Organ effects of antiretroviral therapy in HIV
Treatment of HIV with combination antiretroviral therapy (cART) may have adverse effects on organs such as liver, bone and lungs. In his PhD thesis, Berend van Welzen investigated the effects of HIV itself as well as of various forms of cART and found out that modern cART modalities have brought significant advantages for HIV patients, including lower overall mortality (when co-infected with hepatitis B virus) and reduced risks of liver toxicity and perhaps of osteoporosis as well.
The introduction of combination antiretroviral therapy (cART) has dramatically improved the life expectancy of people living with HIV (PLH). As a result, the focus in treatment has shifted to the long-term effects of HIV and cART on the various organ systems. In his thesis Berend van Welzen (Department of Infectious Diseases, UMC Utrecht) highlights the effects of HIV and cART on three of these organ systems.
Liver
The first part focuses on additional liver diseases in PLH, the main organ-specific cause of death in this group. This section describes, among other things, that since the introduction of the antiretroviral agent tenofovir, the risk of death has significantly decreased in people co-infected with HIV and Hepatitis B virus. Attention is also paid to the occurrence of fatty liver disease as the main cause of liver disease in PLH in the future.
Bone
In the second part of the thesis, the emphasis is on bone-related diseases in HIV. Among other things, data are presented that suggest that the increased bone destruction with the use of certain HIV inhibitors is caused by a disrupted control of the parathyroid glands and thus the calcium metabolism.
Lungs
In the last part of the thesis, two aspects of Pneumocystis jirovecii (PJP) pneumonia in PLH are described, a pneumonia that occurs when the immune system is severely compromised. Over the years, much experience has been gained in the treatment of such an infection, but little is known about the course afterwards. In this section, the recovery of the immune system as well as the persistence of lung dysfunction after a long-term PJP is described.
PhD defense
Berend van Welzen (1986, Leiden) received his PhD title on September 29, 2020 at Utrecht University. The title of his thesis was “HIV & comorbidity in the era of modern antiretroviral therapy – Heritages of the past & challenges for the future”. Supervisor was prof. dr. Andy Hoepelman and co-supervisors were dr. Joop Arends and dr. Tatiana (all Department of infectious Diseases, UMC Utrecht). Berend van Welzen works as an internist-infectiologist at UMC Utrecht.