Researchers urge studies on chronic diseases among HIV patients in developing world

A coalition of scientists has called for urgent research strategies to address the growing problem of chronic comorbidities in HIV patients in developing countries, according to an NIH press release.

The recommendations, which were the result of an NIH-sponsored multidisciplinary conference, entail expanding upon existing HIV research to further evaluate the impact of noncommunicable diseases such as cancer, heart and lung disease, kidney disease, mental illness and gastrointestinal conditions. These conditions may be directly related to HIV infection, HIV drugs or aging.

The researchers outlined the problems and their potential solutions through eight articles and two commentaries featured in a special supplement of the Journal of Acquired Immune Deficiency Syndrome. The articles proposed a research plan aimed at understanding the extent of the noncommunicable disease burden in HIV patients and find the most cost-effective and valuable treatment approaches.

Most of the articles in the supplement pertained to chronic conditions among HIV patients in sub-Saharan Africa, but two essays addressed this issue in low-income regions in Asia, Latin America and the Caribbean. The researchers identified the following topics as warranting further study:

The incorporation of tuberculosis care into HIV treatment should be used as a model for the integration of chronic disease treatment strategies. Specifically, drug delivery systems dedicated to ART and TB medications could be used to deliver important and affordable drugs for noncommunicable diseases. Such an approach could improve long-term survival in HIV patients, while possibly improving compliance to ART;
Research focusing on HIV-associated cancers is necessary. While virally-precipitated cancers related to compromised immune systems are common, the epidemiology of HIV-related cancers is not fully understood;
The potential risk of ART on heart failure in low-resource settings should be investigated. While ART has been shown to increase the risk of heart failure and other cardiopulmonary conditions in high-income countries, this association has not been adequately studied in low-resource locations, where further environmental risk factors may exist;
Additional studies to evaluate the impact of HIV on depression, alcohol abuse and nervous system disorders. These conditions are prevalent in HIV patients, but the tools for detection in low- and middle-income countries are insufficient;
The creation of registries to study the impact of HIV infections or toxins from ART on kidney disease, as well as overall assessment of the incidence and severity of ART side effects.

The researchers also agreed that bolstering HIV research and care initiatives could improve the care of patients with HIV/AIDS, as well as of larger patient populations.

It is estimated that chronic illnesses have surpassed infectious diseases as the most prevalent causes of death in developing nations, according to the NIH. The researchers emphasized the need for research to address this growing health issue.

“Just as the advent of widespread antiretroviral treatment demanded a seismic shift in global human capacity and health systems for the emergency response to HIV, emerging chronic conditions among those with HIV in lower- and middle-income countries will demand no less,” researcher K.M. Venkat Narayan, MD, of Emory University, Atlanta, said in the release.

In addition to representatives of nine NIH institutes and centers, the conference at which these recommendations were generated was attended by WHO, the US Agency for International Development, the CDC, the World Bank and the Office of the Global AIDS Coordinator at the US Department of State.