Between the job, the kids and the partner, you have plenty on your plate. But when you’re living with HIV, your body needs extra TLC. From keeping your CD4s up to protecting your heart, here’s how to stay healthy for the long haul.
It’s hard to believe today. But in the beginning, experts thought that HIV affected gay men exclusively. Between its short-lived first name, gay-related immune deficiency (GRID), the high-profile disclosures and activism of gay men and the blatant homophobia of key policy makers, many Americans continued to think they were immune to HIV well into the epidemic.
Today, women make up half of the AIDS cases worldwide and 26% in the United States. Heterosexual intercourse is the source of 80% of new HIV diagnoses among American women. Women of color are at the eye of the storm, with African-American women accounting for 61% of new cases and Latinas for 16%.
Fortunately, various studies have increased our knowledge about how HIV specifically impacts women, with new trials getting underway to explore the effects of treatment on the female body. For example, last September, Tibotec Therapeutics initiated the Gender Race and Clinical Experience (GRACE) study, to date the largest clinical trial comparing how men and women respond to an HIV drug. About 70% of GRACE participants will be female.
Doctors, who once used a one-size-fits-all treatment approach, now address female HIV patients’ distinct needs. And positive women are being reminded that wellness doesn’t stop at suppressing the virus.
“As HIV treatment has improved, HIV positive women have undergone a transition,” says Vicki Cargill-Swiren, MD, director of minority research and clinical studies at the National Institutes of Health’s Office of AIDS Research. “The question is no longer ‘How can I survive HIV?’ It’s ‘How can I live with it?’”
This POZ Focus will show you how to maintain your overall health throughout the different stages of your life. Since a woman’s work is never done, you’ll also learn how to protect your partner and unborn children. You’ve got a full life to live. It’s time to treat your body accordingly.
Sexual Matters According to the Centers for Disease Control (CDC), it’s harder for a woman to transmit HIV to a man than the other way around. But even if your negative partner wants to skip latex condoms (or dental dams), use them. Although the chances are slimmer, you can still infect your partner with the virus. And having HIV doesn’t make you immune to other STDs, such as chlamydia, gonorrhea, herpes and syphilis—infections that dramatically increase the odds of acquiring or spreading HIV.
If you’re taking birth control pills and HIV drugs simultaneously you should still use condoms for extra pregnancy prevention. According to Rodney L. Wright, MD, director of HIV programs at New York City’s Montefiore Medical Center, HIV drugs can impact how well the pill works. “There are many possible interactions between birth control pills and antiretroviral drugs,” he explains. “It’s very difficult to predict how they’ll respond in the presence of one another. Patients should discuss possible interactions with their health care providers.”
Baby Talk If you’re trying to get pregnant or there’s a chance you might try in the future, talk to your doctor about treatment options. With the right meds for you and your baby, there’s less than a 2% chance that you’ll transmit HIV to your son or daughter. And if you have a low viral load, you may be able to deliver vaginally.
Before you start trying to get pregnant, ask your doctor if any of the HIV drugs in your HAART (highly active antiretroviral therapy) cocktail can cause birth defects. You and your partner should also consult your doctor about the safest way to conceive your baby.
Gender Differences Early studies seemed to indicate that HIV disease progressed more rapidly in women than in men. But further research revealed that women were getting sick more quickly because they were often diagnosed later than men and received medical care only when their immune systems were severely damaged. “Women still walk into the hospital with extremely low CD4 counts,” says Dr. Cargill-Swiren. “Many have sought care for repeated [gynecological problems], but the doctor didn’t bother to test them for HIV. And women are often caregivers. They’re so busy taking care of others that they put off their own health care until they get so ill that everything comes to a stop.”
When you’re not diagnosed with or treated for HIV early enough, you’re at high risk for opportunistic illnesses (OIs), potentially serious conditions that healthy immune systems keep at bay. Most OIs occur at the same rate in women and men, but there are a few differences.
Women are much less likely to get Kaposi’s sarcoma, a form of cancer. And while most HIV positive men carry cytomegalovirus (CMV)—a form of herpes that can cause blindness if the immune system becomes too weak—CMV is less common in women. Keep this in mind should you ever need a blood transfusion. Blood banks don’t test most donations for CMV. If you’re CMV negative, your doctor needs to find a blood source that is as well.
Sideways HIV drugs are largely tested on men, and doses are formulated based on their average body weight. Since women tend to have a lower average body weight and a higher percentage of body fat, “there’s no doubt that women metabolize certain meds differently than men,” says Meg Newman, MD, an associate professor of clinical medicine at the University of California at San Francisco’s Positive Health Program. Hormone levels can also affect how the body processes drugs. So far, research has shown that HIV meds are equally effective for men and women, but they may cause different side effects.
