Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) became a significant threat to the world when they were discovered in the 1980s. After that, these diseases started attacking millions of people in all world countries, causing severe health problems and resulting in death. Since then, medical professionals have achieved essential success in the field of curing HIV and AIDS. As a result, better treatment of the illnesses globally and especially in Africa has contributed to a longer life expectancy of the patients. At the same time, better medicine has exposed HIV-positive individuals to fewer opportunistic infections (OIs) and more comorbidities. Thus, the principal purpose of this paper is to explain why improved treatment implies such controversial outcomes.
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HIV/AIDS and Longer Life Expectancy
The diseases under consideration significantly decreased the duration of life of the affected population in the late 20th-early 21st century. For example, Teeraananchai et al. (2017) explain that “life expectancy deteriorated to 49.5 years” in sub-Saharan Africa by 2000 (p. 256). At the same time, many young individuals from developed countries also died because of HIV and AIDS. It was so because those people did not obtain adequate education and treatment. However, the situation increased dramatically after starting antiretroviral therapy (ART). As a result, life expectancy increased by 43.3 years for 20-year individuals in high-income countries and by 28.3 years in low/middle-income states (Teeraananchai et al., 2017, p. 256). Even though higher longevity is a positive phenomenon, enhanced treatment has provided HIV-positive patients with both advantages and disadvantages, and they will be described below.
Fewer Opportunistic Infections
To begin with, one should comment on what OIs are. This term stands for diseases caused by pathogens that benefit from specific conditions. For example, it can refer to a person’s weakened immune system. As a result, many bacteria or viruses attack an organism and lead to health issues. Adequate treatment is sufficient to minimize the impact of OIs on people, and the case with HIV and AIDS proves it. The information below will explain the lower incidence of Pneumocystis pneumonia, candidiasis, tuberculosis, cerebral toxoplasmosis, and invasive non-typhoidal salmonellosis (iNTS) among HIV-positive persons.
According to Buchacz et al. (2016), this disease is one of the leading OIs when it comes to HIV and AIDS. The patients’ weakened immune systems result in the fact that pathogens penetrate their organisms and harm them. However, some scientific studies demonstrate that the use of ART is a useful way to protect individuals from this disease. Thus, Buchacz et al. (2016) show that the application of this treatment method decreased the number of Pneumocystis pneumonia diagnoses from 733 in 2000-2003 to 309 in 2008-2010 (p. 867).
The situation with the given disease is the same as the one described above. Here, HIV and AIDS make immune systems weaker, which exposes people to candidiasis and its bacteria. ART treatment is also useful here because it contributed to half as many diagnoses of this illness following its application. It refers to 257 cases in 2008-2010 against 466 events in 2000-2003 (Buchacz et al., 2016, p. 867).
Tuberculosis is another OI that should be considered in this case. Caused by a compromised immune system, this disease can result in many complications. One of them relates to the fact that it is challenging to find supplements that “can deal with both viral and bacterial infection” (Alejandre et al., 2018, p. 135). However, Alejandre et al. (2018) explain that the application of Glutathione allows HIV-positive persons to alleviate excessive oxidative stress and improves their immunity. As a result, people become less subject to the adverse effect of tuberculosis.
Cerebral toxoplasmosis (CTX) is another example of the fact that ART is an effective way of curing HIV, and the study by Martin-Iguacel et al. (2017) proves it. The researchers have analyzed cases of 6325 HIV-infected individuals to identify whether the use of this treatment has made any difference. Thus, Martin-Iguacel et al. (2017) admit that the pre-combination antiretroviral therapy era (1995-1996) witnessed significantly higher CTX incidence rates compared to 1997-2014.
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Invasive Non-Typhoidal Salmonellosis
In South Africa, HIV-positive individuals are subject to many OIs, and invasive non-typhoidal salmonellosis (iNTS) is among them. That is why the local health care industry does its best to protect the target population. It is fortunate that ART is accessible for this region, and this treatment improves the situation under consideration. Thus, Keddy et al. (2017) indicate that “from 2003-2013, the incidence of iNTS per 100,000 population per year decreased from 5.0 to 2.2” (p. 1). Consequently, the information above demonstrates that better HIV and AIDS treatment, including ART and Glutathione, has resulted in the fact that HIV-infected individuals are less subject to severe OIs.
