Abstract
Background:
More than four decades ago, the world faced an unprecedented global health crisis with the emergence of the Human Immunodeficiency Virus (HIV) epidemic. The initial years were fraught with challenges and setbacks in HIV treatment. However, the landscape changed significantly with the introduction of combination antiretroviral therapy (cART), which has
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now become remarkably effective in suppressing HIV with minimal side effects. This progress has prompted a shift in focus towards optimizing treatment and monitoring beyond virologic suppression.
Optimizing Treatment and Monitoring of HIV:
Chapter 2 delves into the real-world effectiveness and tolerability of switching to doravirine-based ART. The findings indicate that doravirine-based triple therapy is a non-inferior, effective, and well-tolerated option for ART-experienced individuals.
In Chapter 3, the association between residual viremia and subsequent viral blips in virologically suppressed individuals is explored. Protease inhibitor-based regimens were found to be associated with higher odds of residual viremia.
Chapter 4 elaborates on the impact of different ART regimens on HIV-associated immune activation. Despite insufficient evidence to support the superiority of dual therapy over triple therapy, the study sheds light on the complex interplay between ART regimens and immune activation.
The neurocognitive effects of discontinuing efavirenz are investigated in Chapter 5, particularly focusing on reward processing. Discontinuation of efavirenz did not lead to significant alterations in reward processing in neurocognitive asymptomatic individuals with HIV.
Chapter 6 delves into response inhibition and potential neural mechanisms underlying cognitive improvement after discontinuing efavirenz. The study suggests that discontinuing efavirenz does not substantially affect response inhibition, providing reassurance regarding cognitive functions in individuals with HIV on efavirenz.
Optimizing Treatment and Monitoring of HIV-associated Co-morbidities:
Chapter 7 examines the association between prior Pneumocystis jirovecii pneumonia (PJP) and long-term pulmonary impairment. While past PJP was not independently associated with diffusion impairment, the study underscores the importance of smoking cessation in individuals with HIV.
In Chapter 8, concerns regarding the impact of past PJP on diffusion impairment are addressed. The study concludes that past PJP alone does not significantly affect diffusion impairment in optimally treated HIV.
Chapter 9 presents a quality improvement study aimed at enhancing guideline-adherent hepatitis B virus (HBV) care in people with HIV. The study identifies areas for improvement, such as HDV antibody screening and HBsAg monitoring.
Conclusion:
Chapter 10 discusses the main findings of the dissertation and presents future perspectives. It addresses knowledge gaps and recommends new research projects to further optimize HIV treatment and monitoring.
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