During a typical doctor visit for a review of lab workups, there's so much to talk about but so little time that health matters unrelated to HIV get pushed aside. But with HIVers living longer, there are more health issues to mull over: cholesterol levels, weight and fitness, and cancer screenings. And the year-end exam is the perfect time to catch up on these areas and tune up overall health. So HIV Plus has contacted some leading care providers to find out what they think needs to be discussed during your final checkup of the year.
'I really like to focus on the quality of people's lives,' says Bruce Williams, MD, MPH, a professor at the University of New Mexico Health Sciences Center and medical director for the university's HIV clinic. This typically falls into five main categories of general well-being.
''Medications. Carl Fichtenbaum, MD, an associate professor at the University of Cincinnati College of Medicine, knows that adherence becomes a problem when a patient is displeased with his or her meds. He asks HIVers 'whether the medication is making them feel bad or they can't afford to pay for it or they seem to be missing doses or they just don't like it.'
''Emotional health. Gal Mayer, MD, medical director at the Callen-Lorde Community Health Center in New York City, says, 'If you feel mentally healthy, you'll be subjecting yourself to less risk; you'll be subjecting other people to less risk. You're going to deal with HIV and all of its manifestations and all of its consequences in a much better way.' He adds, 'There are good and healthy ways' to deal with depression, anxiety, and other mental illnesses--such as individual or group counseling as well as appropriate medications like antidepressants.
''Diet and exercise. Nicholas Bellos, MD, an HIV specialist in Dallas, points to research showing that stress management and exercise can raise CD4-cell levels. So he advises his patients to 'get enough sleep, eat right, and get plenty of exercise.'
Michael Saag, MD, director of the University of Alabama at Birmingham Center for AIDS Research, adds, 'Being overweight is a stress on the body for all kinds of reasons.'
' Illicit drugs and alcohol. Fichtenbaum stresses that patients should 'establish an open, communicating, and therapeutic relationship with their doctor so that they can feel comfortable talking about anything important.' This includes being open about drug or alcohol abuse. 'Alcohol in moderation is not necessarily a problem,' Saag says, 'unless a patient has hepatitis C coinfection or hepatitis B--because there's clear association of more advanced liver disease and development of cirrhosis. [Illicit] drugs become problematic in terms of dependency. And especially with regard to interference with the ability to function responsibly'the ability to take medicines on time, to keep appointments. And that's not good at all for their health.'
' Sex. 'If people are not sexually active or sexual beings, they're usually not happy in life,' Fichtenbaum says. 'I think it's important to ask patients whether they are fulfilled and if they are using appropriate protection for themselves and others. Additionally, there are side effects to medications and this disease that cause sexual dysfunction. There's a safety aspect of this too--which is not only for other people. Being safe means not catching something from somebody else as well.' With this in mind, it's important to get a full sexually transmitted disease screening if you are at risk for an infection.
Beyond general well-being, there are some specialized areas that you need to address.
''Cancer screening. All men over 40 should have a digital rectal exam and what's called a prostate-specific antigen test, says Antonio Urbina, MD, medical director for HIV education and training at St. Vincent's Catholic Medical Centers'Manhattan. Discussing your family history of cancer (don't forget heart disease too!) is also important. For example, colonoscopies are usually recommended once you turn 50, but you should begin them earlier if a relative has had colon cancer or polyps.
'Additionally,' Urbina says, 'screenings for women should include a mammography and Pap testing for cervical cancer. And both men and women should have regular skin checkups and have any suspicious moles or warts removed.'
Mayer adds that women should do home breast exams and that both men and women should have anal Pap smears, especially if they have had genital warts or if women have ever had an abnormal cervical Pap smear.
''Osteoporosis. 'There have definitely been more and more reports to show that bone density is affected by HIV and the medications used to treat it,' Mayer says. He recommends getting a DEXA scan, particularly if you've had unexplained joint pain, especially in the hips.
Fortunately, there are medications that can increase bone density, such as Fosamax. Increasing vitamin D and calcium intake can also help if your doctor recommends such moves.
''Hepatitis infection and vaccination. Fichtenbaum says that when he sees new patients he finds that few have been vaccinated against hepatitis A and B, the latter of which can cause potentially fatal liver disease, especially for HIVers. There is no vaccine for hepatitis C virus, which is even more insidious, and doctors stress that screening for both strains of hepatitis is vital since they can each remain asymptomatic for decades.
Saag notes that sadly many patients can have their HIV under control but still be likely to die because of hepatitis B or C coinfection. Luckily, there are various therapies available to fight hep B and C.
''Medication interactions. 'It's really essential for patients to tell their provider about everything they take,' Saag says, 'be it over-the-counter medication or vitamins or supplements or whatever. There can be drug interactions that the patient doesn't know about.' The most famous example, he says, involves Saint-John's-wort, which is used as a so-called natural antidepressant but can make HIV treatments less effective.
Another problem is caused by the anti-acid drugs called proton pump inhibitors, such as Prilosec or Nexium, which can interfere with the absorption of atazanavir.
''Is your doctor up to speed? It's important to know that you're seeing a qualified physician who is up-to-date on the most current information in HIV care. Jerome Levine, MD, chief of the infectious disease division at Hackensack University Medical Center in New Jersey, says patients may find it reassuring to ask general questions (and get answers) about what is happening in HIV medicine--this can let the patient know that the doctor is keeping up with this rapidly changing and evolving field.
''Vaccines and TB screening. The annual flu vaccines generally become available in mid October, so if you haven't gotten one already, now is the time to ask for one. Additionally, Mayer says, all HIVers should have a pneumonia vaccine every five years, a tetanus shot every five to 10 years, and a tuberculosis screening annually.
With a little time and attention during your year-end visit to your doctor, you can make sure that you don't get caught off guard--especially once it's too late--by an ailment that's not directly related to HIV.