A Research Agenda for HIV Survivors
Monday, March 2, 2015
Chronic disease among HIV positive people has been overlooked, say K. M. Venkat Narayan and Sten Vermund.
Over 35 million people worldwide are living with HIV. Massive global efforts and investments to deliver combination antiretroviral therapy (ART) have transformed a fatal infectious disease into a chronic, treatable disease.
HIV-infected people who comply with ART now have near-normal lifespans — but as a result they may face the new threat of chronic noncommunicable diseases (NCDs). Stress, stigma, aging and HIV-related inflammatory changes increase the risk of some cancers as well as diabetes, heart disease, stroke, chronic kidney disease and mental health problems.
The huge gains made from implementing ART globally — 13 million people now get this treatment, nearly 90 per cent of whom live in low- and middle-income countries (LMICs) — will be lost unless the rise of NCDs in HIV survivors is addressed. High-income nations have been tackling this challenge since 1996, and it is time to do the same in LMICs too.
The problem of NCDs in HIV positive people in LMICs has been under-appreciated. This is partly due to scarce data and patchy evidence.
The extent to which HIV positive people who live in LMICs are at higher risk of NCDs than people who are HIV negative is unclear — as are the factors that might put them at higher risk. We also don’t fully understand whether HIV positive people differ from the general population in the disease patterns for various NCDs, either due to HIV itself or its treatment.