Guest Column: Dr. Robert Kauffmann - New Challenges for HIV Practitioners

HIV infection has become a chronic, treatable disease but that doesn’t mean that the HIV-treating specialist can sit back and relax. On the contrary, the need for care of patients with HIV-infection has increased significantly because despite adequate antiviral therapy, HIV patients suffer illnesses that are not directly caused by HIV and are often associated with old age. Because HIV-infected patients show signs of premature ageing, they are more prone to develop these diseases.

The early occurrence of atherosclerosis, cognitive decline and general body weakness are probably related to the residual activity of the HIV infection and incomplete immunological recovery. This creates a state of chronic inflammation and immune activation.

The increased prevalence of chronic renal failure, osteoporosis and osteopenia, insulin resistance, diabetes mellitus and hyperlipidemia is partly caused by toxic medication. Lung, kidney, oesophageal, stomach and skin cancers are more common in patients with HIV infection. Lastly, the complications of hepatitis B and C virus infection require the continued attention of the HIV team.

Should the treatment of these diseases be outsourced to other specialists, or should HIV specialists manage this great diversity of illnesses experienced by HIV-infected patients by themselves. This would imply that the HIV-specialised physician would also have diabetes mellitus, hyperlipidemia, vascular damage, mild chronic renal failure, osteoporosis and hepatitis B and C virus infection in his or her treatment package and should be able to treat their patients for these disorders.

The strength of the HIV treatment team is based on a close relationship with the patient. When the treatment of patients with HIV infection is spread across multiple disciplines (and hospital departments) the outcome of the treatment will not be optimal.

This means that there is a substantial challenge for the HIV treatment team to succeed in meeting the increasing care demands. Stichting HIV Monitoring can help in this challenge through registering the results of the treatment of HIV-infected patients.

Stichting HIV Monitoring

Stichting HIV Monitoring (SHM) makes an essential contribution to healthcare for HIV-positive people in the Netherlands. Working with all recognised HIV treatment centres in the Netherlands, SHM systematically collects coded medical data from all registered HIV patients. SHM uses these data to produce centre-specific reports that allow HIV treatment centres to optimise their patient care and obtain formal certification. SHM’s data also form the basis for the yearly HIV monitoring report and are used in HIV-related research in the Netherlands and internationally. The outcome of SHM’s research provides tangible input into HIV care and prevention polices in the Netherlands.

© Stichting HIV Monitoring