Women taking certain nukes are more prone to lactic acidosis—a rare but serious buildup of lactic acid in the bloodstream. Those on the non-nuke Viramune (nevirapine) are more likely than men to develop skin rashes and liver problems. Women are also more prone to side effects of the PI Norvir (ritonavir), including nausea and vomiting.
Some women on HAART report significant fat loss in their behinds, faces and limbs (lipoatrophy) as well as fat accumulation in their bellies and breasts (lipoaccumulation). Studies confirm these body shape changes but suggest that positive women on meds aren’t more likely than negative women to gain fat as they age.
Whatever the source of your symptoms, be sure to write them down and communicate with your doc. According to Dr. Cargill-Swiren, addressing side effects is an essential part of sticking to treatment. “We know that when women are given drugs that interfere with their functioning and their ability to care for their children and families, many will drop the drugs,” she says.
“The bottom line is to work closely with your practitioner,” adds Dr. Newman. “If you can’t tolerate your meds, let your clinician know. She or he may be able to make accommodations.” One possibility: Therapeutic drug monitoring, which measures the actual amount of a specific drug in your bloodstream and helps your doctor tailor a dose to your needs.
Gyno Know-How Regular gynecological exams should rank high on your list of health care priorities. “HIV positive women should pay as much attention to their reproductive-tract health as they do to their viral load and CD4 count,” says Dr. Cargill-Swiren. Be aware of the following:
Recurring yeast infections: Chronic yeast infections can be an early sign of a flagging immune system. Don’t overlook unusual itching or vaginal discharge. Keep your ob-gyn and your HIV doctor in the loop.
Sexually transmitted diseases: STDs can be more severe and harder to treat if you’re HIV positive. Herpes outbreaks occur more often in positive women. Untreated chlamydia and gonorrhea can develop into pelvic inflammatory disease (PID), which can in turn cause infertility. Sexually transmitted diseases also make it easier to infect someone with HIV.
Human papilloma virus (HPV): Spread by sexual contact, HPV is extremely common—at least 80% of all U.S. women will have it by age 50. Depending on the strain, HPV can cause genital warts and cancer of the cervix or anus. HIV positive women have higher rates of HPV than negative women. They’re also more likely to develop pre-cancerous cervical and anal cell changes known as dysplasia.
The Others HIV is a complex disease, and at times, managing it can be all-consuming. But as you go through each stage of your life, you can’t afford to ignore other health concerns. “Just because a woman is HIV positive, that doesn’t preclude her from other illnesses and the effects of aging,” warns Dr. Wright. “Every woman should get all the tests that normally happen—from regular mammograms and Pap smears to colonoscopies and [bone density] scans when they get older.”
Look out for heart disease, which is the No. 1 killer of women in the United States. The risk is even higher among those taking HIV meds, likely due to the effects of the drugs on blood fats. HIV positive smokers and diabetics face even higher risks. Your doctor will have information about how you can benefit from HAART and maintain a healthy heart.
Many people with HIV also have hepatitis B or C (HBV or HCV). Transmitted through bodily fluids, HBV and HCV can seriously damage the liver. They can also raise the risk of liver toxicity from HIV meds.
The relationship between HIV, HAART and diabetes isn’t fully understood. Studies do show that some HIV drugs cause insulin resistance and raise blood sugar levels. However, obesity and inactivity remain the biggest risk factors for all women. Your doctor can help you prevent or control diabetes with diet, exercise and medication.
Kidney disease caused by HIV (nephropathy) is rare overall, but African Americans are at a higher risk. Some HIV medications can cause kidney toxicity, so keep an eye on blood tests before and during treatment. And keep diabetes and high blood pressure in check; they’re the leading causes of kidney disease.
HIV positive women are more vulnerable to viral cancers, such as cervical cancer caused by HPV. Ask your doctor if the new HPV vaccine will be safe and effective for you. Find out how often you need vaginal Pap smears and cervical exams. Talk about anal Paps as well. A recent study suggests that HIV positive women are more likely to have anal HPV infections than cervical HPV infections.
Women with HIV do not appear to have a higher rate of breast cancer, but every woman is at risk. Have your doc show you the most effective way to do monthly breast self-exams. And find out when you should schedule mammograms or breast ultrasounds.
It’s All About You It’s tempting to focus what energy you devote to your health on HIV. But taking a head-to-toe approach to wellness will lead to a longer, fuller life.
Make it a priority to have regular screenings, including blood pressure and cholesterol tests. And don’t underestimate the power of a healthy lifestyle. Quitting smoking, eating a balanced diet, reducing stress, getting proper rest and exercising regularly will help your immune system stay in fighting shape. Give yourself frequent doses of tender loving care—you certainly deserve it.