An Ounce of Prevention

'I'm turning into my father,' says Don, a 48-year-old New York City resident, when asked about his health. While he's managed to keep HIV at bay--thrush has been his only AIDS-defining infection in his 13-plus years with the virus--age is getting the upper hand. He ticks off a series of ailments that have crept up on him over recent years: high cholesterol, regular heartburn, back spasms, irritable bowel syndrome, damaged tendons in his ankles. 'And after I took testosterone for weight loss and anemia because of pancreatitis,' he adds, 'I began to snore like a buzz saw!' 'It feels like adding insult to injury,' Don continues. 'Not only do I have to deal with HIV and all it entails, but I also have to deal with the everyday issues of plain old aging.' During medical checkups, he has found himself having conversations that stray from the usual HIV-focused issues of viral load and CD4 count to other nitty-gritties. His doctor gets on his case about his tendency to slack off on exercise. (Don has a T-shirt that quips, 'Eat right. Exercise. Die anyway!') He's sworn off french fries (well, 'pretty much') and is prioritizing healthy sources of protein, like fish. Meanwhile, his medicine cabinet is filling up with the sort of health maintenance drugs that many Americans, HIV-infected or not, find themselves relying on in their golden years. In fact, aging HIVers are increasingly grappling with chronic conditions unrelated to their HIV infection. A study published in the September 19, 2006, issue of the Annals of Internal Medicine found that out of a group of nearly 70,000 New York City residents with AIDS who died between 1999 and 2004, more than a quarter succumbed to causes not related to HIV. That rate is a 32% jump from 1999, when about 20% died of other causes. In an ironic way this shift is reason to celebrate. 'I'm actually thrilled that I get to have these different kinds of conversations with my patients--about longevity and things they can do to enhance not only the quantity of their life but also the quality,' says Antonio Urbina, an HIV specialist at St. Vincent's Catholic Medical Center's Comprehensive HIV Center in Manhattan. 'This is definitely the new era of HIV.' Urbina adds that physicians who treat HIV 'need to back up a little bit' when caring for their patients and see a bigger picture of overall health in the context of ordinary aging. In fact, health issues related to aging could be accelerated in HIV patients, according to Nick Bellos, an HIV specialist in Dallas. 'What a lot of people feel is that HIV infection--either by itself or with therapy--will set the clock forward,' he says. 'The kinds of things that you'd be seeing in your patients at 50, 60, 70, you're now seeing at 35, 40, 45.' With those words of caution in mind, HIV Plus provides a list of basic health issues to cover with your physician at least once a year. Cancer Screenings Several of the most common cancers have tests that can catch the diseases in their early stages, when they are most easily treated. Colon. Starting at age 45 or 50, have a colonoscopy once every three to five years. Start earlier if you have a family history of colon or rectal cancer. The test looks for precancerous polyps, which can easily be removed. Skin. See a dermatologist once a year after 40 to check for signs of skin cancer. Begin earlier if you have a family history of the disease, have spent a lot of time in the sun, or have had sunburns. Prostate and Rectal. Men, starting at 40, should have a doctor perform a digital rectal exam and a prostate-specific antigen test to look for signs of cancer. Men who are taking testosterone supplementation, especially African-Americans, might be at higher risk for prostate troubles and should consider starting these tests earlier. Gay men in particular might also need a yearly anal Pap test to screen for rectal cancer related to human papillomavirus infection, which causes genital warts. Breast. For women, annual mammograms are recommended after 40, earlier if there is a family history of breast cancer. Ask your doctor about how to perform a self-exam, which needs to be performed at least monthly. Cervical. The rate of women with HIV who also have human papillomavirus infection, which can lead to cervical cancer, is high. Women newly diagnosed with HIV should see their gynecologist for a Pap smear twice a year--to test for precancerous cells--until they receive four consecutive normal test results. Then an exam once a year is recommended. Cardiovascular Disease Heart disease is the number 1 killer of Americans. Some physicians recommend an annual electrocardiogram after age 40 to check for an irregular heart rhythm. By paying attention to certain risk factors patients can decrease their disease risk. Cholesterol Level. Since many anti-HIV meds might contribute to high cholesterol, have your levels monitored. Making dietary changes, getting regular exercise, and taking statin medications can all help lower cholesterol. Diabetes. Side effects from antiretrovirals can cause development of diabetes, which can lead to heart and kidney disease, among other serious health problems. Genetics and obesity can also influence the onset of diabetes. Have blood sugar tests done regularly to check for signs of the disease. High Blood Pressure. Similar to cholesterol levels, blood pressure can be particularly high in HIV patients and should be monitored regularly. Smoking. Tony Mills, an HIV specialist in West Hollywood, Calif., says the most important thing HIVers can do to improve their health is to quit smoking. 'We've got all these great anti-HIV drugs now,' he says, 'but the risk from smoking for lung cancer, vascular disease, heart disease, stroke, kidney disease is significantly increased in smokers.' Liver Health Anti-HIV medications can be particularly hard on the liver, so regular tests of its function are important. HIVers coinfected with hepatitis B or C are at elevated risk for liver damage and need to pay particularly close attention to this issue. Kidney Health HIV disease itself as well as some antiretrovirals can contribute to kidney problems, so an annual urinalysis--which looks for protein in the urine--is an important way to monitor kidney health. Diet and Exercise 'A lot of the diseases of aging can be really controlled just by increasing physical activity,' says Urbina. He recommends discussing nutrition with your doctor to see if you're on the right track. 'It's very simple. Eat lots of fruits and vegetables,' he says. 'And you should try to include protein in most of your meals. But it should be a high-quality protein--more from fish and even vegetable sources of protein, like tofu, and less from meats.' Immunizations To help prevent pneumonia, all HIVers should have a Pneumovax vaccine, followed by a booster five years later. In addition, make sure you have a tetanus shot every 10 years, get an annual flu shot, and get vaccinated against hepatitis A and B. (There is no vaccine for hepatitis C.) STD Screenings An annual series of tests for sexually transmitted diseases is recommended for men and women who are sexually active and not in a monogamous relationship. Drug and Alcohol Use Be honest with your physician about any drug or alcohol use, especially if you are coinfected with hepatitis. 'Hepatitis C with alcohol,' Bellos says, 'is like pouring gasoline on the fire.' So even though the benefit of living longer with the aid of antiretrovirals also means that HIVers are increasingly susceptible to the more traditional ailments of the aging process, a bit of vigilance on your part while working with your primary physician can help to keep them from progressing to severe health issues.