Once upon a time, before HIV meds and combo therapy were widely available in the United States, “HIV-related complications” usually meant AIDS-related illnesses that preyed on immune systems depleted by HIV. They were mostly serious, often deadly—say, PCP pneumonia or the cancer Kaposi’s sarcoma (KS). While those diseases still hit HIV-positive Americans, the meaning of “HIV-related” has shifted to include a larger set of woes. In the past decade, studies have shown a sharp increase in conditions like liver and kidney disease and high cholesterol. Though not necessarily caused by HIV or HIV meds, these ailments are exacerbated or complicated by HIV and its treatment (making checkups and screenings essential). POZ asked a dozen HIV docs with large practices: What are the top HIV-related conditions today? Read on:
Liver disease is number one. It stems most often from hepatitis C, which afflicts a third of all positive people. HIV can make hep C more aggressive and harder to cure, and liver disease is now a leading cause of U.S. HIV-related deaths. “You have to decide what to treat first, HIV or hep C,” says Theresa Mack, MD, of New York City’s St. Luke’s-Roosevelt Hospital. (Echoing expert consensus, Mack says she tries to control HIV first.) Some docs add that they’re now seeing hep C, traditionally transmitted through shared IV-drug equipment, also spreading through unprotected anal intercourse or fisting. Several report, however, that people who start hep C treatment shortly after infection often clear it. So talk to your doctor about being tested for hep C.
Heart problems. Even when HIV is well controlled, some HIV meds, the virus itself as well as smoking, obesity, genetic predisposition and an unhealthy diet can elevate cholesterol and other lipids (blood fats)—all connected to heart disease. The docs add that they see more cases of elevated lipids—which they can control by switching HIV meds, using cholesterol-lowering drugs or diet and exercise—than actual heart attacks. But attacks do happen, along with diabetes and strokes. Among African Americans and Latinos in particular, says Jeannine Bookhardt-Murray, MD, medical director for the AIDS organization Harlem United, “those things are plaguing people between the ages of 50 and 65.”
Kidney kinks. Many HIV-positive folks, especially those who are black or Latino, are predisposed to kidney-damaging conditions like high blood pressure and diabetes. But HIV itself can damage the kidneys too. Then there’s the HIV med tenofovir (Viread, also in Truvada and Atripla). Its maker, Gilead, has shown that tenofovir slightly impairs kidney function. A few doctors say they fear that the risk to kidney function may increase the longer people stay on tenofovir. San Francisco’s Jon Kaiser, MD, says that many of his HIV patients on tenofovir had some increase in their creatinine levels, a signal of decreased kidney function. Mack says that rising creatinine levels drive her to stop or adjust dosages of tenofovir for some patients too.
The cancer connection. KS, non-Hodgkin’s lymphoma and HPV-related cervical and anal cancers have long been linked to HIV. Now, several doctors report seeing a modest increase in cancers not commonly associated with HIV, such as lung, prostate, colon and pancreatic—even among people with CD4 counts in the 600s, says Bookhardt-Murray. The cause is unclear: Does HIV promote those cancers: or are positive people simply living long enough to develop cancer from other sources? Bookhardt-Murray says, “I think the depletion of CD4 cells in the gut in the early stages of HIV may be linked to the gut cancers.” Brad Hare, MD, medical director of San Francisco General Hospital’s HIV clinic, adds that HIV health care demands “a more comprehensive approach, with attention on screening. It’s simplistic,” he says, “to think that by measuring a CD4 count we can understand what’s going on with the immune system.”
Lung disease. Some docs say that in addition to lung cancer, they are seeing more chronic obstructive pulmonary disease (COPD). Whatever HIV’s role here, says Barbara Zeller, MD, of New York’s Project Samaritan, there’s another reason it’s growing: “Eighty to 90 percent of our clinic patients smoke.” Other docs lit up at the mention of cigarettes, linking them—more than the virus itself—to high risks of heart disease and cancers.
That other HIV-related complication…life. That’s right, docs say: Some of the biggest plagues for positive people today are depression, mental illness, alcohol and/or substance abuse, as well as systemic stresses like being uninsured, underinsured, jobless or dealing with domestic abuse or incarceration. “All the problems we see [in positive people] are exaggerated among the poor,” says Adaora Adimora, MD, of the University of North Carolina Chapel Hill. Her prescription for curing afflictions like poor government aid? “The people who read this magazine,” she says, “need to make sure they vote!”