The role of antiretroviral therapy and changes in lifestyle in the management of HIV infections.
Frank J. Palella, MD: The goals of the therapies that we use are part of the bigger picture of overall health improvement in quality and quantity of life, so both life span and health span. For the treatment of HIV, the antiretrovirals achieve this through suppressing the virus’s ability to make more of itself—to suppress viral replication, to essentially get persons with HIV to a point their peripheral blood viral load is undetectable using our most sensitive tests. By doing that, it improves immune health, stabilizes already healthy immune systems, helps replete those that have been weakened, and allows for the avoidance of illnesses that we know are associated with HIV’s effect on the immune system and the effect on overall levels of inflammation and adverse immune activation.
This being said, the therapies we use need to not create adverse effects, both long or short term, that contribute to risks for conditions that persons with HIV—like all of us—are more likely to encounter as they age: what we call the noninfectious age-associated comorbidities like hypertension, diabetes, hyperlipidemia, neurocognitive issues, kidney or liver issues, weight gain, and bone integrity. The list goes on. The treatments are part of an overall approach to optimize healthy outcomes. The approach, in addition to the antiretroviral therapy, needs to include lifestyle considerations; avoidance of smoking, excess alcohol, recreational drugs that could be very harmful. [This also includes] getting exercise, a healthy diet, sufficient rest, and avoidance of stress. All these things are components, and the therapies we use to treat HIV should not contribute to the ability to achieve these ends, nor should they constitute risks themselves for adverse effects.
Transcript edited for clarity.