The complex interaction of HIV with coinfections, non-communicable diseases, mental and social factors: Epidemiology, dynamics and phylogenetics

Human immunodeficiency virus (HIV) infection is a complex condition interacting with virtually every health aspect of its host. The Swiss HIV Cohort Study (SHCS) is a prospective, multicenter study enrolling HIV-infected people living in Switzerland, representative of the Swiss HIV epidemic. Using the rich and detailed data of the SHCS in combination with viral gene sequences allows the detailed study of several interactions of HIV with other health conditions. This habilitation thesis includes five publications that address different aspects of HIV interacting with comorbid conditions. The first publication serves as an overview of all coinfections, non-communicable diseases and opportunistic infections recorded in the SHCS. The wide range of conditions studied in this project highlights the complexity of different comorbid conditions, ranging from sexually transmitted infections over cardio-vascular diseases, cancer to AIDS-defining diseases. In the second project, we concentrated on the interaction of Mycobacterium Tuberculosis (MTB) and HIV, a coinfection frequently observed in people living with HIV (PLWH) worldwide. We investigated in particular the continuous interaction between MTB and the host during latent MTB infection and potential benefits of the host by augmenting the immune response to other, unrelated pathogens, in this case HIV. The third project has its focus on neurocognitive impairment in PLWH, one of the most frequent non-communicable comorbidities. The fourth project investigates social and mental well-being in HIV long-term survivors, with a particular focus on people who inject drugs, one of the most vulnerable subpopulations among PLWH. The fifth project analyzes the trend of recreational drug use in the SHCS. All studied conditions are highly interlinked: Optimal care of PLWH involves the consideration of many pieces of a puzzle, including not only HIV specific conditions, but also coinfections, other comorbidities, mental well-being and social integration.