Situation with Comorbidities
As has been mentioned above, the enhanced treatment also implies some drawbacks, and they refer to comorbidities. This term denotes additional medical conditions that occur because of the presence of pathogens in the organism. When it comes to people who have HIV or AIDS, their bodies experience a prolonged impact of medication and the viruses. Since these people live longer because of ART treatment, they become exhausted, which makes their organisms subject to multiple health issues. Thus, Ruzicka et al. (2018) stipulate that “older patients had greater numbers of chronic comorbidities” because of that (p. 7). In this case, the most typical conditions include cardiovascular disease (CVD), diabetes, chronic kidney disease (CKD), hepatitis, and lipid disorders.
CVD is a severe threat for people infected with HIV. Irrespective of the positive effect of ART treatment, “in developing countries, approximately 20% of the daily deaths due to HIV/AIDS are attributed to CVD (Nasi et al., 2017, p. 47). This rate is higher among older patients compared to younger individuals. Nasi et al. (2017) explain that it is so because of “the effects of chronic immune activation and inflammation” (p. 47). Consequently, one can conclude that HIV-infected individuals take medicines that increase the risk of cardiac events.
Diabetes is another comorbidity that is common among the population under consideration. In the modern world, there is an evident tendency toward spreading diabetes among HIV-positive people. Pelchen-Matthews et al. (2018) have analyzed their study population and identified that the number of such individuals increased from 531 in 2006 to 813 in 2014 (p. 2407). In addition to that, the researchers stipulate that a higher prevalence of diabetes was identified among older adults. As a result, the given comorbidity is strongly correlated with people’s age.
Chronic Kidney Disease
Many older people who are infected with HIV also suffer from CKD. Pelchen-Matthews et al. (2018) have investigated the state of health of numerous people with HIV and found that older individuals had a higher prevalence of CKD. According to the researchers, the number of people with the given disease became more than twofold larger over eight years, from 315 in 2006 to 791 in 2014 (Pelchen-Matthews, 2018, p. 2407). Since the study participants were older in 2014, it is possible to state that there is a correlation between the age and CKD occurrence.
According to Qadir (2017), the ART era has resulted in the fact that HIV-positive patients have become relatively free from OIs but are now subject to comorbidities. Among them, hepatitis is a typical case because individuals consume large volumes of medication, which affects their livers. Consequently, the liver disease results in the fact that numerous people who are infected with HIV also suffer from various kinds of hepatitis.
The use of antiretroviral drugs contributed to the emergence of lipid disorders among HIV-positive individuals who take them. It is so because the drugs “produced a form of metabolic syndrome accompanied by very elevated plasma triglyceride concentrations” (Brown et al., 2017, p. 4). Even though these agents have improved significantly in recent years, they still affect organisms and result in lipid disorders. Thus, this comorbidity is caused by the use of drugs, rather than by aging.
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Since the HIV and AIDS epidemic is a severe issue in the modern world, scientists do their best to find ways of how to cure these illnesses. Even though the application of antiretroviral therapy has had essential success and contributed to the increased life expectancy of individuals, its overall outcomes are controversial. On the one hand, this kind of treatment is positive because HIV-positive people are less subject to opportunistic infections, including Pneumocystis pneumonia, candidiasis, tuberculosis, cerebral toxoplasmosis, and invasive non-typhoidal salmonellosis. On the other hand, these people live longer and consume more medication, which exposes them to such comorbidities, as cardiovascular disease, diabetes, chronic kidney disease, hepatitis, and lipid disorders. Thus, future research is necessary to identify how it is possible to minimize the harmful effect of these and other comorbidities.
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Nasi, M., De Biasi, S., Gibellini, L., Bianchini, E., Pecorini, S., Bacca, V., Guaraldi, G., Mussini, C., Pinti, M., & Cossarizza, A. (2017). Ageing and inflammation in patients with HIV infection. The Journal of Translational Immunology, 187(1), 44-52.
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Qadir, M. I. (2018). Hepatitis in AIDS patients. Reviews in Medical Virology, 28(1), e1956.
Ruzicka, D. J., Imai, K., Takahashi, K., & Naito, T. (2018). Comorbidities and the use of comedications in people living with HIV on antiretroviral therapy in Japan: A cross-sectional study using a hospital claims database. BMJ Open, 8, 1-10.
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