- Emmanuel Ifeanyi Obeagu
- Department of Biomedical and Laboratory Science, Africa University, Zimbabwe
The coexistence of HIV and sickle cell disease (SCD) presents unique clinical challenges due to overlapping pathophysiological mechanisms, including chronic inflammation, immune dysregulation, and endothelial dysfunction. While antiretroviral therapy (ART) has significantly improved survival and quality of life in HIV-infected individuals, its impact on SCD progression remains an area of concern. Some ART regimens may exacerbate anemia, increase oxidative stress, and impair vascular function, potentially influencing the frequency and severity of vaso-occlusive crises (VOCs). Conversely, effective viral suppression through ART may reduce systemic inflammation and immune activation, potentially benefiting SCD-related complications. This review explores the clinical outcomes of ART in SCD patients, focusing on its effects on VOC frequency, anemia, endothelial function, and long-term disease progression. The choice of ART regimen plays a crucial role in mitigating hematologic and vascular complications, with certain drugs, such as zidovudine, being associated with bone marrow suppression and anemia, while integrase inhibitors demonstrate a more favorable safety profile. Additionally, ART may influence endothelial health, with protease inhibitors linked to endothelial dysfunction, while newer regimens may have neutral or even protective effects. Given these complexities, individualized ART selection is essential for optimizing treatment outcomes in HIV-SCD co-infected patients.
