It’s a new year and a new you. Your best resolution might be to get the annual tests and immunizations every HIV-positive person needs. It’s the strongest commitment you can make to your health. Frank Spinelli, a New York City physician who specializes in treating patients with HIV, helps navigate what tests you need, when you need them, and why it’s worth your trouble.
EVERY 3-6 MONTHS (Unless your doctor advises otherwise, get these screenings at your regular office visits. If you don't see your doctor regularly, then get these tests every six months.)
Blood Pressure What it measures: The pressure of the circulating blood on the walls of your blood vessels. What that means: Because blood pressure is closely related to the strength and rate of your heartbeat as well as the diameter and elasticity of the arterial walls, it is a useful diagnostic tool for a variety of conditions. Why you need it: Elevated blood pressure is associated with a substantially greater risk of heart attack among HIV-positive people, according to a 2012 report by the Veterans Health Administration.
Cardiovascular Disease What it measures: Cholesterol and triglyceride levels, and irregularities in arterial walls or cardiac ventricles. What that means: An assortment of tests, ranging from a simple blood draw to a chest X-ray to various types of ultrasounds, can help your doctor determine how effectively your heart is pumping blood and spot any rhythmic irregularities. Why you need it: HIV infection can double the risk of heart attack, according to a 2011 study from the University of Pittsburgh’s School of Medicine. Additional conditions like diabetes, smoking, and even antiretroviral treatment can also increase your risk for heart attack.
Diabetes What it measures: The amount of glucose in your blood, also known as blood sugar. What that means: While there are several different types of tests for diabetes, most function by looking at the amount of glucose in the blood that has attached to red blood cells as they move through the bloodstream. The more glucose in the blood, the higher the potential for damage to your large and small blood vessels. Why you need it: HIV-positive people are at an increased risk for diabetes, especially if they have additional risk factors such as a family history of diabetes, increased waist circumference, physical inactivity, and African-American or Latino heritage. Because some HIV treatments can affect glucose uptake levels, it’s also important to be screened for diabetes before starting HAART or any nucleoside reverse transcriptase inhibitor drugs, according to Diabetes Spectrum.
EVERY 3 MONTHS
Cholesterol (Lipids) Test What it measures: The amount of fat carried through the blood as triglycerides, phospholipids, and cholesterol. What that means: Lipids include both the “good” cholesterol (HDL) and “bad” cholesterol (LDL), and both HAART and protease inhibitors can affect lipid levels. Why you need it: As HIV progresses, there is a trend of decreasing cholesterol and increasing triglycerides, which can lead to increased risk of heart disease and heart attack, stroke, pancreatitis, and blood clots. Receiving regular lipids tests can help your doctor determine if you should go on cholesterol-lowering drugs or change your diet to minimize this risk. Smoking also increases the risk of elevated lipid levels.
Lymphocyte Subset What it measures: Number of healthy CD4 cells (a.k.a. T cells), B cells, and natural killer (NK) cells. What that means: A lymphocyte subset determines the number or proportion of certain types of white blood cells, which are important in the formation of antibodies that help your immune system. Why you need it: This test can tell you how healthy your immune system really is, which can help doctors monitor your HIV care and make sure you’re getting the best type of treatment.
HIV Viral Load What it measures: The amount of active HIV in your blood. What that means: HIV cells replicate at varying rates, and the rate determines your viral load. The goal is to have as few copies as possible in your blood, known as an “undetectable viral load,” generally considered to be less than 20 HIV RNA copies per milliliter, or less than 75 HIV copies per milliliter, depending on the type of test. Why you need it: Your doctor can assess the state of your HIV infection and how well your medication regimen is working based on the number of HIV copies in your cells. The fewer copies, the better. A viral load of more than 200 copies per milliliter usually means you need to change your antiretroviral therapy. *Only 28% of Americans living with HIV have their viral load under control and at low levels
Complete Blood Count (CBC) What it measures: The number of white and red blood cells, the number of platelets, the amount of oxygen-carrying protein in the blood, and the proportion of blood composed of red blood cells. What that means: White blood cells regulate the body’s ability to fight infection and are often compromised by immune-system disorders such as HIV. Red blood cells carry oxygen into the bloodstream, and an excessively high count can indicate lung disease, which is more common in people who have HIV and people who smoke. Platelets are essential for effective blood clotting and can be lowered by HIV. Why you need it: A CBC is a standard, informative test that can be used to diagnose opportunistic infections, detect blood clotting problems and anemia, and measure cell production and destruction, which is affected by HIV.
