Living With HIV : Beating the Odds

As HIV-positive people live longer, they’re prone to the effects of aging, which can include bone loss and a rising risk of heart disease, diabetes and cancer. And if you have hepatitis B or C, you also need to worry about your liver.

Experts still don’t completely understand how these problems relate to HIV infection itself, drug side effects and the normal aging process, but there’s growing evidence that long-term HIV infection can cause problems even if meds help your CD4s stay high.

“Ongoing immune activation [due to HIV] ends up being a lot like inflammation, and with many chronic inflammatory diseases, aging is accelerated,” Volberding explains. “Many people can fully suppress the virus long-term, but we still expect some health consequences.”

Luckily, you can do a lot to lower the odds of chronic health problems, such as undergo healthy lifestyle changes and get regular lab tests.

“We are what we eat,” says Donald Abrams, MD, director of clinical programs at UCSF’s Osher Center for Integrative Medicine, who also treated some of the first AIDS patients in the early 1980s. “Don’t be a fast food junkie. Eat a plant-based diet with lots of fruits and vegetables and whole grains. Drink green tea instead of cola.”

He also advises exercising at least 30 minutes a day, maintaining a healthy weight, quitting smoking and findings ways to reduce stress “whether it’s meditation, massage, nature or spirituality.”

CAN I TAKE A BREAK FROM TREATMENT?

Many people living with HIV hanker for a “drug holiday”—a reprieve in their daily medication ritual—but ample data show that this is usually a bad idea.

One large study found that people who stopped their drugs when CD4 count rose above 350—then restarted treatment when their CD4s fell below 250—had more AIDS-related opportunistic illnesses than people who stayed on continuous treatment. In addition, they also had more serious heart, liver and kidney problems and saw no improvement in side effects or quality of life.

“The arguments for treatment interruption have been pretty much disproven,” says Dr. Volberding. “You interrupt therapy at your peril. I would really try to avoid it.”
Treatment interruption may be the right choice for certain individuals, for example someone who is experiencing severe side effects or is having surgery.

But it’s important to never just stop taking HIV meds on your own—this can be a tricky and risky process. If you need to stop, talk to your doctor and make a plan that fits with your long-term health strategy.