NON-COMMUNICABLE

DISEASES AMOUNG
PEOPLE LIVING WITH HIV
 HIV and Non-Communicable
Diseases (NCDs)
Many countries with HIV epidemics are now experiencing growing rates of NCDs.

Antiretroviral therapy (ART) for HIV enables people living with HIV (PLHIV) to lead long
and productive lives. However, they are now becoming susceptible to NCDs in later life.
This increasing burden of NCDs is threatening the gains made against TB and HIV.

Studies have predicted that nearly 75% of PLHIV under care and treatment for HIV will
be older than 50 at the end of 2030. With an ageing HIV population, improvement of
survival and quality of life among PLHIV needs screening for and prevention of age‐
related NCDs, including lifestyle changes and use of ART with minimal toxicity.
Non-Communicable Diseases amoung people
living with HIV

01 CARDIOVASCULAR DISEASE

02 DIABETES MELLITUS

03
MENTAL HEALTH

04 RENAL DISEASE

05 CANCER

06 LIVER DISEASE
 CARDIOVASCULAR DISEASE
HIV itself is considered a risk factor for cardiovascular disease. Chronic
inflammation and immune activation associated with untreated HIV infection, as well
as persistent low-level viral replication, may contribute to an increased risk of
atherosclerosis and cardiovascular events.

Screening: Regular blood pressure monitoring

Lipid profile tests- Blood lipids test every five years starting
at 45 years of age.

Cardiovascular risk assessment should be conducted at least

every two years in all adults aged >45 years. This calculation
requires information on the patient’s age, sex, smoking status,
BMI and if they have diabetes or not. (total and high density
cholesterol and triglyceride levels can also be used)
 CARDIOVASCULAR DISEASE
Prevention
Lifestyle modification: Cessation of tobacco use, reduction of salt in the diet,
eating more fruit and vegetables, regular physical activity and avoiding harmful
use of alcohol have been shown to reduce the risk of cardiovascular disease.

Drug treatment of hypertension, diabetes and high blood lipids are necessary to
reduce cardiovascular risk and prevent heart attacks and strokes. Depending on
individual risk factors, aspirin therapy may be considered for primary or
secondary prevention.

Medication Management: If certain drugs are associated with an increased

cardiovascular risk, adjustments to the treatment plan may be considered.
DIABETES MELLITUS
SCREENING
Fasting blood sugar tests, HbA1c tests. Every person above the age of 40 should have
fasting blood sugar or random blood sugar (tested at least 2 hours or more post
prandial) every 1-2 years.

For high-risk patients, screening should start at 30 years and must be done annually.
This include family history of diabetes, history of gestational diabetes, long term use
of steroids or antipsychotic medication and those with history of cardiovascular events.

PREVENTION OF DIABETES MELLITUS IN HIV PATIENTS:

Lifestyle Modification: A healthy, balanced diet and regular physical activity is encouraged to
maintain a healthy weight and improve insulin sensitivity.
Routine screenings for diabetes to help in early detection and management.
Medication Management: If certain medications are associated with an increased risk, healthcare
providers may adjust the treatment plan.
Adherence to ART contributes to a healthier immune system and may indirectly impact the risk of
developing diabetes mellitus.
Patient Education and empowerment about the potential risks and preventive measures
associated with diabetes.
 RENAL DISEASE
HIV infection is a risk factor for both acute kidney injury (AKI) and chronic kidney
disease (CKD). HIV-associated nephropathy (HIVAN) is a specific condition
where the virus directly affects the kidneys, leading to progressive renal damage.
Additionally, chronic inflammation and immune activation associated with HIV
can contribute to kidney problems.

Some antiretroviral drugs have been associated with kidney-related side effects.
Tenofovir disoproxil fumarate (TDF), Ritonavir/lopinavir and Dolutegravir
particularly at higher doses, has been linked to renal toxicity.

Early detection and diagnosis of kidney disease are essential for preventing or
slowing further decline in kidney function and improving outcomes in HIV-
infected persons.
 RENAL DISEASE
Screening should be done annually for all patients and every 3-6 months
Screening for Kidney for high-risk patients.
Renal risk factors: age > 50 years, hypertension, diabetes, obesity, cardiovascular
Disease in HIV disease, smoking, nephrotoxic medications (e.g. chronic use of NSAIDs, Tenofovir,
Patients: atazanavir)
Estimated Glomerular Filtration Rate (eGFR): Measures the rate at which the
kidneys filter blood.
Serum Creatinine : Elevated levels may indicate impaired kidney function.
Urinalysis: To check for the presence of protein or blood in the urine.

