Author: David Rowlands
Image by: Luke Jerram www.lukejerram.com
HIV itself can further increase the risk. Untreated HIV, with its high viral loads, has been linked to cardiovascular disease and experts now recommend starting treatment earlier to avoid cardiovascular damage that many believe is caused by active viral reproduction. However, many of the drugs used to treat HIV can also contribute to cardiovascular disease, by raising cholesterol levels.
Decades of research, involving HIV-negative and HIV-positive people, have repeatedly shown that lifestyle changes such as diet, exercise and quitting smoking can greatly reduce the risk of cardiovascular disease. When lifestyle changes aren’t enough, a number of effective medications and other medical approaches are available. It’s also important to take cardiovascular risk factors into account when making crucial HIV treatment decisions, such as when to start or switch treatment and which medications to use.
HIV in the kidneys
The kidneys play a number of vital roles. For those living with HIV, this includes breaking down some of the medications needed to keep the viral load low and CD4 counts high. Unfortunately, like other vital organs in the body, the kidneys are not immune to diseases that can impair their ability to function. Studies also show that nearly one third of all HIV-positive people have abnormal amounts of protein in their urine—a sign of potential kidney trouble.
Experts reckon that kidney disease will remain a common and potentially serious health threat. Fortunately, much has been learned about HIV and kidney disease in recent years, including the best ways to screen for it, prevent it and treat it.
We need to redesign services to focus on empowering older patients to live a life with HIV. Services need to work with the patient, balancing good HIV treatment with treatment for comorbidities and integrating social care support”
In this article David Rowlands discusses how HIV in the body may affect individuals, brain, liver, heart and kidneys. Effective HIV treatments means more people than ever are living to older age with the disease. However, though it is now considered chronic rather than acute, older people with HIV remain at a disadvantage in comparison to their peers, particularly in terms of quality of life, often having poor levels of health.
People growing older with HIV face many challenges
On top of an already complex condition are the complications and comorbidities arising from increased life expectancy. One study of people over 50 living with HIV found that just under two thirds were on treatment for other long-term conditions, and the number of these conditions was almost double what would have been expected in the general population at this age.
Late diagnoses and mortality
Late diagnosis is the most important predictor of morbidity. A late diagnosis is defined as having a CD4* count <350 cells/mm3 within three months of diagnosis; <350 cells/mm3 is the threshold at which antiretroviral therapy (ART) should begin.
In 2014, 40% of people newly diagnosed in the UK were diagnosed at a late stage of HIV infection. People diagnosed late have a ten-fold increased risk of death within 1 year of HIV diagnosis compared to those diagnosed promptly (3.8% vs. 0.35%)
HIV in the brain
HIV-associated dementia (known as HAD or AIDS dementia complex, ADC) is rarely diagnosed. However, recent evidence suggests that HIV is still affecting people’s brains, even when HIV levels are undetectable in the blood.
So far, it appears that HIV-associated neurocognitive disorder (HAND) is so mild that people don’t notice it. Often, it can only be picked up with extensive neurological and psychological testing. What’s more, some evidence suggests that people who take ARVs that pass into the brain might be less prone to develop neurocognitive problems.
There is still much we need to understand about how HIV affects the brain in people with well-controlled disease: How common it is, which people are most vulnerable to HIV-related brain damage, and whether and how quickly it can progress from a mild disorder to one that is more serious.
There are things that you can do, such as minimizing heavy alcohol and substance use, treating depression and anxiety, and getting physical exercise to help keep the brain healthy and functioning well. This lesson will help you understand HAND and the latest thinking on how common it is and how it might be prevented or treated.
HIV in the liver
For people living with HIV, the liver is of major importance, as it is responsible for making new proteins needed by the immune system, helps the body to resist infection, and processes many of the drugs used to treat HIV and AIDS-related infections. Unfortunately, these same medications can also damage the liver, which can prevent the liver from performing all of its necessary tasks and can eventually cause damage to the liver.
“Hepatotoxicity” is the official term for liver damage caused by medications and other chemicals. It’s important to understand the ways in which medications can cause liver damage, the factors that can increase the risk of hepatotoxicity, and some of the ways in which you can monitor and protect the health of your liver.
HIV drugs are intended to do your health good, the liver recognizes these medications as toxic compounds. After all, they are not naturally produced by the body and do contain some chemicals that could potentially cause damage to your body. Working with the kidneys and other organs, the liver processes these drugs to render them safer. In the process, the liver can become “overworked,” which can lead to liver damage.
Other factors that increase the risk of hepatotoxicity include, being over 50 years of age, coinfected with hepatitis B and/or hepatitis C, taking other medication that can cause liver damage, alcohol or drug abuse, obesity and past history of liver damage.
HIV in the heart
Cardiovascular disease is a general term to describe medical conditions that affect the heart and blood vessels. Examples of major cardiovascular diseases and conditions include coronary artery disease, heart attacks, heart failure and strokes.
Cardiovascular disease is a growing concern for people living with HIV. People with HIV are living longer than ever before, due to the widespread use of antiretroviral (ARV) therapy. And just like their HIV-negative peers, their risk of cardiovascular disease increases once they enter their 50s and 60s.