Around 20 per cent of people infected with HIV have difficulties with their HIV therapy. Berlin-based HIV specialist Gerd Klausen has been talking about the risks and side effects of HIV medication for the past few days. informed in the previous blog post. Today Dr Gerd Klausen reports on the long-term effects of HIV therapy.
What are the consequences for patients who have been taking HIV medication for many years?
In the last five to ten years, we have observed damage to the liver and kidneys in particular in individual cases, as well as changes in the blood lipid metabolism, i.e. an increase in cholesterol levels. This is associated with an increased risk of heart attack or stroke. Some medications are also suspected of causing premature bone loss. Doctors must therefore pay particular attention to these issues. However, other long-term consequences, such as fat redistribution disorders, can now be largely avoided thanks to new medications.
What exactly is lipoatrophy and lipohypertrophy, the medical terms for these fat redistribution disorders?
Lipoatrophy is the very marked loss of fatty tissue in the face, arms and legs. Lipohypertrophy is the increase in fatty tissue, usually in the abdomen and neck. In my view, the drugs that most probably caused these highly stigmatising symptoms were a blessing at the time, despite these side effects, because they saved lives immediately and there were no alternatives. Fortunately, we are no longer reliant on these drugs today.
Mental health problems have also increased among long-term treatment patients in recent years. How can this be explained?
Not only depression and sleep disorders have become a major issue for people with long-term infections, but also organic brain changes. Medication can also play a role here. It is therefore important to always investigate such symptoms more closely in order to be able to react in good time in case of doubt. However, it is sometimes not so easy to convince a patient to change a medication that they have always felt they tolerated well and that may have saved their life.
Does this mean that there are other potential triggers for the psychological problems of an HIV-infected person besides medication?
Yes, because the long-term effects of the infection can also be a cause. This is also one of the reasons why we now treat the virus as early as possible: This prevents it from multiplying unhindered in the body for so long and causing damage. In this way, for example, organic brain changes and diseases of the peripheral nervous system can be largely prevented.
In addition, the psychological processing of the HIV infection and the life changes caused by the illness still play a role that should not be underestimated, for example in terms of sexuality, body image and self-esteem. Even for people who retired early 10 or 15 years ago due to their infection or suffered other social consequences, HIV infection means a massive cut in their biography that has to be processed and coped with.
Medical research and the associated HIV therapy have made immense progress over the past two decades. Can newly infected people who start HIV treatment today hope to grow old without having to suffer from severe side effects and long-term effects?
I actually believe that! And I very much hope that experience over the next decade or two will confirm this. Fortunately, HIV medicine has changed incredibly. The effectiveness of the drugs is better than ever before and today we hardly have any problems with resistance. At the same time, however, the issue of side effects remains very important in medical counselling. In order to prevent the helpful therapy from causing damage at the same time.
Thank you very much for the interview!
More on this topic:
HIV therapies today: from "very good" to "sucks"
