Chronic comorbidities & coinfections among PLHIV

The earlier initiation and expanded access to antiretroviral therapy have significantly reduced the devastating impact of the global HIV epidemic in recent decades. The HIV infection has become a chronic disease, and people living with HIV (PLHIV) are now surviving, ageing, and requiring lifelong care and treatment. Across all age groups, PLHIV are at risk of developing chronic complications and comorbidities, such as noncommunicable diseases and mental health disorders. These conditions may be pre-existing, HIV-associated or due to ageing.

Global awareness of the gravity of HIV-chronic comorbidities among PLHIV has increased in recent years. Member States and partners are now looking to WHO for assessment tools and normative guidance. In 2019, WHO reviewed the existing norms and standards and set the priorities for technical areas and interventions for co-managing major non communicable diseases and mental health conditions among people living with HIV. It has been incorporated in current consolidated HIV guidelines to inform on the approaches for the management of coinfections and comorbidities, referencing the WHO packages of essential noncommunicable diseases (PEN) and the mental health (mhGAP) intervention guides.

Co-infections are common among PLHIV, regardless of immune status.  Some of those coinfections can be silent and do not cause significant impact on HIV disease nor are affected by it. In contrast, certain  co-infections can affect the natural history of HIV infection and vice-versa , with implications in diagnosis, susceptibility, clinical presentation, and care, including timing and choice of drug regimens for treatment and prevention. WHO has developed specific guidance to manage some of these co-infections, focusing on the screening, prophylaxis, treatment  and timing of ART for these conditions.

Member States have requested further guidance on the diagnosis, prevention and treatment of the major opportunistic infections and chronic comorbidities in adults adolescents and children living with HIV. In 2017, WHO published the first guidance for management of advanced HIV disease, and it was expanded in the 2021 consolidated HIV guidelines. WHO has also developed guidelines on the management of tuberculosis, cryptococcal meningitis, histoplasmosis, Buruli Ulcer, visceral, leishmaniasis and common skin and oral conditions associated with HIV.