Emerging clinical issues related to management of multiorgan comorbidities and polypharmacy

Owing to the effective antiretroviral therapy (ART), HIV-infected individuals are living longer, but present with an increased incidence of age-related multiorgan comorbidities. Novel clinical issues arising from these comorbidities and age-associated frailty need to be diagnosed and managed.

Physicians must be trained and new clinical guidelines are required to diagnose and manage specific issues that have arisen from multimorbidity and polypharmacy, including drug-drug interactions, adverse drug reactions and decreased treatment adherence. Reliable tests to evaluate low-grade inflammation, immune activation and other age-related conditions are not yet validated. The early treatment of HIV infection with new low-toxicity ART will probably prevent several HIV-related and ART-related comorbidities. The benefits of a healthy lifestyle are evident. Physicians must prioritize which comorbid conditions to treat in each patient, including an assessment of the benefit/risk ratio for each drug. For HIV-infected late-diagnosed patients, special attention must be paid to ART toxicity and drug-drug interactions. Anti-inflammatory/immune activation modulators are not recommended at present, except statins and aspirin, which can be useful in at-risk patients.

Aging HIV-infected patients require appropriate screening for age-related comorbidities and personalized management to optimize their lifespan and quality of life. New anti-inflammatory/immune modulatory strategies to help manage this condition are awaited.