[Treating HIV disease: back to the patient?]

[Autom. eng. transl.] Over the past 20 years, HIV disease has progressively changed from an invariably lethal disease to a chronic, treatable condition, thanks to the availability of increasingly effective antiretroviral therapies. Widespread use of these therapies also has the potential to contribute to controlling the spread of infection. The incidence of opportunistic manifestations favored by immunodepression is significantly decreased in people with HIV, while chronic-degenerative pathologies, such as cardio- and cerebrovascular, metabolic, bone, renal and hepatic diseases, linked to the state of chronic inflammation, have become much more common. the aging population of these people. In 2030, it is expected that over 80% of people with older HIV will have at least one chronic degenerative disease, compared to 19% of HIV-negative people, and over a quarter of them will have three or more diseases. Among people with HIV, the prevalence of a condition of fragility is increasing. The choice of therapeutic strategies for HIV disease therefore today must be based not only on the ability of drugs to induce a complete suppression of viral replication in the short / medium term. Therapeutic choices must promote long-term adherence and absence of toxicity, have the ability to restore immune homeostasis and thus reduce chronic inflammation and the risk of related diseases, having a positive impact over time on overall conditions of life of the person with HIV, also measured with indicators such as patient related oucomes.