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Ah, the First Time

Ah, the First Time


All adults who are newly diagnosed with HIV infection should be given certain tests for common coinfections and metabolic changes linked with HIV disease that could complicate HIV treatment or require medical attention of their own. ' Syphilis. Left untreated, this sexually transmitted disease can remain latent and virtually unnoticeable for years but can cause neurological problems, which may be more severe in people with advanced HIV disease. An HIV-positive person with syphilis is also more likely to expose sex partners to HIV through open syphilis lesions or even to become infected with another strain of HIV or other STDs through the sores, notes Daniel Klein, MD, chief of infectious disease medicine at Kaiser Hospital in Hayward, Calif. ' Hepatitis A, B, and C. The various forms of hepatitis are serious viral illnesses that can cause liver damage, affecting the ability of the organ to function properly and process anti-HIV drugs and other medications. Hepatitis C can be more severe in patients coinfected with HIV and is a leading killer of HIV-positive adults, says Roxanne Cox-Iyamu, MD, medical director for the northern Virginia office of the Whitman-Walker Clinic. Hepatitis A and B can be prevented with vaccines. ' Cholesterol and triglyceride levels. Some anti-HIV drugs, and possibly even HIV disease itself, are believed to boost bad cholesterol levels and cause high triglyceride measurements, which can increase the risk for cardiovascular problems, says Tom Barrett, MD, a staff physician at Chicago's Howard Brown Health Center. A baseline measure is helpful in determining if high lipid levels exist prior to treatment and what steps, such as lipid-lowering medications or dietary changes, should be taken to lower these. ' Liver and kidney function. Anti-HIV medications can be harsh on these organs, and any abnormalities in their function should be determined before an antiretroviral regimen is chosen, says Michael Allerton, HIV operations policy leader for Northern California's Kaiser Permanente Medical Care Program. Impaired liver function also may be caused by coinfection with hepatitis. ' Anemia. This condition of an abnormally low level of red blood cells is usually marked by fatigue but also occasionally noticed by such symptoms as headaches and shortness of breath'or irregular menstruation in women. Up to 80% of all HIV-positive people will experience symptoms of anemia, either caused by the disease itself, by some antiretroviral drugs, or by opportunistic-infection prophylaxis medications like Bactrim. A test called a complete blood count will determine levels of hematocrit and hemoglobin in the blood; low percentages indicate anemia. Anemia can be treated through dietary changes, vitamin supplements, medications like Procrit and Epogen, and'in severe cases'blood transfusions. ' Pelvic exam and Pap smear. These tests look for signs of cervical dysplasia and cervical cancer, an AIDS-defining condition that HIV-positive women are more prone to, says Judith Feinberg, MD, board chair of the American Academy of HIV Medicine. Many physicians also suggest rectal Pap smears for sexually active gay men.

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