Comprehensive Metabolic Panel What it measures: Liver and kidney function, in addition to assessing the levels of glucose, proteins, and electrolytes in your blood. What that means: A comprehensive metabolic panel tells doctors how well your kidneys and liver are filtering waste produced by your body. It also measures your blood sugar levels and how well your cells are producing calcium, sodium, carbon dioxide, bicarbonate (which maintains the body’s pH balance), and other electrolytes needed for healthy organ function. Why you need it: HIV medication frequently affects liver and kidney function, which is why it’s important to monitor blood urea nitrogen and creatinine, both of which determine how well your kidneys are filtering waste out of your blood.
*Annual Exam It sounds like something for kids going to camp or college, but the annual physical exam is a must for HIV-positive folks. It should include comprehensive health screenings, with a rectal exam, breast and gynecological exams for women, and a look at waist circumference, which is a simple tool to assess abnormal accumulations of deep abdominal fat, or visceral adipose tissue, caused by HIV and highly active antiretroviral therapy.
Thyroid Stimulating Hormone What it measures: Amount of thyroid hormone, which regulates the body’s metabolism. What that means: Your metabolism controls how quickly and effectively your body processes nutrients and can be affected by a number of factors, including HIV itself, HAART, and other medical conditions that you may have along with your HIV. Why you need it: HIV-positive patients being treated with HAART are at an increased risk for hypothyroidism (often called underactive thyroid), which causes an abnormally low level of secretion of thyroid hormone. It will also test for thyroiditis, an inflammation of the thyroid gland that can be triggered by HIV.
Testosterone (for men) What it measures: Levels of the male hormone created and secreted by the genitals. What that means: Low testosterone levels, also known as hypogonadism, result from deficient natural production of the hormone. There is some evidence that AIDS-based wasting may be affected, in part, by hypogonadism. Why you need it: Low testosterone is connected to low sex drive and erectile dysfunction, which some studies suggest upward of 60% of HIV-positive men experience. Low testosterone production has also been linked to anemia, osteoporosis, muscle loss, and depression. For some patients, hormone replacement therapy may be a viable option to counter some of the effects of hypogonadism.
Hepatitis B and C What it measures: The presence of hepatitis B or hepatitis C virus, an infection of the liver and a common coinfection among HIV-positive people, due to the similar modes of transmission. What that means: According to the Centers for Disease Control and Prevention, as many as one third of HIV-positive patients are also infected with hepatitis. Liver disease, which is often related to hepatitis infection, has become the leading cause of non-AIDS-related death among the HIV-positive population. Why you need it: Since HIV-positive patients are already at increased risk of liver disease, it is critical to regularly screen for the virus. Spinelli also recommends vaccinations against hepatitis A and hepatitis B for all HIV-positive patients.
Vitamin D What it measures: Levels of vitamin D, a fat-soluble vitamin found in only a few food sources or through exposure to sunlight. What that means: Vitamin D deficiency has been connected to bone demineralization in aging HIV patients. Why you need it: Vitamin D deficiency is common in people with HIV, because you use more vitamin D for regular bodily functions than someone who is HIV-negative. Additionally, some studies have found that HIV patients on nonnucleoside reverse transcriptase inhibitors have an increased incidence of vitamin D deficiency.
Anal or Cervical Pap Smear What it measures: The existence of certain strains of human papillomavirus, which is responsible for most types of cervical and anal cancers as well as genital warts. What that means: Women should regularly receive a cervical Pap smear, and women who have cervical HPV or participate in anal sex, as well as HIV-positive men, should all receive anal Pap smears yearly. Why you need it: Cervical cancer (which is almost always caused by HPV) in women and anal cancer in both men and women occur more frequently in conjunction with HIV infection. In addition, according to the CDC, HPV can cause cancers of the vulva, vagina, penis, and throat. It can also lead to infertility in women or be transferred to children during delivery. Regular screening is an important proactive step, and there is evidence that HPV vaccinations can help protect against the development of anal and cervical cancer.
*Look out for Cancer As men and women with HIV grow older, it is crucial that doctors routinely screen them for anal, cervical, and colon cancer, as all of these cancers have a higher incidence in those who are HIV-positive. Spinelli recommends an annual colonoscopy in all HIV-positive patients older than 50. Similarly, men over age 50 should be regularly screened for prostate cancer, and women should get annual mammograms after age 50. Women should also get other screenings for breast and gynecological cancers as soon as they are diagnosed with HIV.
Remember, this information is intended as a recommendation and should not take the place of your primary care physician’s guidance. It is intended to supplement your individual treatment plan and offer you a starting place to take control of your health care.