March 8, 2009

March 8, 2009
Combating Complications

Thanks for stopping by to check out another day in my life. Today is Sunday and another beautiful and warm day here in north Florida.

I am enjoying a down day of sorts since my next couple of upcoming weeks are extremely busy and are going to tax my endurance. (You have to remember I have been positive for a very long time.)

I had my morning protein shake followed by an abs and legs workout. Still working on getting my body back into shape after having to take several months off due to illness and injury. I can tell a huge difference in the past couple of months and now. I know I prefer seeing my body solid instead of flabby. Not to mention I am more confident when I feel I am looking good.

I guess that is why I would like to talk about complications today.

While ARV therapy has tremendously improved the length and quality of HIV positive people’s lives, side effects and a high risk of non AIDS related complications remain all too real. In fact, researchers estimate that half of all premature deaths among people with HIV are not related to AIDS, but instead stem from other medical issues that are becoming increasingly prevalent among those living with the virus. As researchers learn more about these health challenges, they also stumble upon useful clues to prevent and manage them.

Cardio Risk

* Two major studies reported at CROI confirm earlier reports that ongoing use of the protease inhibitor Kaletra (lopinavir/ritonavir)—as well as Lexiva (fosamprenavir), Agenerase (amprenavir) or Crixivan (indinavir)—increases the risk of a heart attack, independent of other factors associated with cardiovascular disease. These studies plus an Australian clinical trial also mirror previous reports establishing a link between cardiovascular disease (CVD) and abacavir (found in Ziagen, Epzicom and Trizivir). Conversely, the results of a government funded AIDS Clinical Trials Group study failed to find a link between abacavir and a higher risk of a heart attack.

* Seeking to unravel the mystery surrounding heart problems in people taking abacavir, researchers have found that HIV-positive men and women on the drug do not have higher levels of blood vessel inflammation a possible explanation put forth in the past. But according to another study reported at CROI, those on abacavir may have overly reactive blood clotting factors that may lead to heart attacks.

* 16th CROI delegates also heard new evidence that HIV itself can harden the arteries as much as other risk factors, including age, smoking and diabetes, do. According to University of California in San Francisco (UCSF) researcher Carl Grunfeld, MD, highly specific scans of the carotid arteries of people living with HIV found significant blood vessel thickening compared with HIV negative controls a finding that has been overlooked by other groups and may help explain the higher risk of CVD in people with the virus, even without other risk factors.

* Results of one study showed that many risk factors that help raise the risk of death are modifiable, suggesting that behavioral changes and proper medical care can extend life. Whether it’s CVD or non AIDS related cancers, smoking, low body weight, diabetes or high blood pressure all of which can be controlled they each doubled, tripled or quadrupled the risk of death.

* Smoking tops the list of modifiable risk factors targeted by many public health efforts there’s no shortage of data linking cigarettes to substantially higher rates of CVD, cancers and lung disease in relatively young HIV positive people. But it can be a difficult habit for HIV positive people to break, according to one CROI study. While no more than 10 percent of individuals participating in one of two Rhode Island programs abstained from smoking for six months, higher success rates among Hispanics compared with other racial or ethnic groups were encouraging.

Disturbing Cancer Answers

* From the U.S. Centers for Disease Control and Prevention (CDC): Roughly 25 percent of HIV positive women, with their higher risk of cervical cancer, are not receiving annual Pap smears to screen for abnormalities that can lead to the potentially fatal malignancy. Efforts to step up education and integrated care are very much needed, the CDC presenters argue, to ensure that HIV positive women are receiving recommended preventive care.

* A California analysis of collected data indicates that HIV positive people with non-Hodgkin’s lymphoma (NHL)—a cancer of the immune system—face a significantly higher risk of death than HIV negative individuals with the same malignancy. While this CROI report was troubling in light of previous studies showing improved survival in recent years, another encouraging report made many delegates sit up and take notice: By measuring certain protein fragments in the blood, it may be possible to screen individuals to determine their risk for the cancer.

Nervous System Symptoms

* Distal sensory polyneuropathy (DSPN, also known as peripheral neuropathy or PN)—nerve damage that can cause tingling and pain in the feet and hands—affects more than half of all people with HIV. While fewer people are now using ARVs considered to be prime DSPN causes, notably Videx (didanosine) and Zerit (stavudine), people living with HIV are now more likely to suffer from other risk factors for the potentially debilitating condition: diabetes and elevated triglyceride levels.

* Rates of AIDS related dementia remain at an all time low, but another albeit, much milder central nervous system problem appears to be on the rise: HIV associated neurocognitive disorder (HAND). Not surprisingly, aging is a risk factor. One study found at least one symptom of HAND including problems with remembering, thinking and learning new tasks in 37 percent of HIV positive individuals averaging 46 years old, whereas another reported the rate to be in excess of 50 percent in a cohort of HIV positive individuals averaging 67 years old. An expanding waistline is also associated with HAND, as is a diabetes diagnosis, which increased the risk more than sevenfold.

Treatments to Watch

* Testosterone is present in women as well as men, and a study reported at CROI indicates that long term testosterone replacement therapy is safe and beneficial for women with low levels of the natural hormone. When the ovaries and adrenal glands are not producing enough testosterone, low dose replacement therapy in the form of skin patches applied twice weekly used for 18 months yielded significant improvements in body composition, bone mineral density and quality of life in a study involving 23 women living with HIV.

* For HIV positive people with lipoatrophy, Avandia—a member of the “glitazone” drug class approved for the treatment of diabetes—may help reverse fat loss. The encouraging results of a study presented at CROI counter those of several earlier clinical trials, likely because patients in this one were no longer treating their HIV with either zidovudine (found in Retrovir, Combivir and Trizivir) or stavudine (Zerit)—two HIV meds believed to cause lipoatrophy. Unfortunately, the researchers only looked at fat changes in the legs and arms; it is not clear from this study whether Avandia reverses fat loss where many people find it most distressing: in the face.

So as I always say, you need to arm yourself with all the information you can find in order to arm yourself in your battle with HIV and AIDS.

Wishing you health, hope and happiness.

Big bear hug,

Daddy Dab