The complications of HIV vary based on how early the infection is found, how well antiretroviral therapy (ART) works, and the person’s overall health. If HIV is untreated, the immune system weakens over time. This makes the body vulnerable to infections and some cancers. Even with treatment, long-term issues may occur because of inflammation, immune activation, or drug side effects. Understanding the complications of HIV helps patients and doctors manage health more effectively.
Complications can be infectious or non-infectious. Infectious complications come from germs taking advantage of weak immunity. Non-infectious complications come from HIV itself or its treatment. ART greatly reduces the risk of both, but ongoing care is essential.
Opportunistic Infections
Opportunistic infections (OIs) are among the most common complications of HIV when ART is not used. These infections strike when the immune system becomes too weak to fight everyday germs. A CD4 count below 200 cells/mm³ raises the risk.
Common OIs include:
- Tuberculosis (TB): The top cause of HIV-related death worldwide. HIV increases the chance of both active and latent TB.
- Pneumocystis pneumonia (PCP): A fungal lung infection causing severe breathing problems, common with CD4 counts under 200.
- Candidiasis: A fungal infection in the mouth, throat, or genitals. It can spread to the oesophagus or lungs in severe cases.
- Toxoplasmosis: A parasite that can affect the brain, causing seizures and confusion.
- Cytomegalovirus (CMV): A virus that can cause blindness or stomach issues in advanced HIV.
- Cryptococcal meningitis: A fungal infection of the brain and spinal cord, often life-threatening.
ART, antibiotics, and CD4 monitoring reduce these risks greatly.
HIV-Related Cancers
Another major group of complications of HIV includes cancers. Some are AIDS-defining cancers, which signal severe immune weakness.
Key cancers include:
- Kaposi’s sarcoma: Cancer of blood vessels, appearing as dark skin spots. Linked to HIV and HHV-8 virus.
- Non-Hodgkin lymphoma: A fast-growing cancer of lymph nodes or brain.
- Cervical cancer: More common in HIV-positive women due to HPV infection.
HIV also raises the risk of anal cancer, liver cancer, and lung cancer because of chronic inflammation and co-infections.
Neurological Complications
HIV can cross into the brain and affect the nervous system. ART lowers this risk, but problems still occur, especially without treatment.
Common neurological complications:
- HIV-associated neurocognitive disorders (HAND): Ranges from mild memory loss to HIV dementia. Symptoms include poor focus and mood changes.
- Peripheral neuropathy: Tingling or pain in the hands and feet caused by HIV or ART side effects.
- Meningitis and encephalitis: Brain infections caused by germs like Cryptococcus or CMV.
Regular check-ups and early ART help prevent these issues.
Heart and Blood Vessel Problems
HIV increases the risk of heart disease because of inflammation, drug effects, and lifestyle habits like smoking.
Common issues include:
- Heart attacks and strokes (coronary artery disease).
- High blood pressure in the lungs (pulmonary hypertension).
- Inflammation of the heart muscle (myocarditis).
Healthy lifestyle changes and regular heart checks are vital.
Kidney and Liver Complications
HIV can damage the kidneys and liver directly or through co-infections.
- HIV-associated nephropathy (HIVAN): A kidney disease common in people of African descent.
- Hepatitis B and C co-infection: Raises the risk of liver failure and cancer.
- Drug-induced liver damage: Some HIV medicines can harm the liver.
Blood tests monitor these organs regularly in people on ART.
Metabolic and Bone Problems
HIV and ART can lead to:
- Lipodystrophy: Uneven fat changes in the body.
- Diabetes and insulin resistance: From HIV or medication.
- High cholesterol: Increases heart disease risk.
- Bone weakness: Osteopenia and osteoporosis are more common, increasing fracture risk.
Healthy eating, exercise, and medication adjustments help manage these problems.
Final Thoughts on HIV Complications
The complications of HIV can affect almost every body system if left untreated. But with early testing and strict ART use, most complications can be avoided or treated. Regular check-ups and full-body care are the best ways to stay healthy with HIV.
