Comorbidities and HIV: Time to Mainstream Care

Although HIV creates a significant global burden, it is only one of many conditions of concern to global health policy makers. And increasingly, individuals who have HIV also have comorbid non-communicable diseases including cardiovascular disease, hypertension, and diabetes. Care for individuals with HIV is shifting to encompass care for these conditions in addition to the specialized care patients need for their infection. This is particularly important since HIV infection increases risk for several comorbidities.

The journal AIDS Care has published a systematic review that looks at the opportunity to provide coordinated care for HIV and non-communicable conditions. The authors reported that it's feasible to integrate services and indicated that building on existing protocols and community advocacy is prudent.

The authors noted that 4 primary models integrate HIV/AIDS care with diabetes, hypertension, and/or cardiovascular disease. These include:

• Provision of diabetes services at HIV clinics
• Provision of hypertension and diabetes services with HIV services, which was the most commonly reported model
• Integration of cardiovascular and HIV services
• Thorough integration of all 4 conditions in the local care model

The authors, who examined primarily low-income countries that had high rates of HIV infection, indicated that the models varied considerably in what they provided. Some provided screening and case detection/referral, while others added monitoring, patient education, and consolidated treatment.

The authors advocated for incorporating treatment for comorbidities into the HIV treatment model. This addresses patients needs in one place—a form of one-stop shopping—and simplifies the health care delivery system. Additionally, they noted, leadership is needed to catalyze change and promote service integration to ensure that patients with HIV are receiving the care that they need for their comorbidities.

An important point is this: patients with HIV need to be mainstreamed into the health care system so they receive the same range of services that other patients receive. All countries, including the United States, need to plan for the increasing number of patients with HIV who have comorbidities as they live longer.

Reference

Haldane V, Legido-Quigley H, Chuah FLH, et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS Care. 2017 Jul 5:1-13. doi: 10.1080/09540121.2017.1344350. [Epub ahead of print]