With advances in HIV care, survivors face other disease risks

August 13, 2014, Wolters Kluwer Health

As effective treatments for HIV become more widely available in low- and middle-income countries, there's an urgent need to assess and manage health risks in the growing number of people living with HIV. An update on non-communicable diseases (NCDs) among HIV-positive populations in LMICs appears as a supplement to in JAIDS: Journal of Acquired Immune Deficiency Syndromes.

In an introductory article, Dr K.M. Venkat Narayan of Rollins School of Public Health, Emory University, Atlanta, and colleagues outline a research and capacity-building agenda to better understand and meet the challenge of NCDs in the growing number of people living with HIV in Sub-Saharan Africa and other parts of the world. They write, "Strengthening in-country research capacity in targeted areas…must be a high priority."

Research and Planning to Meet Health Needs of People Living with HIV

Large-scale HIV treatment and prevention programs have substantially lowered the rates of HIV infection and deaths from HIV/AIDS. Dr Narayan and coauthors write, "Today, with over 35 million people living (and aging) with HIV and over two million becoming infected every year, we are faced with a new challenge: addressing morbidity and mortality from NCDs—heart disease, stroke, diabetes and metabolic complications, renal disease, cancers, liver disease, and mental illness—that increase with age and may be related to HIV and its treatment."

In most low- and middle-income countries, increased availability of HIV care has not been accompanied by parallel services for NCDs, leading to preventable, premature illness and death. Rising NCD rates threaten to set back, or even reverse, the impressive gains in HIV-infected populations.

The new supplement to JAIDS grew out of a 2013 conference of international experts, hosted by the Fogarty International Center and the Office of AIDS Research and jointly chaired by Dr Sten Vermund of Vanderbilt University School of Medicine and Dr Narayan. After the meeting, scientists from the United States and from low- to middle-income countries collaborated on a series of articles surveying the current scientific landscape of HIV and NCDs, as well as the research and training needs to address this critical issue.

The special issue addresses specific types of NCDs, including cancers; kidney and genitourinary diseases; metabolic and bone disorders; cardiovascular and pulmonary diseases; mental health, neurological diseases, and substance use; and gastrointestinal, liver, and nutrition problems. Other topics include key issues related to research methods and cost-effectiveness of setting up programs to address NCDs. In addition, two expert commentaries present the perspective of Latin American and Asian countries. The open access supplement is available at http://www.JAIDS.com.

In their introduction, Dr Narayan and colleagues outline a set of research priorities to manage the challenges of NCDs in HIV-positive populations, addressing the areas of surveillance and clinical epidemiology, basic and clinical research, implementation science and health systems, and infrastructure training, capacity, and workforce development. They write, "In a time of scarce resources, imaginative enhancement of HIV research and care platforms and expanded training for researchers and providers can strengthen health systems and improve the overall care of persons living with HIV/AIDS."

In the long term, investment in the training of promising scientists from low- and middle-income countries— is viewed as a "transformative" part of strategies to address the changing needs of those infected with HIV according to a preface by Dr Roger I. Glass, Director of the Fogarty International Center. He writes, "The papers in this supplement…articulate an agenda from which we can begin to address the spectrum of research, training, effective implementation, and evidence-based policy needed to confront this new challenge" of HIV and NCD comorbidities.

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