Daniel DeMontigny

Anti-HIV drugs have saved millions of lives since their introduction in the mid-1990s. The average life expectancy of those infected would have increased significantly, but remains below that of the general population, at least for infected people in North America and Europe. While since the 1980s the focus has been on the control of opportunistic diseases and the significant side effects of monotherapies, the focus is now on the chronic diseases associated with HIV infection and triple therapy. According to a meta-analysis of 80 studies, published in 2018 and involving 793,635 people infected with HIV from 1990 to 2015, the leading cause of morbidity and mortality among HIV-positive people medicated would be due to cardiovascular disease (CVD), specifically in regions of the world with the highest rates of HIV infection, particularly in sub-Saharan Africa and Asia-Pacific, territories that encompass more than 60% of HIV-associated cardiovascular diseases worldwide, and in Europe ballast. The incidence of CVD would have tripled during this period.

In fact, the cardiovascular system is just one of the metabolic systems that would be affected by HIV: the liver, kidneys and bones, the central and peripheral nervous system, as well as the lungs, can also be affected together. In addition to this scenario, the metabolic syndrome (high triglycerides, bad cholesterol and glycemia, hypertension, abdominal overweight), mainly due to lifestyle, sedentary lifestyle but also to the presence of HIV, co-morbidities such as hepatitis C and, in some parts of the world, tuberculosis. In addition, some types of cancer, unrelated to AIDS, may develop

in the presence of chronic infections and would be strongly associated with the degree of immunodeficiency caused by HIV (CD4 + count). Several factors independently cause an inflammatory environment, even with undetectable viral load. It is shown that the immune system of an infected person would behave like a very old individual, so-called immunosenescence, which would result in an intensified inflammation of the body, thus causing the degeneration of several systems. and, consequently, a higher rate of disease and mortality. According to this model, people infected with chronic viral diseases would experience premature and accelerated aging.

Some factors predispose this acceleration: HIV (treated or untreated), type of treatment and duration, co-morbidity with other chronic or metabolic diseases, age over 45 or regular injecting drug use .

Diagnosis and initiation of treatment at a later stage of infection would complicate the prognosis. Regular screening and prompt treatment can reduce related metabolic complications and improve quality of life. The accumulation of inflammatory factors accelerates degeneration and one must manage what can be controlled such as the quality and quantity of food, regular exercise moderate (shorter and intense for better results), reducing its consumption of alcohol, improved sleep, reduced or eliminated smoking. Regular follow-up with your doctor, preferably in a multidisciplinary team, ensures faster detection of metabolic and systemic diseases and determines appropriate treatments.