As HIV becomes a long-term chronic condition, there are new and emerging risks — including cardiovascular diseases and treatment toxicity.
Image: Tumi Pakkies | Independent Newspapers
AS the life expectancy for people living with HIV continues to rise, the focus for healthcare systems has shifted towards managing comorbidities, medication-related risks and long-term organ health.
We aim to transition members to safer and more advanced therapies to prevent chronic kidney disease, bone density loss and other downstream complications — while still reducing long-term healthcare costs and disability burdens.
Our HIV management programme has proven to be our biggest success, having met and exceeded the UNAIDS targets for HIV management.
Often referred to as 95/95/95, the aim of these targets is for 95% of people living with HIV to know their status, 95% of those diagnosed to receive antiretroviral therapy (ART), and 95% of those on ART to achieve viral suppression. We achieved these targets in 2024 and are now closer to achieving 97/97/97.
In practical terms, the 95/95/95 targets mean that most People Living With HIV (PLWH) know their status, are receiving effective treatment, and have achieved viral suppression. This translates to fewer HIV-related complications, longer quality of life and less HIV transmission through U=U (Undetectable viral load=Untransmittable HIV virus), resulting in a reduced number of new HIV cases.
Due to robust HIV treatment, life expectancy in PLWH has increased. As a result, ageing-related illnesses, polypharmacy and treatment toxicity become more prominent, and patient-centred care and treatment integration become vital. Clinicians need to have a holistic view of the patient to consider treatment customisation.
Ultimately, success beyond viral suppression can be measured by the quality of life in PLWH – through reduced opportunistic infections, fewer hospitalisation instances and better management and prevention of noncommunicable diseases.
Of course, as HIV becomes a long-term chronic condition, there are new and emerging risks — including cardiovascular diseases and treatment toxicity. These risks require proactive screening and intervention and careful selection of treatment regimens to minimise long-term harm.
Transitioning patients to newer therapies is thus critically important if health institutions are serious about patient-centred care and the quality of life in PLWH beyond viral suppression. This further supports sustainable, affordable, quality health care by mitigating costs in complication management and hospitalisations.
Comorbidities such as chronic kidney disease (CKD) and bone density loss are becoming increasingly important in HIV care. These complications do not only come with ageing but can occur prematurely in PLWH. This can be caused by the HIV itself or certain classes of HIV treatment.
We have made proactive moves to introduce kidney-friendly and bone-density-preserving HIV treatments for its members.
It should also be remembered that alternative or newer HIV treatment might cost more upfront, but the benefits, including significant reductions in costs related to morbidity, specialist care and hospitalisation, will be evident long-term.
Today, we can reduce new HIV infections through Pre-Exposure Prophylaxis (PrEP), Post Exposure Prophylaxis (PEP), and anti-retroviral therapy (ART), which serves to reduce opportunistic infections and other complications related to disease progression and HIV transmission.
Furthermore, digital health technology enables data-driven decisions to be made, such as patient risk stratification that can address treatment optimisation and improved care coordination. This technology also helps us monitor the outcomes of HIV management.
Another crucial aspect of HIV management is the impact of treatment on Disability-Adjusted Life Years (DALYs). This speaks to the morbidity — the life lived with disability — and the mortality, or years lost, due to the disease. HIV management has come a long way and has significantly reduced DALYs by introducing robust ARTs with fewer side effects, promoting good adherence and longer quality of life.
Crucially, better HIV care enables economically active individuals, the most affected group in South Africa, to be physically well, employable, and able to remain at work. This reduces absenteeism and supports household stability. At a societal level, it strengthens workforce productivity, reduces dependency, and contributes to the broader economic resilience of our country.
Additionally, it promotes and improves population health and social stability, reduces long-term healthcare costs, and maintains workforce productivity and, thus, economic sustainability. This, in turn, means that it also aligns with environmental, social and governance (ESG) principles.
Key lessons that could benefit the wider healthcare system include coordinated care and investment in primary healthcare that focuses on preventative programmes and integrated chronic disease management. These lessons can be applied across other chronic conditions and healthcare settings.
HIV management will continue to advance, with focus shifting towards being a chronic condition, using therapies that are safer to the ageing body, and integration with other chronic diseases. This will help to ensure a long quality of life beyond viral suppression.
We will continue to shift the conversation from basic HIV survival to one of HIV longevity, with the associated improvement in patient quality of life and the ongoing delivery of sustainable healthcare economics.
* Dr Katlego Lekganyane is a general practitioner at Platinum Health Medical Scheme.
** The views expressed here do not reflect those of the Sunday Independent, Independent Media, or IOL.