People living with HIV who have access to antiretroviral therapy (ART) are living longer and healthier lives. The clinical management of such patients is evolving towards a new spectrum of comorbidities.
Current antiretroviral medications have improved side effect profiles and afford new opportunities for ART optimization and toxicity management. There is a greater awareness of increased risks of certain comorbidities than HIV-uninfected individuals. Diseases of the cardiovascular system, kidneys, liver, cognitive function, malignancies, and metabolic bone disease appear to be more common among HIV-infected patients. Certain infections continue to be a significant cause of comorbidities in such patients, including viral hepatitis and human papilloma virus; yet new agents to treat hepatitis C virus (HCV) infection will dramatically alter the prognosis of coinfected individuals. There is a growing appreciation for the importance of considerations of mental health, as well as sexual and reproductive health.
Overall, the goal of care is to help people living with HIV to age as healthy as possible. Integrating the disease prevention and management of this wide range of issues will be a challenge to clinicians and HIV support services. Healthcare providers caring for people living with HIV must be knowledgeable not only about HIV treatment but also about the management of other comorbidities in the context of HIV.