Revista Horizontes: primavera/otoño 2017 | Año LX Núms. 116-117

4 LONG-TERM COMPLICATIONS OF INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS: ONGOING RESEARCH Dra. Sharilyn Almodóvar Department of Immunology and Molecular Microbiology Texas Tech University Health Sciences Center Summary Infection with Human Immunodeficiency Virus (HIV) remains a significant issue. Thanks to the unquestioned success of antiretroviral therapies, HIV-infected individuals are living longer, with a life expectancy similar to the uninfected population. However, low levels of HIV can still maintain a persistent immune activation and inflammatory status in the patients, which make patients significantly more vulnerable to serious health conditions that may include neurocognitive issues, cardiovascular diseases, musculoskeletal disorders, kidney and liver disease, as well as cancer. This essay, written by a scientist, presents the big picture of the health challenges that an HIV-infected individual may face nowadays; the health complications that go beyond infection and AIDS. In addition, it emphasizes on the importance of joining efforts between physicians in the clinic, scientists in the laboratories, as well as the critical role of the patients in moving research forward. What is New Regarding HIV Disease? According to the 2016 HIV Surveillance report of the Centers for Disease Control and Prevention, there are 35,323 Puerto Ricans living in the Island diagnosed with Human Immunodeficiency Virus (HIV), including those who have been classified as Stage 3 (AIDS) at any given time, and 523 new people diagnosed in 2016 (CDC, 2016). These numbers put Puerto Rico on the Top Ten States/Areas of New HIV diagnoses in 2016, with 17.8 new cases per 100,000 individuals (kff.org , 2017). As scientists, we always get the question: why you haven’t cured HIV yet? It is true that, as of the end of 2017, we still do not have that wondrous medication to cure HIV infection. The fight against a virus that evolves so quickly to defeat natural and synthetic molecules and virtual predictions enough times to put pharmacogenomics, pharmacodynamics, bioengineering, and bioinformatics in jaque has been cumbersome. Nevertheless, we cannot deny the fact that antiretroviral therapy has reached important milestones. Since its development in 1996, and after several formulations, combinations, successes and failures, people with HIV who have access to antiretroviral therapy can now live as long as any uninfected person. Research studies in the United States and in the United Kingdom showed that HIV-infected individuals can live as long as 70-73 years (Moore, Keruly, & Bartlett, 2012; Nakagawa et al., 2012). This means that ~ treated ~ HIV infection is largely a chronic disease now. Thus, that’s good news. It’s like having hypertension or diabetes for the rest of a lifetime but the patient has an infection with a deadly virus if left untreated. This implies that HIV-infected population is aging as any healthy individual. Nevertheless, HIV people remain vulnerable to serious health complications. Long-Term Complications of HIV HIV-infected individuals are now suffering from diseases that are over-represented in that population compared to uninfected individuals. Those diseases can be very complex and hard to diagnose in HIV-infected persons, as they present a complex array of symptoms. At the deeper level, HIV infection is associated with neurocognitive issues (Farhadian, Patel, & Spudich, 2017), disturbances in the metabolic programing inside the cells that lead to cardiovascular diseases, for example (Teer & Essop, 2018), musculoskeletal disorders (Pretell-Mazzini, Subhawong, Hernandez, & Campo, 2016), kidney disease (Jotwani, Atta, & Estrella, 2017), liver disease (Kaspar & Sterling, 2017), all of which may mediate accelerated aging (Van Epps & Kalayjian, 2017), and cancer (Galati & Zanotta, 2016). From the point of view as a researcher, the general concepts mentioned above all represent opportunities to better learn and understand something well enough to become an expert. It represents the opportunity to design experiments, fail, repeat, redesign, and succeed enough times to make a career in any field in biomedicine or basic science. It represents the opportunity to train the juniors who represent the next crop of scientists. It also represents the fact that there is a lot of hard work being done behind the stages…. From the medical standpoint, molecular interactions of the virus with cells in the infected host lead to serious challenges to the daily practice. Imagine an HIV patient going to their HIV doctor to get their prescription for antiretroviral therapy, a blood test to check their viral load and CD4 counts, as part of their routine checks. Some cases get seasoned with what may seem general complications that may go from headaches, forgetfulness, learning struggles, difficulty in maintaining a healthy weight, respiratory issues, joint disease, etc. These along with genetic predispositions and environmental factors are the cherries on the top of the cake. It may take years to hit the right referral, the right health test, the right medication to really pinpoint the root of the issues. A doctor with holistic training working in an infallible health care system may be “all” that is needed. It may take years to identify, for example, a liver vascular issue mediated by HIV in a lucky patient receiving an integrative clinical care. Most of the time, the diagnosis is never made or it’s too late…