HIV infection and treatment: beyond viral control

Since 1996, Infection caused by the human immunodeficiency virus(HIV) can be successfully treated with a combination therapy of 3 antiviral drugs from 2 different classes. Life expectancy has increased dramatically by this treatment. Especially in the early years these combination therapies had many adverse effects and the regimens were difficult to take because of a high pill burden. We have demonstrated in 120 HIV-infected patients that a simplified combination of 3 drugs from the same class in a fixed-dose tablet can successfully maintain viral suppression, after this has been reached by a standard combination. This simplified regimen, though not strong enough by itself , was still successful after 1 year and 2 years. Although in the meantime newer combination therapies have become preferred regimens, we think that in special circumstances these single-class combinations still can be used, at least temporarily. Life expectancy of HIV patients is still lower than in HIV-negative people. HIV patients have an increased risk of cardiovascular diseases. We have measured with a simple device the fluorescence level of the skin. HIV patients have a higher level of skin auto fluorescence than age-matched healthy persons. Just as in patiens with diabetes or a kidney diasese, the level of autofluorecence predicted the occurrence of cardiovascular disease after 5 years. Risk of venous thrombosis is also increased in HIV infection. We show that after one year of anti-HIV combination therapy levels of coagulation markers have decreased but have not completely normalized compared with healthy persons