A report from Gabriel Chamie, MD, MPH, UCSF assistant professor of medicine, Division of HIV/AIDS, San Francisco General Hospital and Trauma Center:
Since HIV has became a manageable chronic disease following the introduction of effective combination antiretroviral therapy in the mid-1990s, there has been increasing awareness of the impact of HIV on non-AIDS events, such as cardiovascular disease and non-AIDS associated cancers.
In this [International AIDS Conference] session, speakers presented research addressing HIV infection and non-AIDS events.
J. Schouten presented data from a prospective cohort study in Amsterdam to pose the question of whether age-related co-morbidities are more prevalent at a younger age in HIV-infected vs. uninfected persons. Co-morbidities were significantly more prevalent among a clinic-based HIV-infected cohort vs. a control group identified from a sexually transmitted infection (STI) clinic, and the presence of multiple co-morbidities (in the same patient) occurred more commonly and at younger ages in the HIV-infected group.
As both HIV infection and activated platelets are associated with CV events, M. O’Brien and her co-investigators examined the association of HIV with platelet activation and the impact of low-dose ASA on platelet activity and immune activation over a one-week period. Twenty-five HIV-infected patients with an undetectable viral load for more than 6 months were compared to 44 HIV-uninfected subjects. Both groups were given aspirin (81 mg) and markers of platelet and immune activation were measured after one week.
At baseline, the HIV-infected group had increased platelet activation compared to the uninfected group, though the significantly higher smoking rates in the HIV-infected participants may have contributed to this. After one week of treatment, platelet aggregation and immune activation markers decreased in HIV-infected patients given aspirin. As an audience member commented, “It’s nice to see aspirin, which we give to everybody, finally being studied,” in HIV infection.
C. Dufouil examined the impact of diabetes and pre-diabetic hyperglycemia on cognitive function in HIV-infected adults in a cross-sectional analysis, and found increases in the prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorders and HIV-associated dementia in both pre-diabetic and diabetic patients compared to those without either. However, several questions remain unanswered, such as whether or not improved glycemic control improves cognitive function (or prevents further cognitive decline).
In data from a retrospective chart review from 2005-2011 in New York, M. Nigo presented a comparison of clinical and epidemiologic characteristics of acute stroke patients by HIV status. The HIV-infected patients (n=41) were on average younger and a greater proportion were male, African-American, and current smokers compared to HIV-uninfected stroke patients (n=101).
The strokes were more often ischemic and the severity of the strokes tended to be less severe in HIV-infected persons compared to HIV-uninfected persons. No differences were seen in the prevalence of hypertension, diabetes or hyperlipidemia, leading the investigators to conclude that HIV infection increases stroke risk, though several possible confounders (i.e. substance abuse [including cocaine]) were not measured.
In summary, with continued improvements in life expectancy among HIV-infected persons on effective antiretroviral therapy, non-AIDS conditions will continue to grow in importance and ongoing research into non-AIDS events, aging and HIV is needed.