Multidisciplinary collaborative integrated management of increasingly prominent HIV complications in the post-cART era

Abstract

Objectives: With the prolonged survival time of AIDS patients, complications of various systems and organs of HIV infection are increasingly prominent. These diseases have become the major factors influencing the quality of life and prognosis of HIV-infected persons, and multidisciplinary cooperation treatment is urgently needed.

Methods: The Chinese HIV/AIDS Clinical Trial Network has conducted a series of multicentre clinical cohort studies over the past 16 years, in which studies related to people living with HIV systemic complications. Based on the results of previous studies, this review establishes the complications of Chinese people living with HIV after long-term cART.

Results: HIV's direct damage to human cells, chronic abnormal inflammatory activation after HIV infection, long-term drug side effects caused by cART and persistent reservoirs cause systemic complications in people living with HIV. We summarised the clinical characteristics of the complications of HIV infection in China from the aspects of the liver, cardiovascular, the nervous system, the kidney, bone metabolism, blood glucose, and lipid metabolism.

Conclusions: The management of the complications of HIV infection is a major link in improving the survival treatment and prognosis of patients in the future. The joint participation of doctors from different departments of general hospitals in the management of comorbidities is the main theme for future improvement of quality of life and prognosis for people living with HIV.

Keywords: AIDS; HIV; cardiovascular; cognitive disorder; complication; osteoporosis.

Fig 1

Multisystem complications of HIV infection. cART, combination antiretroviral therapy; HBV, hepatitis B virus; HCV, hepatitis C virus; NVP, nevirapine; ZDV, zidovudine; ABC, abacavir; EFV, efavirenz; PI, protease inhibitor; AS, atherosclerosis; TF, tissue factors; CSF, cerebrospinal fluid; CKD, chronic kidney disease; TDF, tenofovir; GFR, glomerular filtration rate; BMD, bone mineral density; DBP, vitamin D‐binding protein; 25OHD,25‐OH vitamin D; PTH, parathyroid hormone; IFG, impaired fasting glucose; BMC, bone mineral content; LM, lean mass; d4T, stavudine; ddI, didanosine.