Complications of HIV infection

complications of HIV infection

Complications of HIV can be caused due to the direct result of long term infection, aging, antiretroviral therapy or other patient factors (1).

Complications in Patients with HIV/AIDS include:

• neuropsychiatric
  • opportunistic infections of the brain and spinal cord e.g - cerebral toxoplasmosis, Cryptococcal meningoencephalitis (or cryptococcoma), viral meningoencephalitis
  • primary central nervous system lymphoma
  • HIV-associated neurocognitive disorders - impairment ranges from mild (asymptomatic neurocognitive impairment) to severe (HIV-associated dementia)
  • neuropathy e.g. - distal sensory polyneuropathy
  • myelopathy
  • radiculopathy - usually a lumbrosacral polyradiculopathy
  • early-onset Alzheimer disease
    • has been observed increasingly in patients with HIV infection, even in those with well-controlled HIV disease
  • concurrent chronic psychiatric and substance use disorders - is estimated to be present in around 50% of patients with HIV
    
    
• cardiovascular
  • higher rates of myocardial infarction and atherosclerosis
  • the incidence of other HIV associated complications have decreased due to widespread use of combination antiretroviral therapy e.g. - cardiomyopathy, myocarditis, percarditis
  • infective endocarditis - occurs almost exclusively in those who use injection drugs
    
    
• pulmonary
  • Pneumocystis jiroveci(formerly Pneumocystis carinii)pneumonia
  • pulmonary arterial hypertension
  • chronic obstructive pulmonary disease
  • lung cancer
    
    
• oral and oesophageal
  • candidial infection - often affects the oral cavity
  • aphthous ulcers and oral ulcers/esophagitis caused by cytomegalovirus or herpes simplex virus
    
    
• other digestive tract complications
  • CMV infection
  • infection from Cryptosporidum species, microsporidia, or Isospora belli
  • HIV induced enteropathy (or AIDS enteropathy)
  • intestinal malignancies e.g. - non Hodgkin lymphoma, Kaposi sarcoma
  • fat malabsorption (pancreatic exocrine insufficiency)
  • proctitis and anorectal ulcers from sexually transmitted infections
    
    
• pancreatic and hepatobilliary complications
  • HIV-associated pancreatitis - mainly caused by antiretroviral use and hypertriglyceridemia
  • nonalcoholic fatty liver disease
  • chronic liver disease from viral or nonviral hepatitis
  • hepatocellular carcinoma
    
    
• renal/genitourinary
  • sexually transmitted infections e.g. - Chlamydia trachomatis
  • HIV associated nephropathy
  • acute and subacute complications related to antiretroviral therapy e.g. - protease inhibitor -associated nephrolithiasis and nephrotoxicity from tenofovir (Viread) use
  • chronic kidney disease not caused by HIV associated nephropathy
    
    
• endocrine
  • impaired lipid and glucose metabolism
    • insulin resistance, diabetes, dyslipidemia, and lipodystrophy may be occasionaly caused by antiretroviral therapy
  • HIV associated wasting
  • lipodystrophy
  • premature ovarian failure
  • adrenal insufficiency - may be caused by direct HIV infection of the adrenals, disseminated opportunistic infections, malignancy, or medication use (e.g. - systemic ketoconazole
  • testosterone deficiency - especially in men with advanced HIV infection or AIDS
    
    
• musculoskeletal system
  • osteopenia, osteoporosis, osteonecrosis
  • myopathy, myositis
    
    
• haematologic or oncologic
  • anaemia of chronic disease
  • lymphoma
  • multiple myeloma

Reference:

• (1) Chu C, Selwyn PA.Complications of HIV infection: a systems-based approach. Am Fam Physician. 2011;83(4):395-406.