Abstract
E
To determine its long-term effects, we retrospectively examined the records of 63 patients (41 males, mean age 36 years, range 20–73) at the Infectious Diseases Unit, University of Verona. Each of these patients was diagnosed with HIV and started on ART between December 1999 and December 2001 (i.e., 127 to 103 months ago).
Pre-ART mean CD4 cell count was 269/μl (3-1,041). Pre-ART HIV-RNA levels had not been determined in six patients and were >500,000 copies/ml in five patients; in the remaining 52 patients, mean HIV-RNA level was 74,441 copies/ml (2146–413,391). Of the patients 41 had been consistently adherent to ART over time, 7 inconsistently adherent, and 15 virtually nonadherent (as assessed by periodic interviews).
All but three patients (initially on zidovudine-lamivudine) had been on three drug combination therapies [two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (PI) in 23 cases, two NRTI and one NNRTI in 31 cases, and three NRTI in 6 cases] since ART began.
Of the adherent patients, three died of non-Hodgkin's lymphomas 3–5 years after starting ART. In the same period, three nonadherent patients died: one of liver cirrhosis, one of hepatocellular carcinoma, and one of progressive multifocal leukoencephalitis (PML).
Of the remaining 57 patients, eight (one nonadherent, three females; age at diagnosis 60, 59, 48, 47, 45, 43, 38, 36 years, mean age 47) developed hypertension 3–9 years after starting therapy, and four (all adherent; one female; age 61, 58, 51, and 34 years, mean age 51) were diagnosed with diabetes mellitus 2–8 years after starting ART. Seven to 9 years after starting ART two other patients developed cancers (rectal carcinoma or cervical cancer), one had a stroke, one was diagnosed with porphyria, and one had subclinical hypothyroidism. Six years after starting therapy, one adherent male patient aged 45 years had hypercholesterolemia and another adherent male patient of the same age had hypertriglyceridemia. Therefore, of 41 consistently adherent patients seven (17%) developed hypertension and four (10%) developed diabetes mellitus. In the general population for the same age groups (35–60 years) the prevalence of diabetes was 2–4% in Verona 4 and the prevalence of hypertension was 13–15% in Italy. 5
No relationships were found between occurrence of the above and type of ART.
Our results indicate that cardiovascular and metabolic complications occur in the long-term in quite a large number of adherent patients on ART. Although they might have occurred in the absence of ART, the ages and lifestyles of a number of patients were not typical of, or predisposing to the diseases that developed. Careful monitoring of ART is mandatory, especially in developing countries where the occurrence of these diseases in younger patients could constitute a serious problem for overburdened health systems.
Footnotes
Author Disclosure Statement
No competing financial interests exist.