Efforts to end the HIV epidemic must not ignore people already living with HIV

NIH experts highlight importance of addressing HIV-associated comorbidities.

People living with HIV have an increased risk of developing numerous other conditions, even when HIV is treated with antiretroviral therapy. NIAID

What

Efforts to prevent new HIV transmissions in the United States must be accompanied by advances in addressing HIV-associated comorbidities to improve the health of people already living with HIV, National Institutes of Health experts assert in the third of a series of JAMA commentaries. Previous commentaries detailed the proposed Ending the HIV Epidemic: A Plan for America, which aims to reduce new HIV transmissions in the United States by 75% in five years and 90% in 10 years, and discussed the challenges posed by the emerging opioid injection epidemic in rural areas.

Assuming the aspirational goals of Ending the HIV Epidemic are achieved, at least one million people in the United States still will be living with the virus. With effective antiretroviral therapy (ART), people with HIV can expect a near-normal lifespan. But even when treated with ART, people living with HIV are at heightened risk for numerous comorbidities, including heart disease, kidney disease, osteoporosis, liver disease, certain cancers and neurocognitive disease.

Successfully addressing HIV-associated comorbidities will require research advances to better understand how these conditions develop, write Anthony S. Fauci, M.D., director of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and colleagues. Clinical trials to assess treatments for HIV-associated comorbidities and efforts to reduce health care disparities also must be prioritized.

Insight into the mechanisms underlying the chronic immune activation and dysfunction associated with HIV could lead to new therapies to manage numerous HIV-associated comorbidities, including heart disease. In this regard, the REPRIEVE clinical trial is investigating whether a statin medication can reduce the risk of cardiovascular disease among people with HIV. Other factors involved in driving HIV-associated comorbidities include side effects of long-term ART use, such as lowered bone mineral density, and coinfections, such as viral hepatitis. Establishing a better understanding of these comorbidities and how to manage them will be essential to reduce the burden these conditions place on individuals and the health care system, the authors conclude.

Article

AM Lerner, RW Eisinger and AS Fauci. Comorbidities in persons with HIV: the lingering challenge. Journal of the American Medical Association DOI: 10.1001/jama.2019.19775 (2019).

AM Lerner and AS Fauci. Opioid injection in rural areas of the United States: a potential obstacle to ending the HIV epidemic. Journal of the American Medical Association DOI: 10.1001/jama.2019.10657 (2019).

AS Fauci et al. Ending the HIV epidemic: a plan for the United States. Journal of the American Medical Association DOI: 10.1001/jama.2019.1343 (2019).

Who

NIAID Director Anthony S. Fauci, M.D., is available for comment.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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