Editor’s note: Anti retroviral therapy (ART) significantly improves the life expectancy of HIV infected individuals. However, in recent years, the incidence rate of cardiovascular diseases and other complications related to obesity, type 2 diabetes, and metabolic syndrome (namely, abdominal obesity, hypertension, elevated triglyceride levels, dyslipidemia, and changes in blood glucose levels) has gradually increased among HIV infected people, which has become a growing concern. The complex interaction between sustained low-level immune activation, ART related metabolic toxicity, and non HIV related risk factors in chronic HIV infection may increase the risk of these comorbidities in HIV infected individuals. At the 19th European Conference on AIDS (EACS 2023), Professor Susanne Dam Nielsen of the University of Copenhagen, Denmark, made a special report on the study of non infectious complications among HIV infected people, focusing on the latest research progress of cardiovascular disease, pulmonary disease and metabolic system disease complications. Our reporter invited Professor Nielsen to conduct an in-depth interview on this topic at the conference.
My name is Susanne Dam Nielsen. I’m a professor of infectious diseases at the University of Copenhagen, Lesothepetale. I’ve been working with HIV since the mid -90s. The last 15 years or so my focus has been on comorbidities in infectious with HIV, impact of information and immunodeficiency.
Q：Could you briefly describe the main focus of your research at the Department of Infectious Diseases at the University of Copenhagen?
Prof. Nielsen: Yes. So I’m the PI of the Copenhagen Comorbidities and HIV or COCOMO study. The main focus of that study is to determine the burden of non -infectious comorbidities among persons with HIV. They are mainly well treated. We have focused on cardiovascular diseases, on pulmonary diseases and metabolic diseases.
Q：Thank you. And you mentioned earlier in the morning sessions that monary comorbidity has been understudied. Why do you think more research is urgently needed in this field?
Prof. Nielsen: Well, I think for the last 10 years or so we have been well aware that there’s an issue with cardiovascular diseases and I think we’ve come really far. We have good studies. We have a very nice meta -analysis showing twice the risk of ischemic heart diseases and we are now doing intervention studies like the recent repeat study showed that you could use daggers to lower risk of cardiovascular diseases even in those with no intermediate risk. So for pulmonary comorbidities the picture is somewhat different. we can see that there’s an increased risk of airflow limitation, there’s an increased risk of COPD. But really little is being done compared to what we have done in cardiovascular diseases. So we know there’s a problem. We recommend people to stop smoking, but basically we still need to understand the pathogenesis in order to intervene. And once we know how to intervene, we also need randomized studies testing different kind of interventions.
Q：Could you share more about the risk factor for COPD in people with HIV?
Prof. Nielsen: Yes. So main risk factors are agents smoking. That’s the same as in the general population, but these past two, three years, it’s become evident that persons with HIV, they have steeper decline in lung function than the general population. This steeper decline in lung function is associated with inflammation. It’s also associated with risk factors such as drug use. And those are the risk factors we have identified so far. Thank you.
Q: Is there any link between HIV or HIV treatment and the prevalence of COPD in people with HIV?
Prof. Nielsen: So the start study that tested immediate versus deferred ART treatment also had pulmonary sub -studies. And they found that there was no difference in decline in lung function among participants that had early versus deferred ART stuff. They also looked at incidence of COPD and they found no difference. The main problem with that study is that it included mainly younger persons with HIV, with a median age around 40, and COPD is the disease of the elder. So, but that’s the evidence we have from a randomized trial. There are some data suggesting that people with HIV that are treated with protease inhibitors have higher burden of pulmonary diseases. But I mean, there can be several, these are not randomized study. So there are different reasons for that.
Q: Thank you. And our final question is, how does COPD impact HIV treatment? Excuse me. How does COPD impact HIV treatment?
Prof. Nielsen: So I think I would like to first answer how does COPD impact the patients because COPD in persons with HIV is associated with really important problems like lower quality in life with more hospital admissions and importantly also with higher all -course mortality. So COPD in persons with HIV is really important as the impact on treatment. I think that’s mainly the interaction between some HIV treatments and inhalation steroids because there’s an interaction so you have to be aware of the interaction if you prescribe a inhalation steroid.
