In February, just in time for Black History Month, studies revealed that in New York City, African-American men and women with HIV have, respectively, a 6% and 9% greater chance of death than do other positive racial groups and that 51% of new HIV cases nationwide occur in black people. It’s also long been known that African Americans all over the U.S. suffer disproportionate cases of heart disease and diabetes—whether from family history or environmental causes. Moreover, it’s now becoming clear that, possibly for genetic reasons, HIV meds and the virus itself can severely affect African Americans, causing more HIV-related kidney damage and worsening some drug side effects. What, then, can a positive black person do?
When Jack Miller was diagnosed with HIV in 1994, he had already developed high cholesterol. With hypertension and diabetes present on both sides of his family tree, the New Yorker wasn’t surprised that he would have to learn how to control not only the virus but also his blood fats and sugars. Miller’s doctor works with him to accomplish this, but many other African Americans with HIV have more questions than they get answers. Now POZ, with the help of M. Keith Rawlings, MD, of the Integrated Minority AIDS Network Inc. (IMANI), and Lloyd Bailey, MD, of St. Vincent’s Midtown Hospital in Manhattan, provide a lead on how to handle three crucial treatment topics for African Americans with HIV:
Caring for the kidneys
Kidney disease, or HIV-associated nephropathy (HIVAN), occurs when HIV attacks the cells in the kidneys. One survey found that African Americans constituted 94% of HIVAN cases. Overall rates of this HIV-related kidney disease have fallen since the introduction of combo therapy has effectively controlled HIV and kept it from mounting the attack. Bailey advises that “HIV is more toxic to the kidneys than HIV treatment,” adding that starting HIV meds when T cells are near 350, not 250, may lessen HIVAN risk.
Have a (healthy) heart
Higher rates of hypertension, coronary artery disease (CAD) and diabetes among black people may require monitoring blood pressure, taking extra meds and choosing HIV drugs that don’t strain the heart. Bailey advises that you needn’t avoid HIV treatment. Just work closely with your care providers to protect your heart as well.
An extra side of side effects
Rawlings says that two HIV med side effects may hit black people harder: Emtriva hyperpigmentation (darkening of the palms) and Sustiva-induced nightmares. Both are possibly worsened by genetic differences affecting how the drugs work in your body.
But Rawlings and Bailey have given both of these meds to black patients successfully and always watch them closely for any possible hyperpigmentation or psychological effects. Bailey says Sustiva nightmares are temporary in most cases, regardless of race.
Rawlings names a larger problem: black access to health care. “It remains an issue,” he says, “and delays in seeking treatment contribute to more illness and death in the black community.”
So be sure to bring your whole health to your next office visit, with HIV front and center.