1. Regular Monitoring: Routine kidney function monitoring is essential to detect

Prevention of Kidney
any changes early.
Disease 2. Hydration: Maintaining adequate hydration is crucial to reduce the risk of
kidney complications.
3. Management of hypertension, diabetes and changing treatment plan for
individuals on chronic NSAIDs treatment.
4. Tenofovir Alternatives: For individuals at higher risk of kidney issues,
healthcare providers may consider using other antiretroviral drugs with a more
favourable renal profile.
LIVER DISEASE
HIV itself is considered a risk factor for liver disease. Chronic HIV infection can lead to inflammation
and damage to the liver, increasing the risk of conditions such as hepatitis and cirrhosis.

Some antiretroviral drugs, particularly certain protease inhibitors e.g. ritonavir and non-nucleoside
reverse transcriptase inhibitors (NNRTIs) e.g nevirapine, delavirdine and efavirenz, have been
associated with potential liver-related side effects.

A number of medicines used to treat other infections that people with HIV are vulnerable to can also
cause liver problems, as can statins, which are used to treat high cholesterol, and drugs used to treat
tuberculosis (TB).

SCREENING
1. Liver Function Tests (LFTs): These blood tests measure the levels of enzymes and other
substances produced by the liver. LFT should be done at first diagnosis of HIV, at regular intervals
in the first six months of treatment and then at least once a year after that.
2. Hepatitis B virus (HBV) and C (HCV) Testing: As co-infections with hepatitis B or C are common in
individuals with HIV, testing for these viruses is crucial.
3. People with ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
4. Imaging Studies: In some cases, imaging studies like ultrasound may be used to assess the liver's
condition.
 LIVER DISEASE
Prevention
Careful Medication Management: Regular monitoring and adjustments of antiretroviral
therapy to minimize potential liver-related side effects.

Hepatitis Vaccination: Vaccination against hepatitis A and B can prevent co-infections

that may worsen liver health.

Moderate Alcohol Consumption: Limiting alcohol intake is important for overall liver
health.

Avoiding Hepatotoxic Substances: Minimizing exposure to substances that can harm

the liver, such as certain over-the-counter medications and recreational drugs.
 MENTAL HEALTH ISSUES (DEPRESSION)
HIV is associated with an increased risk of mental health conditions, including depression. Living with a
chronic condition, concerns about disclosure, social stigma, and potential side effects of medications can
all contribute to mental health challenges.
Depression is a common co-morbidity in HIV-infected patient populations, with prevalence rates of
20%-30%.

Screening for depression in HIV patients involves a combination of

Screening clinical assessment and standardized tools such as the Patient
Health Questionnaire-9 (PHQ-9) to assess the severity of
depressive symptoms. Routine mental health assessments during
clinical visits are also important.

Psychosocial Support Groups: Connecting individuals with HIV to

Prevention
support groups can provide a sense of community and reduce feelings of
isolation.

Routine screening for early diagnosis and intervention. A patient should

be screened at least once in 6 months using the PHQ-9.
 Osteoporosis

HIV infection itself has been identified as a risk factor for bone loss and osteoporosis. The reasons for
this include chronic inflammation, the direct effect of the virus on bone cells, and lifestyle factors.
Additionally, factors such as low body weight, vitamin D deficiency, and hormonal imbalances can
contribute to bone density reduction in individuals with HIV.

Some antiretroviral drugs, particularly certain protease inhibitors and tenofovir disoproxil fumarate
(TDF), have been associated with an increased risk of bone loss and osteoporosis.

Screening for osteoporosis in HIV patients involves assessing bone mineral

density through dual-energy X-ray absorptiometry (DXA) scans. Healthcare SCREENING FOR
providers may recommend DXA scans for individuals with specific risk factors, OSTEOPOROSIS
including long-term use of certain antiretroviral drugs, low body weight,
IN HIV
smoking, and low vitamin D levels.
PATIENTS:
 OSTEOPOROSIS
Strategies to prevent osteoporosis in individuals with HIV include:
Calcium and Vitamin D Supplementation: Ensuring adequate calcium and vitamin D
intake to support bone health.

Weight-Bearing Exercises: Engaging in regular weight-bearing exercises, such as

walking or resistance training, to promote bone density.

Smoking Cessation: Quitting smoking, as smoking is a risk factor for osteoporosis.

Hormone Replacement Therapy (HRT): In some cases, hormonal therapies may be

considered, especially for postmenopausal women.
 References:

JC Yombi, R Jones, A Pozniak, J-M Hougardy, FA Post, Monitoring of kidney function in HIV-positive
patients (2015) available at https://doi.org/10.1111/hiv.12249

Hadavandsiri, F., Shafaati, M., Mohammad Nejad, S. et al. Non-communicable disease comorbidities in
HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue.
Sci Rep 13, 12730 (2023). https://doi.org/10.1038/s41598-023-39828-6