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Section Two: Special Situations

Part Two of Three in Project Inform's "What You Should Know About When to Start and What Meds to Use" Booklet

January 2013

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If You Smoke Tobacco

If You Smoke Tobacco

On its own, HIV can worsen some common diseases, like heart and lung disease, bone loss and various cancers. Nearly twice the number of HIV-positive people smoke compared to HIV-negative people. So when you add smoking tobacco (or marijuana) -- and to a smaller extent chewing tobacco -- to HIV infection, then these diseases actually have a chance to develop at a faster rate. This is especially true for heart disease and for head, neck and anal cancers.

Almost all doctors would agree that stopping smoking is the number one thing you can do to significantly improve your health. Although it can be a frustrating and difficult process to go through -- and most people have to try it more than once -- the bottom line is that you can greatly reduce your risk of these health hazards even within one year of stopping. By the time you're ten years away from your last cigarette your risk for many of these diseases is about the same as people who never smoked.

There are many different types of stop-smoking programs and products that may work. On the one hand, some people try stopping on their own with products bought over the counter, like nicotine gum, patches and lozenges. Your doctor can also write a prescription for you, such as Chantix or Wellbutrin. On the other hand, some people prefer to talk with others who are going through the same process and find that support groups or programs at community agencies are more successful for them.

For more info, a good website is

If You Have Other Conditions

Dental Health

An often overlooked way to keep good general health is by visiting your dentist regularly. Poor oral health, like untreated gum disease, can contribute to other conditions like stomach, heart or lung disease. Why? Because the inflammation and bacterial infections in the mouth can spread down into the upper chest. See your dentist every six months, and if you feel comfortable with it disclose your HIV status.



While HIV meds have certainly extended people's lives, unfortunately we've also seen many more HIV-positive people b ecome overweight or obese. This can lead to diabetes, hypertension, and heart and kidney disease -- conditions already more common in HIV-positive people and in African Americans and Latinos. For older adults with HIV, being physically active may be even more important to help from becoming frail.

If you're able, consider joining a gym. If you can't, then taking brisk 20-minute walks a few times a week can help a great deal. At-home exercise routines are available through DVDs, TV and gaming stations. Use online sources or find healthy eating programs through your local health department or community organizations. Ask for help when you don't know where or how to start.

Hepatitis C (HCV)

About 1 out of 4 Americans with HIV also have hepatitis C, but many don't know it. If you haven't been tested, ask for a HCV antibody test. If that comes back positive, then get an RNA test done to see if you have chronic hepatitis C. If you do, get your health assessed by someone who is experienced in making decisions about treating both.

HIV infection can make hepatitis C worse. It's unclear whether hepatitis C makes HIV worse. Newer HCV meds can cure hepatitis C in about 3 out of 4 co-infected people. For more info, call 877-HELP-4-HEP (877-435-7443).

Hepatitis B

Before starting HIV meds, you should have been tested for hep B. If you were negative, then get the hep B vaccine.

If you have chronic hep B, then your current HIV regimen should include one of these meds because they're also used to treat hep B: Viread (Atripla, Truvada), Emtriva (Atripla, Truvada), or Epivir (Combivir, Epzicom, Trizivir).

HIV can make hep B worse, including cirrhosis and end-stage liver disease. It's unclear whether hep B makes HIV worse. It's rare for co-infected people to clear hep B, so treating it is more about keeping it less active over time to reduce damage. Seek doctors experienced in treating both.

Anal and Other HPV Cancers

The human papillomavirus (HPV) can cause abnormal cells to grow (dysplasia), which sometimes can turn into cancer. These include cancers of the mouth, throat, cervix and anus. (HPV also causes the common wart which isn't cancerous.)

HIV-positive men who have sex with men are at a much higher risk than normal for anal cancer. HIV-positive women are also at a higher risk whether or not they have anal sex, and are at higher risk for cervical cancer than HIV-negative women. Work with your doctors about how best to prevent these conditions by routine screening.


Type 2 diabetes is usually seen as people age. It is more common among HIV-positive people, but many don't know their risk and go undiagnosed. Some HIV meds, such as protease inhibitors, can contribute to diabetes to some degree. It's still possible to manage both diabetes and HIV, given the various medicines used for both.

Bone Loss

Many HIV-positive people have lower than normal bone mass, perhaps due to HIV and ongoing inflammation. Certain HIV meds, such as Viread, can also cause bone loss. Having this bone loss may mean there's a higher risk for fractures or breaks.

Some studies find that this loss levels out within a year or two of starting meds, but other studies show continued loss over time. Bone density screenings are helpful for finding bone loss. Vitamin D and calcium supplements may help prevent bone problems, as well as prescription medicines.

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This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.

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