HIV & Comorbidity in the era of modern antiretroviral therapy: Heritages of the past & challenges for the future

Abstract

The introduction of combination antiretroviral therapy (cART) has led to a dramatic increase in life expectancy for people living with HIV (PLWH). As a result, the long-term effects of HIV and cART on different organ systems are the main topics of interest in current HIV management. In this thesis, the focus is on comorbidity in three of these organ systems.

The first part encompasses the spectrum of liver disease in PLWH, the most important organ-specific cause of death in this population. We describe how the risk for mortality in people living with both HIV and Hepatitis B virus infection has declined over the years, coinciding with the introduction of the antiretroviral drug tenofovir. Furthermore, this part includes a narrative review on fatty liver disease, which is becoming the most prevalent liver disease among PLWH.

In part two, the focus is on bone-related disease in PLWH. In one of the chapters, data are presented suggesting that cART-related loss of bone mineral density is due to dysregulation of the parathyroid glands and calcium homeostasis.

In the last part of the thesis, two aspects of Pneumocystis jirovecii pneumonia (PJP) in PLWH are described. PJP is a pneumonia which occurs when patients have a severe impaired immune system and is the most common AIDS-defining condition in PLWH. Over the years, the treatment has improved significantly, but little is known on the long-term effects of PJP. In this part, the immunological recovery and the prevalence of persistent lung function abnormalities after PJP are described.