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25 Things You Need to Do if You Have HIV

June 2011

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22. Keep your bones strong through weight-bearing exercise, sun exposure, a diet containing enough vitamin D and calcium, and stopping smoking.

  • Average score: 3.64 (with 5 the highest and 1 the lowest)
  • Percentage voting 5: 23%
  • Percentage voting 4 or 5: 55%

People with HIV run a higher risk of bone mineral loss (osteopenia and osteoporosis) and broken bones than do people in the general population.1-3 HIV infection itself and certain HIV medications can raise the risk of bone mineral loss.

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HIV-positive people can help keep their bones healthy through weight-bearing exercise, getting enough vitamin D and calcium in the diet, and getting enough sun exposure to help the body make vitamin D. Exactly how much sun exposure is enough to stimulate vitamin D production without raising the risk of skin cancer is not known. The National Institutes of Health Office of Dietary Supplements suggests "approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and ... moderate use of commercial tanning beds that emit 2%-6% UVB [ultraviolet B] radiation is also effective."4

Your HIV provider may also recommend daily supplements of vitamin D and calcium. Regular bone mineral density screening is not recommended for people with HIV and no other risk factors for bone mineral loss.5,6 Such screening is recommended for HIV-positive people 50 and older, especially if they have one or more risk factors for low bone mineral density.5,6

Factors that raise the risk of osteoporosis and fractures in people with HIV include early menopause, infrequent menstruation before menopause, low testosterone in men, diabetes, lymphoma, emphysema, more than 3 alcoholic drinks per day, low dietary calcium, use of methadone or opiates, physical inactivity, smoking, chronic metabolic acidosis, chronic infection, chronic kidney disease, depression, vitamin D deficiency, and use of certain antiretrovirals, glitazones (diabetes drugs), glucocorticoids (for asthma and other conditions), and proton pump inhibitors (stomach acid reducers).6

References

  1. Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab. 2008;93:3499-3504.
  2. Young B, Dao CN, Buchacz K, Baker R, Brooks JT; HIV Outpatient Study (HOPS) Investigators. Increased rates of bone fracture among HIV-infected persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000-2006. Clin Infect Dis. 2011;52:1061-1068.
  3. Womack JA, Goulet JL, Gibert C, et al. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One. 2011;6:e17217.
  4. National Institutes of Health. Office of Dietary Supplements. Dietary supplement fact sheet. Vitamin D. http://ods.od.nih.gov/factsheets/vitamind/. Accessed June 22, 2011.
  5. Aberg JA, Kaplan JE, Libman H, et al; HIV Medicine Association of the Infectious Diseases Society of America. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:651–681. http://cid.oxfordjournals.org/content/49/5/651.full. Accessed May 19, 2011.
  6. McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010;51:937-946. www.ncbi.nlm.nih.gov/pmc/articles/PMC3105903/?tool=pubmed. Accessed June 22, 2011.


23. Discuss risk factors and testing for kidney disease with your HIV provider.

  • Average score: 3.63 (with 5 the highest and 1 the lowest)
  • Percentage voting 5: 25%
  • Percentage voting 4 or 5: 54%

Almost one third of HIV-positive people have abnormal kidney function; the risk is higher in blacks.1 Severely damaged kidneys may make dialysis necessary and raise the risk of death.

Experts in HIV-related kidney problems recommend that everyone be tested for existing kidney disease after they test positive for HIV and regularly thereafter, depending on their risk of kidney disease.1

Kidney disease risk factors include black race, a CD4 count under 200, a viral load above 4000 copies, diabetes, hypertension, and hepatitis C virus infection.1 Certain HIV medications can cause or contribute to poor kidney function.

Reference

  1. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559-1185. http://cid.oxfordjournals.org/content/40/11/1559.long. Accessed June 22, 2011.


24. Talk to your HIV provider about appropriate testing for cancer. Some cancers -- including some non-AIDS cancers -- are more common in people with HIV than in the general population.

  • Average score: 3.61 (with 5 the highest and 1 the lowest)
  • Percentage voting 5: 17%
  • Percentage voting 4 or 5: 65%

Cancer is the second leading cause of death in the United States.1 Earlier detection of cancer can make it easier to manage.

HIV-positive people have a higher risk of certain cancers -- including non-AIDS cancers -- than people in the general population.2,3 Certain viruses that commonly afflict people with HIV -- including human papillomavirus (HPV) and hepatitis viruses -- can cause or raise the risk of cancer (see points 14, 18, and 21 above). Quitting smoking is critical to preventing several types of cancer (see point 5 above).

References

  1. Centers for Disease Control and Prevention. Leading causes of death. www.cdc.gov/nchs/fastats/lcod.htm. Accessed June 22, 2011.
  2. Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009;52:611-622. www.ncbi.nlm.nih.gov/pmc/articles/PMC2790038/?tool=pubmed. Accessed June 22, 2011.
  3. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370:59-67. www.theLancet.com/journals/Lancet/article/PIIS0140-6736%2807%2961050-2/fulltext. Accessed June 22, 2011.
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This article was provided by The Center for AIDS. Visit CFA's website to find out more about their activities and publications.
 
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