViiV, outside the submitted work. OS reports being sub-investigator in clinical trials by Merck and Gilead, and speaker for Gilead, outside the submitted work. AdSC reports being principal investigator in clinical trials by Merck and Gilead, speaker for Gilead and participating in advisory boards for Gilead and ViiV, outside the submitted work. AnSC, CP, MD, GM, VEL, IMD, OC and AdSC participated in the Gilead expert meeting/advisory board on the topic of comorbidities in PLWH. All other authors – none to declare.

Figures

Figure 1
Figure 1. Algorithm for monitoring and managing cardio-metabolic disorders in patients with HIV infection
ART - antiretroviral therapy; BMI - body mass index; BP - blood pressure; CV - cardiovascular; ECG - electrocardiogram; PLWH - people living with HIV. *If there are any HIV-related CVD-risk enhancers, the risk may be greater than calculated. Blue arrows represent the steps that can be managed by the ID specialist; red arrows represent enhanced collaboration with the cardiologist and/or diabetologist in higher risk patients for adequate monitoring and treatment.
Figure 2
Figure 2. Algorithm for monitoring and managing bone disease in patients with HIV infection
DXA - bone densitometry by dual-energy X-ray absorptiometry; CTX - C-telopeptide; P1NP - procollagen type 1 N-terminal propeptide; TBS - trabecular bone score. *As indicated in EACS Guidelines. Blue arrows represent the steps that can be managed by the infectious disease specialist; red arrows represent enhanced collaboration with the endocrinologist or other bone disease specialist in higher risk patients for adequate monitoring and treatment.
Figure 3
Figure 3. Algorithm for managing and monitoring kidney disease in patients with HIV infection
eGFR - estimated glomerular filtration rate; HBP - high blood pressure; RRT - renal replacement therapy. *D:A:D score for risk assessment. **Serum creatinine increased 1.5-fold from baseline, known or suspected to have occurred in the last 7 days. Blue arrows represent the steps that can be managed by the infectious disease specialist; red arrows represent referral to nephrologist in higher risk patients for adequate monitoring and treatment.
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References

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