- Comorbidity and ageing in HIV infection
- Award date
- 27 January 2017
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
In the era of modern combination antiretroviral therapy (cART) the HIV-infected population is ageing. Studies have suggested that HIV-infected individuals, even if appropriately treated with cART, may be at increased risk for several age-related conditions.
In this thesis a variety of age-related conditions were examined within the AGEhIV Cohort, a cohort of ageing HIV-infected individuals, predominantly on long-term cART with suppressed viraemia, and HIV-uninfected controls of similar age and socio-demographic background. Through the collection of detailed information on HIV-disease history, ART exposure, traditional risk factors, markers of body composition and inflammation we were able to provide more insight into the pathophysiology of the conditions we studied.
HIV-infected study participants were more likely to have low bone mineral density, renal impairment, and had higher levels of markers of aortic stiffness and liver fibrosis. Furthermore, HIV infection was independently associated with a higher likelihood of frailty, a state of vulnerability to adverse outcomes. Our studies suggest that these age-related conditions may, to a larger extent than previously appreciated, be explained by factors unrelated to HIV infection and/or cART exposure. Many traditional and modifiable risk factors, such as cigarette smoking, hypertension, and dyslipidaemia are prevalent in HIV-infected populations; appropriately addressing them will decrease the burden of age-related comorbidity. Furthermore, the risk for age-related conditions was not evenly distributed among the HIV-infected population; those having experienced more advanced prior HIV disease appeared to be at particularly increased risk. Ongoing efforts to diagnose and treat HIV-infected patients early may also significantly decrease the risk for age-related comorbidity in the HIV-infected population.
Thesis (complete) (Embargo until 27 January 2019)
Chapter 3: Higher prevalence and faster progression of kidney disease in HIV-infected middle-aged individuals on stable combination antiretroviral therapy compared with uninfected controls (Embargo until 27 January 2019)
Chapter 4: Difference in aortic stiffness between treated middle-aged HIV type 1 infected and uninfected individuals largely explained by traditional cardiovascular risk factors, with an additional contribution of prior advanced immunodeficiency (Embargo until 27 July 2017)
Chapter 5: Liver fibrosis in HIV-infected individuals on long-term antiretroviral therapy: associated with immune activation, immunodeficiency and prior use of didanosine (Embargo until 27 June 2017)
Chapter 7: Cigarette smoking and inflammation, monocyte activation, and coagulation in HIV-infected individuals receiving antiretroviral therapy, compared with uninfected individuals (Embargo until 27 August 2017)
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