Q&A: HIV Related Illness

Q: What are the top three potential health conditions that people living longer with HIV have to be aware of?


 A: The three major health problems in patients with HIV disease as they live longer lives are cardiovascular disease, neoplastic disease (cancers) and liver disease. There is some overlap between cancer and liver disease since viral hepatitis (liver infection) can lead to liver cancer.

I discussed cardiovascular disease in an earlier article (Reducing Cardiovascular Risks in HIV Disease: A Heart to HAART discussion) which is archived on this site. In the article, I discussed how inflammation from a chronic infection (HIV disease) can damage blood vessels and contribute to the inflammatory process of atherosclerosis. To complicate the problem, many HIV patients also have hypertension, diabetes, obesity, and smoking as contributing risk factors. Some of the HIV medicines are culprits as well, but many of the newer drugs are safer and don’t contribute to the risk for heart disease.

The situation with cancers is complicated and will be discussed in more detail in a series of future articles. There are some cancers that are directly related to the immune suppression caused by HIV disease. An example of this type of cancer is Kaposi’s sarcoma, a cancer that frequently involves the skin.  Fortunately, as we have improved treatments for HIV and people start treatment earlier, this cancer has become less common.  Even some patients who are sick with AIDS and develop Kaposi’s sarcoma may experience rapid improvement once HIV treatment is started.  Many cancers common to HIV patients are caused by viruses that people with normal immune function can control.  An example would be Non-Hodgkins Lymphoma, a type of cancer that affects the lymphatic system. The lymphatic system drains fluid from the tissue and returns it to the circulation. It also plays an important role in immune defense. Non-Hodgkins lymphoma is believed to be caused by the Epstein-Barr virus (EBV). There are now more effective treatments for this type of cancer.   

 Another reason why cancers are increased in HIV disease is because people with HIV are living longer. Because many cancers take a long time to develop in the general population, we didn’t see these types of cancers in HIV patients 20 years ago because the patients died sooner. Now that patients live longer, we are seeing lung, breast, and prostate cancer develop in HIV patients. Since these are fairly common cancers, a lot of research is trying to figure out if these cancers occur more in HIV patients than the general population.  Some studies seem to indicate that lung cancers may be increased in HIV patients, just another reason to stop smoking!

Liver disease is probably the third most common major complication in HIV infected persons. One reason is that up to a third of HIV patients in the US may also be infected with hepatitis B virus  (HBV) or hepatitis C virus (HCV) or both.  Viral hepatitis, if untreated, can lead to cirrhosis of the liver. The liver is the body’s largest organ and is normally a pulpy organ with lots of cells receiving lots of blood flow.  With cirrhosis, this pulpy tissue becomes replaced by a tough fibrous tissue that has few cells capable of carrying out the liver’s job. Not only that, these changes in the liver tissue lead to impaired circulation in the body, since so much blood normally flows through this organ. As bad as cirrhosis is, the picture can get even worse, because cirrhosis may progress to liver cancer.  Having HIV infections makes the damage from hepatitis viruses progress faster that just having the hepatitis infection without HIV . Aside from viral hepatitis, alcoholic hepatitis can also lead to cirrhosis.  Alcohol abuse and dependency is another problem that many HIV patients face.  Fortunately, there are a number of good treatments for alcohol dependency. Again, there are some HIV medicines that can cause damage to the liver.  Some of the drugs in one class (the nucleoside class) can occasionally cause an accumulation of fat in the liver cells called steatohepatitis.  The drugs most likely to do this are not used very much any more.

So HIV patients must work with their medical providers to reduce all these risks.  Regular screenings can help detect cancers early when they are most likely to be cured by treatment.  Starting HIV treatment early may protect form developing cancers.  Vaccination against HBV will prevent infection and the chance of liver cancer from this virus.  A vaccination against human papilloma virus may be effective in preventing cervical and/or anal cancer in HIV patients but the studies are still ongoing.

Protect your liver by avoiding excessive alcohol use and getting treated for alcohol dependency.  If you have HBV or HCV infection, do not drink alcohol at all. Discuss with your medical provider your HIV meds to make sure they are safe to the liver.