Snopková Svatava
Vnitr Lek. 2017 Fall;63(7-8):502-506.
Modern antiretroviral treatment belongs to the greatest success of current medicine. HIV infection has gone from a death sentence to a manageable chronic disease which develops several decades. Thanks to treatment advances, people with HIV can and do live long and full lives. In the last two decades, the incidence AIDS defining illnesses have been dramatically reduced especially opportunistic infections and malignancies, whereas the role of non-infection comorbidities has risen than age-matched HIV uninfected adults. These comorbidities include cardiovascular diseases, venous and arterial thrombosis, metabolic disorders, chronic liver and renal diseases, nervous system disorders, osteoporosis and some cancers. This relatively large group of diseases is known as non-AIDS defining or indicating diseases and these diseases are associated in HIV uninfected general population with older age and ageing Most HIV positive individuals on antiretrovirals present an abnormal level of immune activation, inflammation and hypercoagulable condition. These hallmarks are typically seen in older HIV uninfected general population and are associated with aging and the immunosenescent phenotype. The explanation for this phenomenon is unclear. There are multiple factors, which may apply pathophysiologically, including the residual immune dysregulation syndrome and antiretrovirals alone. It is clear that changes in the nature of chronic HIV infection put it in internal medicine. Cardiology, internal medicine, geriatric and oncology syndromes are dominating manifestations in HIV positive patients on antiretrovirals. Care management for HIV infected individuals will need to draw on a wide range of medical disciplines in diagnosis and treatment. Clarification of these phenomena would be beneficial for the treatment of these non-infectious diseases in HIV positive and as well in HIV negative general population.Key words: antiretroviral therapy - HIV infection - immune dysregulation - immunosenescence - non-AIDS disease.
现代抗逆转录病毒治疗是当代医学最伟大的成就之一。HIV感染已从被判死刑转变为一种可控制的慢性疾病，病程长达数十年。得益于治疗进展，HIV感染者能够且确实过上了长寿而充实的生活。在过去二十年中，艾滋病界定疾病的发病率大幅下降，尤其是机会性感染和恶性肿瘤，而非感染性合并症在年龄匹配的未感染HIV的成年人中的作用有所上升。这些合并症包括心血管疾病、静脉和动脉血栓形成、代谢紊乱、慢性肝脏和肾脏疾病、神经系统疾病、骨质疏松症以及某些癌症。这一相对庞大的疾病群体被称为非艾滋病界定或指示性疾病，在未感染HIV的普通人群中，这些疾病与老年和衰老相关。大多数接受抗逆转录病毒治疗的HIV阳性个体呈现出免疫激活、炎症和高凝状态异常。这些特征通常在未感染HIV的老年普通人群中可见，并且与衰老和免疫衰老表型相关。这种现象的解释尚不清楚。有多种因素可能在病理生理上起作用，包括残余免疫失调综合征和单纯的抗逆转录病毒药物。显然，慢性HIV感染性质的改变使其进入了内科领域。心脏病学、内科、老年医学和肿瘤学综合征是接受抗逆转录病毒治疗的HIV阳性患者的主要表现。对HIV感染者的护理管理将需要在诊断和治疗中借鉴广泛的医学学科。阐明这些现象将有利于HIV阳性以及HIV阴性普通人群中这些非感染性疾病的治疗。关键词：抗逆转录病毒疗法 - HIV感染 - 免疫失调 - 免疫衰老 - 非艾滋病疾病
