This Month in HIV: Breaking HIV/AIDS Research From CROI 2007
On to the next subject: heart disease. A few years ago, as you remember, there was a lot of talk about a higher rate of heart disease in people with HIV. There's less and less talk about that.
Yes. As I said, it's another gray area. The D:A:D study has shown a 26 percent increase in cardiovascular disease in HIV. Is that induced by the virus? Is that induced by the drugs? We people with HIV have all the typical risk factors -- high cholesterol and triglycerides, low good cholesterol or HDL. [To read more about heart disease and HIV, click here.]
"I do tell people: Just keep an eye on your lipids. You'll be amazed how many patients don't know [their cholesterol and triglycerides levels]."
Forty percent of us are smoking. So we have the normal risk factors that most Americans have, too. However, we know that many drugs, many HIV medications increase cardiovascular risk factors -- particularly triglycerides. We do have low HDL, even before we start taking medications. When we become infected our cholesterol is pretty low. Our cholesterol actually goes down -- our good and bad cholesterol. Triglycerides tend to spike up a little bit.
Then, when we take HIV meds, the HDL sometimes goes up and improves a little, but it never reaches normal levels. Triglycerides go up even higher. So, yes. There is an influence from HIV medications, and it is not clear whether or not treating HIV itself, the virus, and decreasing all the inflammatory factors around that, how that measures against increasing risk factors, especially when it comes to lipids.
So, I think that we're not clear. I do tell people: Just keep an eye on your lipids. You'll be amazed how many patients don't know that they should be monitoring their lipids.
Meaning the cholesterol and triglycerides.
The cholesterol and triglycerides. You would be amazed! Most people tell me in my lectures, "Well, I really don't know. I guess they don't tell me my lipid levels because they're OK, right? They would tell me if they were not."
I say, "Well, never assume; always ask."
"I have been living with this disease for so long, and I'm always wondering, 'Well, is it going to be a heart attack, or is it going to be a cancer that's going to get me eventually?'"
At least every six months, you should get your lipids and your cholesterol checked, especially right before you start HIV therapy. And it's a good idea to talk to your doctor about more lipid-friendly medications, especially if you have a history of heart disease in your family. Definitely, I tell people, "Do not smoke." If you are smoking you may as well forget about your cholesterol, because you are defeating the purpose. Cardiovascular exercise is important. Of course, so is eating less fats, decreasing your sugar intake, etc., etc.
Then next to heart disease is another depressing subject: cancer. There were a lot of studies about that at CROI. There seems to be incremental data coming out about a growing incidence of cancer seen in people with HIV. As a community activist, and as a long-time survivor, what do you think of that?
I have a lot of interest in this, I have to say. I have been living with this disease for so long, and I'm always wondering, "Well, is it going to be a heart attack, or is it going to be a cancer that's going to get me eventually?"
The D:A:D study, the data collection on adverse events of antiretroviral drugs [Data Collection on Adverse Events of Anti-HIV Drugs, a collaboration between 11 observational groups of HIV-infected persons in Europe, North America, and Australia], followed 23,000 -- almost 24,000 -- patients, all over the world. What they have found is that, yes, we're living longer, obviously, and cancers are starting to show up a lot more. [To read more about cancer and HIV, click here.] They looked at two types of cancer: non-AIDS related and AIDS-related. Among the non-AIDS related cancers, the biggest one was lung cancer. So I tell people, "Definitely do not smoke or be around smokers." GI tract cancers, like liver cancer were also common. ... A lot of us that have hepatitis B have to be very careful because we have a much higher risk for liver cancer. I tell people, "If you are not hepatitis B positive, get vaccinated. Please get vaccinated."
Leukemia, lymphomas and anal cancers were documented. That's a particularly interesting part of my activist work, because I don't think there's enough work being done on anal cancer, especially on its diagnosis.
"I tell people, 'Decrease your risk factors. The smoking definitely has to go. The hepatitis B treatment and/or prevention should be taken care of. Have somebody look at your butt. Have your butt checked, even if you think you never have had anal sex.'"
Do you think most men who have anal sex are getting Pap smears?
No. No. The interesting thing -- and I have read a lot about anal cancer -- is that it's not only the gay men who are getting it; the straight men with HIV also have a higher incidence. People who have never had anal sex, also get it. It's all related to HPV, the HPV [human papillomavirus] virus, and most of us are positive to HPV. So, yes. Gay men that have anal sex and are HIV-positive have a higher incidence. But I'm trying to make a clear distinction: Heterosexual men and women with HIV also have a higher incidence.
Anal Pap smears are not part of the standard of care. Most doctors are not trained to do that -- at least most doctors in HIV care. I, myself, I'm very blessed and lucky. I fly from Houston to New York City to see somebody there, Dr. Goldstone. [To read an interview with Dr. Goldstone, click here.]
Goldstone, right. He specializes in it.
Yes. I have to fly to New York to see him. He asked me, "Why do you fly to New York to do this?" It's because I can't find anybody else that has the expertise in diagnosis and treatment. I had precancerous lesions, myself. It's definitely something that I'd like to see a lot more work on, because it seems anal cancer is already starting to show up.
On the AIDS-related cancer side, the non-Hodgkins lymphomas and Kaposi's sarcomas have lower incidence today than at the beginning of the epidemic. But yet, they're still there. So, yes, we have to keep an eye on this. I tell people, "Decrease your risk factors. The smoking definitely has to go. The hepatitis B treatment and/or prevention should be taken care of. Have somebody look at your butt. Have your butt checked, even if you think you never have had anal sex because research definitely shows that HIV increases the incidence of anal cancer."
Copyright © 2007 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.
This article was provided by TheBody. It is a part of the publication This Month in HIV.
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