Elevated (liver) concerns

Question: I am a 43-year-old male who has been in regular care for my HIV for almost 10 years. I’m stable on my HIV drugs and I feel good. My T-cells are pretty great at around 700 and I’ve been undetectable for some time now. Lately, my doctor seems more worried about my risk of heart attack, and wants me to start a couple of meds for blood pressure and cholesterol. I feel way too young to worry about heart problems and I really don’t want to take even more pills every day. Are my doctor’s suggestions now typical?

Answer: First, congratulations on how well you seem to be doing with your HIV treatment. As an HIV Specialist, my primary goal is to optimally treat my patients’ HIV, but as an internist and primary care physician, I also have the goal of managing my patients’ overall wellness. So, we as HIV caregivers now give more attention to other issues that can affect lifespan and quality of life.

I understand your concern with adding more pills. Recommendations like this are never made lightly by your doctor. But when there is clear evidence that options to prevent or treat other related medical issues are available and beneficial, it’s advisable to consider those treatments, even if you don’t feel symptomatic.

Your doc’s recommendations for reducing your chance of a heart attack or stroke are important, but are also only one part of a larger strategy that anyone can employ for themselves. I would advise you to work with your doctor to understand the risks vs. benefits of adding the protective treatments you inquired about. In a vast number of cases, the risks and inconvenience are far outweighed by the benefits to your general long-term health, but each case is unique. Don’t be unduly afraid of having to add medicines to manage or avoid these problems. HIV regimens are often much simpler than they used to be anyway, so adding new therapies is often not too difficult. In addition, here are some ways you can help protect yourself from CV (cardiovascular) complications of normal aging and life with HIV disease:

Stop smoking! This may be the most critical item for CV health (not to mention lung health and cancer prevention). There are several medical options now available to help you quit too; definitely speak to your doctor about these if you think you need help.

Eat a healthy diet and maintain a healthy weight! Patients with stable HIV are just like anyone else, and in our calorie-dense, fast food society we often slowly gain weight in middle age and beyond. Also, our food choices are often not dense in nutrients. Keeping ahead of the weight curve and choosing nutritious foods are important for everyone for the prevention and treatment of CV disease, diabetes, and hypertension, and to keep feeling well and energetic. There are many resources available to help you to make better food choices. The “Nutrition Center” on the American Heart Association website (www.heart.org) is a good start, as is the section called “HIV and Your Heart”.

Get regular exercise! If you already have some issues that limit your physical abilities, get guidance from your doctor, but even moderate daily movement like long, brisk walks are very helpful. More vigorous exercise is suggested for those who are able.

Since you are obviously already adherent to a daily medication regimen, I would expect that you will be as good as, or even better than, the average population at controlling any issues with your added medicines.

As a last note to other readers, there are now several studies and observations showing potential adverse effects of untreated HIV on many other aspects of your health besides just your T-cell count, in part due to chronic inflammation and inflammatory responses. This may be particularly important as a CV risk factor, and any patient not on HIV therapy should discuss these issues with their doctor. 
It is increasingly important to keep HIV viral load suppressed to reduce these other risks, especially if you have other baseline cardiac risks.

Good luck, and best wishes for continued good health!

—Paul DenOuden, MD, AAHIVS
Multnomah County Health Department
Portland, OR

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