Long term effects in chronic HIV infection; clinical and laboratory studies

Without treatment, end-stage HIV infection is accompanied by a high prevalence of opportunistic infections. This prevalence has dropped dramatically after the introduction of cART. During effective treatment the burden of neurologic complications is also small, but not negligible. There is considerable debate about the prevalence, pathogenesis and clinical relevance of certain neurological complications such as stroke, neurocognitive disease and the residual risk of opportunistic infections. To understand the interplay between HIV and the CNS, we first reviewed current literature. In addition, a cross-sectional cohort study at the Erasmus MC is described. The goal was to assess the prevalence of cognitive disorders in a chronically infected and well-treated HIV population. An appropriate screening strategy as advised by the European AIDS Clinical Society was applied and assessed for sensitivity and specificity using the Neuropsychological Assessment as a gold standard. Also, socio-economic characteristics of the patients involved in the TREVI study are described. It focuses on various factors involved in the quality of life and labor participation. We collected blood specimens during the TREVI study and isolated plasma and peripheral blood mononuclear cells (PBMC’s) to investigate immune activation in a well-treated HIV-infected population at different treatment intervals. This experiment was designed to assess the effect of long-term treatment on the expression of pro-inflammatory cytokines in PBMC’s and plasma. Further more, we applied a novel tool to assess the risk for metabolic complications by measuring hair cortisol. Based on anthropomorphic and laboratory data, we identified patients with the metabolic syndrome and investigated whether this was correlated to cortiso