About
Antiretroviral therapy (ART) improved life expectancy and health condition of people living with HIV (PLHIV), and access to ART increased significantly worldwide over the last decades. However, despite virological control, the risk to develop non-AIDS comorbidities remains higher in PLHIV. This risk of developing comorbidities is also increasing with aging. Even in high-income countries (HIC), cardiovascular disease risk is higher in PLHIV than in the general population. Importantly, the Reprieve study showed that clinical management of PLHIV should not focus only on viral control, but also take into account the clinical management of the comorbidity risks.
Unlike in HIC, the number of molecules remains very limited in low- and middle-income countries, PLHIV thus remaining on the same molecules for extended time. This likely results in a higher frequency of drug toxicity and ART resistance and might put PLHIV at increased risk for comorbidities. Other factors (e.g. environmental, co-infections, immune activation) might also impact their frequency. Unlike Africa, the type and frequency of comorbidities is not yet well documented in Asia, while the characteristics of populations may differ between settings (BMI, diet, etc.).
In Vietnam, in 2021, the HIV prevalence in adults was estimated at 0.3%, which represented a total of 240,000 adults living with HIV. Several reports documented the high rate of virological success in PLHIV in Vietnam, and a low mortality. The number of PLHIV on ART for several years is therefore increasing.
The main goal of this study is to describe the prevalence of a wide range of comorbidities (diabetes, hypertension, cardiovascular disease risk, renal impairment, hepatitis steatosis and fibrosis, mental disorder, colorectal cancer, cervical cancer in women, anal cancer in men who have sex with men, and low bone mineral density) in a large multi-center study (4 clinical sites in Hanoi) of 1251 adult PLHIV on ART for ≥5 years, and to identify associated factors. The prevalence of comorbidities will be compared between three ART duration groups: 5-9, 10-14 and ≥15 years, of course accounting for other factors (i.e. type of ART molecules, age, gender). A secondary objective is to document the rate of linkage to care in those for whom a comorbidity was discovered. To assess it, a second timepoint, 6 months after enrolment, is considered.
We will document the level of systemic inflammation, evaluate the association between inflammation and occurrence of comorbidities and if inflammation patterns emerge between comorbidities. The level and type of immune activation will also be investigated by flow cytometry in a subgroup of participants, with and without comorbidities paired by gender, age and ART duration. Finally, a plasma and peripheral blood mononuclear cells (PBMC) collection will be constituted to allow future mechanistic explorations.
A social science study will be conducted in a selection of participants and healthcare workers who will be invited to take part in focus-group discussion and/or in-depth individual interviews. Topics addressed will be related to HIV care, quality of life, general health and aging.
The project is co-funded by ANRS-MIE, we are currently activey looking for co-funding.
