Figure 1

Pathogenesis of serious non-AIDS events. HIV infection causes progressive decline in CD4 T cells through direct cytopathic effects and immune mediated killing of infected cells, as well as indirectly via immune activation. Other drivers of immune activation include co-infections and microbial translocation. HIV can contribute to organ dysfunction through detrimental effects on hepatic stellate cells and renal tubular cells. HIV may also be oncogenic. Co-infection with HBV and HCV is especially important in liver related events. In addition, patients’ underlying co-morbidities e.g. smoking, cardiovascular risk factors, and ART related toxicities also contribute to SNAEs.