Head and heart in treated HIV infection

The introduction of combination antiretroviral therapy (cART) in 1996 changed HIV infection from an inevitably fatal condition into a chronic manageable disease. During the last decade however, concerns have been raised about the increasingly important role of non-AIDS comorbidities as causes of death in cART-treated patients and a potential excess prevalence of non-AIDS comorbidities among HIV-infected individuals.
As most published studies lacked a comparable HIV-uninfected control group, it remained unclear whether or not certain comorbidities were truly occurring more often and/or at a younger age in the HIV-infected population, and if so, whether this excess risk was attributable to HIV-related factors.
To obtain more insight into these issues, the AGE_hIV Cohort Study was set up in 2010 in Amsterdam, The Netherlands. This prospective cohort study was designed to compare the prevalence, incidence and risk factors of non-AIDS/ageing-associated comorbidities and organ dysfunction among HIV-infected individuals and highly similar HIV-uninfected controls.
This thesis is based on cross-sectional analyses of baseline data gathered through the AGE_hIV Cohort Study and focuses on two prominent and concerning non-AIDS/ageing-associated comorbidities in the context of chronic treated HIV infection: vascular complications (‘heart’) and cognitive impairment (‘head’).
We have shown many non-AIDS/ageing-associated comorbidities, especially vascular complications, to be more prevalent among HIV-infected participants as compared to uninfected controls. Two categories of risk factors towards comorbidity consistently surface, namely immune deficiency and metabolic/vascular factors. Avoiding, modifying, or treating these factors is therefore of great importance to minimize the risk of developing comorbidity in the long term.