Comorbidity in HIV-infection: from epidemiology to immunology

Abstract

Outline of the thesis

The role of HIV-induced immune activation in relation to comorbidity in HIV-infected patients is the general theme of this thesis. More specifically, the prevalence of cardiovascular disease (CVD) and its associated risk in a HIV-infected population. Furthermore, the improvement of endothelial function, by adjustment of cART and the related immunological changes. Finally, the role of immune activation on osteoporosis in HIV infection is explored.

Results

The general conclusions of this thesis are that CIMT (carotid intima media thickness) is still increased in HIV-infected patients, predominantly caused by classical CVD risk factors, which are more prevalent in this population. Second, using CVD risk prediction can aid in awareness of the CVD risk and the risk factors causing this. Third, Immune activation in well-treated patients does not seem to influence CVD or osteoporosis, however cART does increase CVD risk factors and modification shows an effect in decreasing lipids and a slight increase in FMD, the latter needs to be interpreted with caution. Finally, in osteoporosis however a positive effect of NNRTI’s and a negative effect of PIs is seen.

Future perspective

I expect a decrease of CVD in HIV-infected patients in the coming years, due to a decrease in immune activation and adequate targeting of classical CVD risk factors. As more HIV-infected patients are started on cART upon diagnosis of HIV-infection, this will results in higher nadir CD4+ T cell counts and lower levels of immune activation. Furthermore, using modern technology, such as mobile applications and implementing these into the standard HIV-care can aid with the treatment of CVD through creating awareness and increasing self-management in the treatment of modifiable CVD risk factors. After acknowledgement of these risk factors and treatment as such, a similar decline in CVD as that seen in the general population will be seen in HIV-infected patients. The decline is already in motion, as reported by Klein et al.