Multidisciplinary Collaborative Integrated Management of Increasingly Prominent HIV Complications in the Post-cART Era

L Lin; TS Li

Disclosures

HIV Medicine. 2020;21(11):683-691. 

In This Article

Abstract and Introduction

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.

Introduction

Combination antiretroviral therapy (cART) can effectively control virus replication in people living with HIV (PLWH), which, in turn, develops into AIDS, a chronic infectious disease. The length of survival is not the primary concern of HIV-infected patients who are currently receiving treatment. The advent of cART and the introduction of early antiviral therapy have greatly reduced both the incidence of opportunistic infections and tumours in PLWH. While the survival period of patients with AIDS continues to improve, the persistence of the virus reservoir, abnormal immune activation and lifelong administration of HIV medication make patients more prone to heart, nerve, kidney, metabolism and other system and organ complications, defined as various non-AIDS-defining diseases (NADs). The comorbidities of both HIV- and non-HIV-infected patients have different clinical characteristics. The difference of the cART regimen has different effects on organs and complications among patients. During the post-cART era, these diseases have become the principal factors that affect the quality of life and prognosis of PLWH; therefore, it is urgent to conduct comprehensive treatment through multidisciplinary cooperation. The Chinese guidelines for diagnosis and treatment of HIV/AIDS (2018) proposed a whole-process management of HIV infection for the first time, which refers to a whole-process comprehensive diagnosis and treatment and service care management mode provided by a multidisciplinary team after HIV infection is diagnosed.[1]

The Chinese HIV/AIDS Clinical Trial Network (CACT) was established in 2004, initially involving 17 medical and health institutions. The CACT has conducted a series of multicentre clinical cohort studies over the past 16 years with the support of the Ministry of Science and Technology's National Key Technologies R&D Programme, in which studies related to PLWH systemic complications are listed (Table 1). Based on the results of previous CACT studies, this review establishes the complications of Chinese PLWH after long-term cART, aiming to provide clinicians from different departments with the clinical characteristics of the various complications of HIV infection. Moreover, we have formed a multidisciplinary team constituted by experts in infectious diseases to jointly promote the management of PLWH, namely the screening and treatment of NADs, thus improving quality and experience of life.

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