Morbidity and mortality in HIV-infected individuals - a shift towards comorbidities

Combination antiretroviral therapy (cART) has dramatically improved the prognosis of HIV-infected persons to a level close to a normal life expectancy in a significant proportion of treated individuals. On starting cART HIV-induced immune deficiency can be prevented or, if already present, reconstituted. Remaining morbidity and mortality is partly due to late presentation of patients, when CD4-T-cells have already fallen below 200 cells/microL often accompanied by symptomatic disease. However, at present morbidity and mortality are mainly related to comorbidities such as hepatitis and tumours at least partly associated with HIV infection. It should be noted that, as HIV-infected patients become older, long-term toxicity of antiretroviral drugs may play an important role in increasing the risk of cardiovascular diseases. The changing pattern of HIV-associated diseases may indicate the need for specific preventive measures in this population.