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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 383-385
Noninfectious complications in HIV disease: Need for rational changes in HIV disease management in the highly active antiretroviral therapy era


Department of Microbiology, Apollo Health City, Jubilee Hills, Hyderabad, India

Click here for correspondence address and email

Date of Web Publication7-Nov-2013
 

How to cite this article:
Ramana K V, Rao R. Noninfectious complications in HIV disease: Need for rational changes in HIV disease management in the highly active antiretroviral therapy era. Ann Trop Med Public Health 2013;6:383-5

How to cite this URL:
Ramana K V, Rao R. Noninfectious complications in HIV disease: Need for rational changes in HIV disease management in the highly active antiretroviral therapy era. Ann Trop Med Public Health [serial online] 2013 [cited 2019 May 26];6:383-5. Available from: http://www.atmph.org/text.asp?2013/6/3/383/121019
Dear Sir,

Human immunodeficiency virus is a retrovirus belonging to the family Lentiviruses, which are responsible for chronic and long-lasting infections including the Simian immunodeficiency virus (SIV) in monkeys. Since 1981, when the first AIDS cases were reported, human immunodeficiency virus (HIV), poses a challenge to human beings and the UNAIDS global estimate reveals that currently more than 33.2 million people are living with HIV infection world wide. [1] HIV infection leads to variable disease course in different people. The HIV disease progression is characterized as rapid, typical or intermediate, and late or nonprogressors. The majority of infected individuals (70--80%) experience intermediate disease progression in which they show HIV RNA rise, CD4 + T-cell decline and later development of AIDS related illness in 6--10 years. A total of 10--15% of the infected patients whose CD4 + T cells rapidly decline and go into AIDS within few years of infection are called rapid progressors. The late progressors (5%) can remain asymptomatic and healthy without showing significant changes in CD4 + T-cell counts even for 10 years among them are long-term nonprogressors, who survive for more than 10 years after getting infected. [2] The biological basis of this variability in the disease progression is still unknown, though some studies have related the long-term nonprogressors (those infected with HIV type I but show no decline in CD4 cell counts) to the presence of defective virus. Due to the chronicity of the disease and the extent of morbidity and mortality it causes, management of such individuals has become a challenge for physicians treating HIV-infected patients. Monitoring the disease progression and the response to highly active antiretroviral therapy (HAART) is traditionally carried out using TCD4 + cell counts and HIV/RNA viral load. [2] Many clinical and laboratory markers have been used to estimate disease progression in HIV1 infection. Markers of AIDS development include viral markers (plasma HIV RNA load, serum p24 Ag, serum anti p24 antibodies), surrogate markers (antibodies against p17, gp 120, gp 41, and nef gene product) and nonspecific markers including CD4 + T-cell counts, CD8 + T-cell counts and delayed type hypersensitivity test. Other alternate markers include elevated serum β2 microglobulin, neopterin (D-erythro-1¢,2¢,3¢- trihydroprpylptrin), dehydroepiandrosterone (DHEAS), serum cortisol, and many others including CRP, ESR, serum albumin, tumor necrosis factor (TNF), interferon-γ, interleukin-2(IL-2), IL-4. [3] Introduction of HAART in 1995, though initially was limited to developed nations, there was a gradual increase in access to HAART even in poor countries. [6] Initiation of HAART though reduced the mortality, morbidity arising from antiretroviral side effects were a cause of concern. Studies have shown a significant reduction in mortality of HIV infected individuals for the post-HAART era compared to the pre-HAART era. Considering the ill effects of HAART regimen, initiation of antiretroviral therapy was planned only for patients with CD4 cell counts <200 mm 3 . HAART is now recommended for patients whose CD4 counts are between 350 and 500 mm 3 . Irrespective of CD4 cell counts initiation of HAART can be taken by the physician treating HIV-infected patients based on the age, type of antiretroviral drug, its adverse reactions, and compliance for long duration of drug regimen by the patient. [3] Either with or without laboratory support, clinical assessment for the presence of opportunistic infections, side effects of HAART on various system, and presence of immune reactivation inflammatory syndrome (IRIS) can be done by looking for various signs and symptoms. [4] Studies conducted in the past have demonstrated the role of HIV infection by itself irrespective of HAART therapy can result in the development of metabolic disorders including altered lipid metabolism. [5] Previous reports have also suggested the association of cardiovascular disease (CAD), acute cardiovascular events, and HAART therapy. HIV/AIDS, after the introduction of HAART has taken a different course where, people infected with HIV have been considerably living longer due to reduced incidence of opportunistic infections and other AIDS-related conditions. Of late HIV-infected individuals have been bothered by noninfectious complications that need emergency medical attention and care. [6] HIV disease pathogenesis though is complicated significant research has been done to prove that HIV has the ability to disturb the cell metabolism. Oxidative stress, programmed cell death (apoptosis) can result in accumulation of free radicals and in turn be responsible for prolonged inflammatory activity. HIV has now emerged as a chronic infection that can influence most of the human systems. Physicians treating HIV seropositive patients should think beyond opportunistic infections and consider other factors including the nutrition, the toxic effects of HAART, age, and other causes. HIV patient care should be multifaceted involving specialist HIV primary care physicians, infectious disease specialists, and emergency physicians considering the ways by which HIV and HAART have changed treatment and management of HIV-infected individuals. Physicians treating such patients need to consider patient evaluation based on all such factors before and after initiation of HAART to effectively reduce morbidity and mortality.


   Acknowledgements Top


We express our gratitude to Dr NTR University of Health Sciences, Vijayawada, Andhrapradesh, India

 
   References Top

1.World Health Organization, United Nations Children's Fund, UNAIDS (2009). Towards universal access: Scaling uppriority HIV/AIDS interventions in the health sector. Progress report 2009. Geneva: World Health Organization; 2009.  Back to cited text no. 1
    
2.Ramana KV, Chary J, Sabitha V, Mohanty SK, Rao R. Role of hematological and alternate markers in human immunodeficiency virus disease progression. Am Med J 2010;1:84-7.  Back to cited text no. 2
    
3.Ramana KV. HIV Disease Management in the Highly Active Antiretroviral Therapy (HAART) Era. J Med Microbiol Diagn 2012;1:e101.  Back to cited text no. 3
    
4.Ramana KV, Mohanty SK. Opportunistic intestinal parasites and TCD4 + cell counts in human immunodeficiency virus seropositive patients. J Med Microbiol 2009;58:1664-6.  Back to cited text no. 4
    
5.Ramana KV, Rao R, Sabitha, Venugopal B, Rafi MD, Rao SD. Biochemical parameters in human immunodeficiency virus disease progression. J Medical Microbiol Diagnosis 2012;1:103.  Back to cited text no. 5
    
6.Ramana KV, Ratna Rao, Sabitha. Abnormal Levels of γ-Glutamyl Transpeptidase (GGTP), ALT, AST in Human Immunodeficiency Virus-1(HIV-1) Infection. Biochem Physiol 2012;1:101.  Back to cited text no. 6
    

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Correspondence Address:
K V Ramana
Department of Microbiology, Apollo Health City, Jubilee Hills, Hyderabad, Andhra Pradesh; Prathima Institute of Medical Sciences, Karimnagar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.121019

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