Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

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Abstract

In the last 10 years, interesting results have been reported concerning the impact of highly active antiretroviral therapy (HAART) on the changing pattern of organ‐specific manifestations of HIV‐1 infection. There has been a clear step‐wise reduction in the incidence of several opportunistic infections (OIs), particularly Pneumocystis carinii pneumonia, whereas a nonsignificant reduction in incidence has been observed for other organ‐specific diseases, including invasive cervical cancer and Hodgkin disease. In addition, several organ‐specific manifestations, including HIV‐associated nephropathy, wasting syndrome and cardiomiopathy, are a direct consequence of damage by HIV‐1, and so HAART may have a therapeutic effect in improving or preventing these manifestations. Finally, the introduction of HAART has seen the emergence of several complications, termed immune reconstitution inflammatory syndrome, which includes OIs such as cytomegalovirus vitritis, Mycobacterium avium complex lymphadenitis, paradoxical responses to treatment for tuberculosis, and exacerbation of cryptococcosis. Because not all HIV‐1 organ‐specific manifestations are decreasing in the HAART era, this review will analyse the influence of HAART on several organ‐specific manifestations, and in particular OIs related to several organs, cerebral disorders and HIV‐1‐related neoplasia.

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Most cited references 98

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Metabolic abnormalities associated with human immunodeficiency virus (HIV) infection, including dysglycemia and hyperlipidemia, are increasingly prevalent, and there is concern about the possibility of an association with accelerated cardiovascular and cerebrovascular disease. We conducted a retrospective study of the risk of cardiovascular and cerebrovascular disease among the 36,766 patients who received care for HIV infection at Veterans Affairs facilities between January 1993 and June 2001. For antiretroviral therapy, 70.2 percent of the patients received nucleoside analogues, 41.6 percent received protease inhibitors, and 25.6 percent received nonnucleoside reverse-transcriptase inhibitors for a median of 17 months, 16 months, and 9 months, respectively. Approximately 1000 patients received combination therapy with a protease inhibitor for at least 48 months, and approximately 1000 patients received combination therapy with a nonnucleoside reverse-transcriptase inhibitor for at least 24 months. Between 1995 and 2001, the rate of admissions for cardiovascular or cerebrovascular disease decreased from 1.7 to 0.9 per 100 patient-years, and the rate of death from any cause decreased from 21.3 to 5.0 deaths per 100 patient-years. Patient-level regression analyses indicated that there was no relation between the use of nucleoside analogues, protease inhibitors, or nonnucleoside reverse-transcriptase inhibitors and the hazard of cardiovascular or cerebrovascular events, but the use of antiretroviral drugs was associated with a decreased hazard of death from any cause. Use of newer therapies for HIV was associated with a large benefit in terms of mortality that was not diminished by any increase in the rate of cardiovascular or cerebrovascular events or related mortality. Fear of accelerated vascular disease need not compromise antiretroviral therapy over the short term. However, prolonged survival among HIV infected patients means that longer-term observation and analysis are required. Copyright 2003 Massachusetts Medical Society

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Author and article information

Journal

Journal ID (nlm-ta): HIV Med

Journal ID (iso-abbrev): HIV Med

Journal ID (doi): 10.1111/(ISSN)1468-1293

Journal ID (publisher-id): HIV

Title: HIV Medicine

Publisher: Blackwell Science Ltd (Oxford, UK )

ISSN (Print): 1464-2662

ISSN (Electronic): 1468-1293

Publication date (Electronic): 08 March 2005

Publication date (Print): March 2005

Volume: 6

Issue: 2 ( doiID: 10.1111/hiv.2005.6.issue-2 )

Pages: 66-78

Affiliations

[ ¹ ]Department of Infectious Diseases, General Hospital and Macchi Foundation, Varese, Italy

Author notes

[*] Dr Donato Torre, Department of Infectious Diseases, General Hospital and Macchi Foundation, Viale Borri 57, 21100 Varese, Italy. Tel: + 39 0332 811351; e‐mail: donatotorre@ 123456libero.it

Article

Publisher ID: HIV268 Other ID: 268

DOI: 10.1111/j.1468-1293.2005.00268.x

PMC ID: 7165991

PubMed ID: 15807712

SO-VID: dea9b94e-5681-44bf-affa-ad9c0efd1332

License:

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