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complications in patients with HIV1 infection

Complications: 1) opportunistic infections* 2) malignancies - non-Hodgkins lymphoma - Burkitt lymphoma (spontaneous tumor lysis syndrome) - primary CNS lymphoma - Kaposi sarcoma - papillomavirus-related malgnancies - cervical cancer - prostate cancer & lung cancer may become the most common malignancies among persons living with HIV by 2030 [6] - long-term suppression of HIV1 with antiretroviral therapy attenuates cancer risk [7] - suppressed patients still at higher risk than general population - unsuppressed: 1748 cases per 100,000 person-years - early suppression (<2 years): 1475 per 100,000 - long-term suppression (2+ years): 1155 per 100,000 - uninfected veterans: 742 per 100,000 [7] 3) dermatologic conditions - Herpes zoster (prior to development of AIDS) 4) ocular disorders - CMV retinitis 5) oral disorders 6) respiratory tract disorders - increased risk of invasive infection with Streptococcus pneumoniae - bacterial pneumonia prior to development of AIDS - pulmonary hypertension (0.5%) no relation to CD4 count [13] 7) gastrointestinal disorders 8) hepatobiliary disorders, including cirrhosis 9) pancreatic disorders 10) renal disorders 11) rheumatologic disorders 12) urogenital disorders - vaginal candidiasis (prior to development of AIDS) - sexually-transmitted disease - syphilis: diagnosis & management same with & without HIV1 infection [14] 13) neurologic disorders: - chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) - antiretroviral therapy for prevention & treatment [1] 14) hematologic disorders - HIV1-induced thrombocytopenia 15) endocrine disorders a) insulin resistance - control of diabetes b) hyperlipidemia from antiviral protease inhibitors c) body fat distribution changes [1] 16) cardiac disease - cardiovascular risk is higher in patients with HIV1 infection than the general population [1] - cardiovascular risk from hyperlipidemia caused by antiviral protease inhibitors is more than offset by risk reduction associated with controlling HIV1 infection [1] - smoking cessation - atorvastatin for hyperlipidemia - blood pressure control 17) osteopenia & osteoporosis [1] 18) frailty in elderly with HIV1 infection - HIV1 infection alone is a risk factor for developing premature geriatric syndromes, including frailty [4,9] - frailty in elderly with HIV1 infection is largely driven by comorbidities [11] 19) coinfection with HCV (see HIV/hepatitis C-coinfection) 20) immune reconstitution inflammatory syndrome - occurs after initiation of antiretroviral therapy [1] - inflammatory response to opportunistic infection - inflammatory response resulting in thyrotoxicosis 21) drug-drug interactions with ritonavir * opportunistic infection with Pneumocystis jirovecii is the most common cause of death in patients with AIDS [1] * Mycobacterium avium & CMV generally occur in HIV1 patients with CD4 counts < 50/uL [1] Notes: - diseases of old age develop earlier in HIV-infected patients even those with prolonged suppression of HIV replication [4] - non-AIDS-related cancers are now responsible for as many deaths as AIDS among HIV-infected patients [5] - HIV1-related deaths declined from 9.1 to 4.7 per 1000 people with HIV1 infection from 2010 to 2017 [8] - HIV1-related deaths were similar between white & Latinx people, & disparity between whites & blacks decreased by 66% [8]

Related

Acquired Immuno-Deficiency Syndrome (HIV infection stage 3, AIDS) infectivity of HIV opportunistic infection

Specific

AIDS dementia complex; AIDS encephalopathy; HIV-associated dementia (HAD) HIV nephropathy HIV-associated arthritis HIV-associated myositis HIV-associated vasculitis HIV1 protease inhibitor lipodystrophy HIV1/AIDS-associated cardiac disease HIV1/AIDS-associated dermatologic disorder HIV1/AIDS-associated endocrine disorder HIV1/AIDS-associated gastrointestinal disorder (includes HIV1-associated diarrhea) HIV1/AIDS-associated hematologic disorder HIV1/AIDS-associated hepatobiliary disorder HIV1/AIDS-associated malignancy HIV1/AIDS-associated neurologic disorder HIV1/AIDS-associated ocular disorder HIV1/AIDS-associated opportunistic infection HIV1/AIDS-associated oral disorder HIV1/AIDS-associated osteoporosis HIV1/AIDS-associated pancreatic disorder HIV1/AIDS-associated respiratory tract disorder HIV1/AIDS-associated rheumatologic disorder HIV1/AIDS-associated urogenital disorder HIV1/hepatitis C-coinfection HIV1/malaria coinfection HIV1/tuberculosis coinfection immune reconstitution inflammatory syndrome (IRIS) mycobacterial infections in patients with HIV perinatal transmission of HIV

General

infectious complication; infectious sequella

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021.
  2. Journal Watch 24(11):88-89, 2004 Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, Waters DD. Progression of atherosclerosis as assessed by carotid intima- media thickness in patients with HIV infection. Circulation. 2004 Apr 6;109(13):1603-8. Epub 2004 Mar 15. PMID: 15023877
  3. The Data Collection on Adverse Effects of Anti-HIV Drugs Study Group: Liver-related deaths in person effected with the human immunodeficiency virus: The D:A:D study. Arch Intern Med 2006k 166:1632 PMID: 16908797
  4. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Smith CJ et al Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. The Lancet, 384(9939):241-248, 19 July 2014 PMID: 25042234 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960604-8/abstract
  6. Shiels MS, Islam JY, Rosenberg PS et al. Projected cancer incidence rates and burden of incident cancer cases in HIV-infected adults in the United States through 2030. Ann Intern Med 2018 May 8 PMID: 29801099 http://annals.org/aim/article-abstract/2680725/projected-cancer-incidence-rates-burden-incident-cancer-cases-hiv-infected
  7. Park LS, Tate JP, Sigel K et al Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study. Ann Intern Med. 2018. June 12. PMID: 29893768 http://annals.org/aim/article-abstract/2684480/association-viral-suppression-lower-aids-defining-non-aids-defining-cancer
  8. Bosh KA, Johnson AS, Hernandez AL, et al. Vital Signs: Deaths Among Persons with Diagnosed HIV Infection, United States, 2010-2018. MMWR Morb Mortal Wkly Rep 2020;69:1717-1724 PMID: 33211683 Free article https://www.cdc.gov/mmwr/volumes/69/wr/mm6946a1.htm
  9. Kooij KW, Wit FW, Schouten J et al. HIV infection is independently associated with frailty in middle-aged HIV type 1- infected individuals compared with similar but uninfected controls. AIDS. 2016;30(2):241-250 PMID: 26684821 https://journals.lww.com/aidsonline/Fulltext/2016/01140/HIV_infection_is_independently_associated_with.10.aspx
  10. Fukui SM, Piggott DA, Erlandson KM. Inflammation strikes again: frailty and HIV. Curr HIV/AIDS Rep. 2018;15(1):20-29 PMID: 29411315
  11. Lellouche L, Gutierrez LA, Leclercq P et al. Frailty in aging people living with HIV: A matched controlled study. J Acquir Immune Defic Syndr 2021 Jul 6; [e-pub]. PMID: 34238822 https://journals.lww.com/jaids/Abstract/9000/Frailty_in_Aging_People_Living_With_HIV__a_matched.95850.aspx
  12. NEJM Knowledge+ Hematology
  13. NEJM Knowledge+ Complex Medical Care
  14. DHHS Panel. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Syphilis. Department of Health and Human Services 2023 Sep 7; [e-pub] https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/whats-new