What chronic illnesses are people with HIV more likely to experience?

New research looks into the chronic illnesses that people living with HIV are at most risk of developing.

In the United States, over 1 million people are currently living with an HIV infection. Worldwide, 1.8 million people have HIV.

Overall, the incidence of HIV infections has declined over the past few decades. The mortality rate from an acquired immunodeficiency syndrome (AIDS)-related illness fell by nearly 80% since the year 2002, according to some estimates.

Despite these trends, HIV remains a global health priority. Worldwide, the leading cause of death among people with HIV is tuberculosis.

However, in countries such as the U.S. where tuberculosis is uncommon, people with HIV die from other conditions that are not related to the immunodeficiency virus. Conditions include diabetes, kidney disease, liver disease, and cardiovascular conditions.

New research set out to examine more closely the specific conditions that people with HIV are at risk of developing.

Lee Smith, a reader in Physical Activity and Public Health at Anglia Ruskin University in London, United Kingdom, is the senior author of the new review.

The findings appear in the journal Clinical Infectious Diseases.

Smith and colleagues carried out a so-called umbrella review "of meta-analyses of observational studies."

The authors looked at 3,413 studies and included 20 in their assessment.

Smith and team rated the evidence available as "convincing, highly suggestive, suggestive, weak, or nonsignificant." The 20 studies they assessed included 55 health conditions that people with HIV are living with.

The research found that people with HIV are at significant risk of coughing and breathlessness, chronic obstructive pulmonary disease (COPD), as well as "ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures."

The authors write: "These results indicate that even with the high availability of [antiretroviral therapy], [people living with HIV] experience disproportionately more chronic respiratory illness in comparison to seronegative populations."

Furthermore, the risk of ischemic heart disease among people living with HIV, write the authors, might be due to the higher prevalence of smoking and drug use within this population.

However, they add that this "may also be related to underlying, chronic inflammation and immune activation, combined with coagulation abnormalities and atherosclerosis."

The study's senior author comments on the findings, saying, "There has been a major shift in how we view HIV. It is no longer a death sentence but rather a manageable chronic illness."

"By pooling data from different studies," Smith continues, "we've been able to show for the first time that even with the rise in life expectancy among people living with HIV, this population now seems to be disproportionately affected by chronic illnesses often attributable to lifestyle issues, such as smoking, drug, and alcohol use, or more commonly associated with an older population."

However, the authors emphasize that they cannot be sure that lifestyle factors cause these conditions.

"We're unable to say for certain which are caused or exacerbated by HIV and its treatment, and which are related to lifestyle."

-Lee Smith

"However, the elevated risk levels highlighted in our study should hopefully lead to further research to improve both the prevention and early detection of these comorbidities in people living with HIV. Public health bodies worldwide should reflect on these findings," the authors conclude.