By Rick Blake, Washington Correspondent
The Trump Administration is considering issuing an Executive Order “to prioritize the funding, facilitation, development and commercialization of therapies focused on HIV/AIDS comorbidities for the U.S. HIV population that experience insulin intolerance, stroke, heart, disease, inflammation, diarrhea, gastrointestinal intestinal diseases. diarrhea and other HIV comorbidities.” This aims to be a part of the Administration’s effort to end the epidemic by 2030. There have been similar legislative proposals in the U.S. House of Representatives. Can there be a meeting of the minds?
Fifteen to 30 percent of U.S. HIV patients currently experience one or more comorbidities. Currently, People Living with HIV and AIDS (PLWHA) have higher co-morbidity rates that HIV-negative people. People living with HIV on Medicaid generally have more health problems than those with commercial health coverage. In addition, nearly half of people living with HIV in the US are age 50 or older and are more susceptible to HIV comorbidities that lead to sub-optimal immune responses.
As more live due to ARV therapies, an aging HIV population are beginning to die from conditions other than those that are HIV-related. Antiretroviral therapy (ARV) has for a generation prolonged the lives of U.S. citizens infected by the HIV retrovirus. While ARVs prolongs the life of those infected, it does not fully restore health. Long-term patients on ARVs remain at higher risk for a wide range of comorbidities. In addition, scientific studies have attributed ARV-associated diarrhea and other comorbidities as drivers of non-adherence to ARV therapies, thus lessening their effectiveness. Addressing chronic inflammation in HIV is particularly critical because inflammation is strongly associated with the development of morbidity and mortality in the HIV population.
Research studies in the Journal of Infectious Diseases Comorbidities Among US Patients With Prevalent HIV Infection—A Trend Analysis Gallang, Hsue, et al, those from the last Conference on Retroviruses and Opportunistic Infections (CROI 2019) Increased Prevalence of Prolonged QTC in Persons Living With HIV Compared to Controls D. Knudsen, Jonas B. Nielsen; Sudden Cardiac Death Among HIV-Infected and Uninfected Veterans Freiberg, Meredith S. Duncan, et al; HIV Post SCD Study: 80 Percent of Autopsy-Defined Sudden Arrhthmic Death in HIV Tseng, Ellen Moffat, et al; Elsevier’s published study, Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: A cross-sectional study Maciela, Moreira, et al and many others show a much higher prevalence for heart disease, stroke and many other comorbidities for those with HIV and AIDS.
Drs. Anthony Fauci, Bob Redfield et al have generally responded to Trump’s State of the Union statement concerning ending the epidemic in 10 years. This means an emphasis on more treatment, diagnosis and rapid testing. However, those long term HIV and AIDS salvage patients need diagnosis and treatment for HIV co-morbidities, particularly those that experience insulin intolerance, stroke, heart, disease, inflammation, diarrhea, gastrointestinal intestinal diseases and diarrhea. They cannot wait any longer.
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Originally published on PanAware on Wordpress.com on August 20, 2019. By Jeannie Wraight (column by Rick Blake, Washington Correspondent).