'Looking after the survivors': the health of a cohort of long-term human immunodeficiency virus patients 25 years on.

Abstract

Patients with human immunodeficiency virus (HIV) infection have higher rates of cardiovascular disease, metabolic disorders and malignancy than their uninfected peers. To survey the health of a South Australian cohort of long-term HIV patients, who had been diagnosed with HIV prior to the availability of combination antiretroviral therapy. Data from 88 patients were collected retrospectively across four domains: demographics, HIV history, antiretroviral medication and medical comorbidity. There were high rates of cardiovascular risk factors, in particular active smoking, dyslipidaemia and diabetes mellitus, which translated into a high rate of ischaemic heart disease and cerebrovascular accidents. A large proportion of the patients suffered depression and cognitive impairment. Approximately one-fifth of the cohort had been diagnosed with a malignancy, with anal cancer being the most prevalent. Many patients had experienced permanent toxicity from antiretroviral therapy. The present study showed high rates of 'non-HIV morbidity' in a group of long-term HIV patients in South Australia. Clinicians should aggressively modify cardiovascular risk factors, ensure appropriate immunisations, monitor mental health and consider targeted malignancy screening in these patients. A robust clinical infrastructure and multidisciplinary team is required to facilitate the complex care needs of long-term HIV patients.