Table 1.

Prevention, Assessment and Treatment Strategies for Chronic Comorbidities in HIV

Chronic Condition	HIV Risk	Prevention Strategies	Monitoring/Assessment Strategies	Treatment Strategies	Structural Strategies
ASCVD	1.5- to 2-fold greater risk	↓ Hypertension, ↓Hypocholesteremia ↓ Hyperglycemia ↓ Weight Smoking ↑Physical activity ↑ Healthy diet	Routine (or at home) blood pressure monitoring Routine weight, waist circumference, and smoking assessment Annual fasting lipid panel & HgA1c ASCVD risk calculator Exercise vital sign Coronary calcium scoring Cardiorespiratory fitness testing	Maintain a suppressed HIV viral load Nutrition consultation and follow-up Physical activity prescription Lipid lowering agents Antihypertensive agents	Shift to collaborative care models to include cardiovascular specialist, pharmacist, registered dietician, physical therapy
COPD	~10% higher risk	Smoking (consider using the 5 As) ↓ exposure to environmental pollutants Administer influenza & pneumococcal vaccines	Smoking (pack/year) assessment Pulmonary function tests for those over age 40 and/or with respiratory symptoms	Maintain a suppressed HIV viral load Respiratory inhalers Pulmonary rehabilitation, administration of oxygen therapy	Collaborative care models to include respiratory specialist, pharmacist, smoking cessation counselor Support community and workplace initiatives to reduce tobacco use (e.g., tobacco-free zones, tobacco/vaping taxes, age of purchase)
Lung Cancer	~2-fold greater risk (Hernández-Ramírez et al., 2017)	Smoking (consider using the 5 As) ↑Physical activity ↑ Healthy diet	Smoking (pack/year) assessment Annual low-dose CT for those at high risk	Surgery
Liver Cancer	4-fold higher risk	↓Injection drug use ↓Alcohol & tobacco use ↑Safe sex Administer Hepatitis B vaccine	Substance use screening and brief intervention at each encounter Ultrasonography with or without alpha-fetoprotein tests every 6 months for those at high risk	Maintain a suppressed HIV viral load Direct acting antiviral medications Transarterial chemoembolization & radioembolization, Stereotactic body radiation therapy Systemic chemotherapy	Collaborative care models to include hepatology, pharmacist, substance use/behavioral medicine specialist Support use of needle exchanges
Anal Cancer	19-fold higher risk	Administer HPV Vaccine ↓ Exposure to HPV (e.g., condom use) Treat anal lesions Smoking	Unclear benefit of routine screening using anal cytology	Radiation therapy Chemotherapy Excision of lesion
Diabetes Mellitus	~2-fold reduced risk in HIV, but growing (Herrin et al., 2016)	↓ Hyperglycemia ↓ Weight ↑Physical Activity ↑ Healthy Diet	Daily glucose testing (by the PLWH) Regular fasting glucose test & HgA1c Exercise vital sign Food Insecurity assessment	Nutrition consultation and follow-up Physical activity prescription Blood glucose lowering agents	Adopt collaborative care models to include endocrinology, nephrology, pharmacy, registered dietetics, physical therapy Support increased access to promote food security including SNAP

Note. ASCVD – Atherosclerotic Cardiovascular Disease, COPD – Chronic Obstructive Pulmonary Disorder, 5 As – Ask, Assess, Advise, Agree, Assist, HPV – Human Papillomavirus, PLWH – People Living with HIV, SNAP - Supplemental Nutrition Assistance Program