title: [Treating HIV disease: back to the patient?]
abstract: HIV disease has dramatically changed in the last two decades from a progressive, lethal disease to a chronic manageable condition. These changes are due to the availability of potent antiretroviral combination therapy, which also have the potential to contribute significantly to the control of the epidemic. Among persons living with HIV, incidence of immunosuppression-related opportunistic illnesses has clearly decreased, while an increase was observed in the prevalence of age-related noncommunicable comorbidities, including cardiovascular, metabolic, renal, bone and hepatic disease, due to chronic inflammatory state and to an overall aging of the population of persons with HIV. It has been predicted that by 2030 more than 80% of older persons with HIV will have at least one comorbidity, compared to 19% of non HIV-infected persons, and that one fourth of these persons will have three or more comorbidities. Among persons with HIV, the prevalence of frailty is increasing. Choice of therapeutic approach to HIV disease should take into account, in addition to the ability of drug combination to suppress viral replication, the potential for long term adherence to treatment, the lack of long term toxicity, the possibility to fully restore immune function and prevent immune activation, thus reducing the risk of chronic inflammation related disease. In addition the overall impact of treatment on patients' well-being must be considered, and patients related outcomes should be used to measure this impact.
authors: UOC Epidemiologia Clinica, INMI Lazzaro Spallanzani - IRCCS, Roma.
authors: Enrico
authors: E
authors: Girardi
authors: Clinica Malattie Infettive, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università di Milano.
authors: Antonella
authors: A
authors: d'Arminio Monforte
authors: Istituto Superiore di Sanità, Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Roma.
authors: Laura
authors: L
authors: Camoni
authors: Istituto Superiore di Sanità, Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Roma.
authors: Patrizio
authors: P
authors: Pezzotti
authors: Clinica delle Malattie Infettive, Dipartimento di Scienze Mediche e Chirurgiche del bambino e dell'adulto, Università di Modena e Reggio Emilia.
authors: Giovanni
authors: G
authors: Guaraldi
authors: UOC Immunodeficienze Virali e Neuro-Oncologia Infettiva, INMI Lazzaro Spallanzani, Roma; Dipartimento di Clinica e di Ricerca Clinica, INMI Lazzaro Spallanzani, Roma.
authors: Adriana
authors: A
authors: Ammassari
authors: Area Dipartimentale HIV/AIDS, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma.
authors: Andrea
authors: A
authors: Antinori
authors: Sezione di Malattie infettive, Dipartimento di Scienze Mediche, Università di Torino.
authors: Stefano
authors: S
authors: Bonora
authors: Clinica Malattie Infettive, Università di Modena.
authors: Cristina
authors: C
authors: Mussini
authors: Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Roma.
authors: Antonella
authors: A
authors: Cingolani
authors: Chair European Community Advisory Board.
authors: Giulio Maria
authors: GM
authors: Corbelli
authors: Settore Farmaceutico-Protesica-Dispositivi medici Regione del Veneto.
authors: Silvia
authors: S
authors: Adami
authors: CliCon - Health, Economics & Outcome Research.
authors: Luca
authors: L
authors: Degli Esposti
authors: Coordinamento Regionale Unico sul Farmaco, Verona.
authors: Margherita
authors: M
authors: Andretta
mesh_terms: D019380:Anti-HIV Agents; D002908:Chronic Disease; D015897:Comorbidity; D015658:HIV Infections; D006801:Humans; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents