HEALTH: HIV and the risk of non-communicable diseases

HEALTH: HIV and the risk of non-communicable diseases

NAIROBI, 22 December 2011 (PLUSNEWS) - While antiretroviral drugs have significantly improved the life expectancy [ http://www.plusnews.org/report.aspx?reportid=93269 ] of people living with HIV, the virus - and often the ARVs themselves - can make people more susceptible to non-communicable diseases than the rest of the population.

 Here are six non-communicable diseases that are more likely to affect people living with HIV:

 Heart disease - Several studies have made the link between coronary disease and HIV infection: one [ http://www.retroconference.org/2011/PDFs/809.pdf ] presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) in March 2011 found that HIV-infected participants had an increased risk of "acute myocardial infarction" - heart attack - compared with demographically and behaviourally similar HIV-negative study participants.

 Another 2011 study [ http://archinte.ama-assn.org/cgi/content/short/171/8/737 ] found that HIV infection was a risk factor for heart failure, with ongoing viral replication associated with a higher risk of developing heart failure.

 The link between ARVs and heart disease is less clear; one study [ http://www.retroconference.org/2011/Abstracts/40434.htm ], also presented at CROI, found that HIV infection increased the risk of coronary heart disease, but ARVs and higher CD4 counts - a measure of immune strength - significantly reduced this risk. However, a 2011 Canadian study [ http://www.ncbi.nlm.nih.gov/pubmed/21499115 ] found that several ARVs - abacavir, efavirenz, lopinavir, and ritonavir - were all associated with an increased risk of heart attack.

 Cervical cancer - After breast cancer, it [ http://www.medscape.com/viewarticle/714655 ] is the second most common cancer among women worldwide; more than 80 percent of new cases and deaths from the disease occur in developing countries.

 Studies have found that HIV-positive women are at higher risk of human papillomavirus (HPV), a precursor to cervical cancer; women with low CD4 counts seem to be particularly vulnerable.

 HPV can be prevented with a vaccine recommended for pre-adolescent girls before they reach their sexual debut but the vaccine is too expensive for most women in developing countries. In addition, cervical cancer screening levels remain very low in many poor countries; for instance, just 3.2 percent of Kenyan [ http://www.plusnews.org/report.aspx?reportid=93209 ] women aged 18-69 are tested every three years, compared with 70 percent of women in the developed world.

 Other cancers - People living with HIV are more susceptible to several cancers, including Kaposi sarcoma, Hodgkin's and non-Hodgkin's lymphoma, anal cancer, skin cancer and liver cancer - than HIV-negative people, a new study has found.

 Published in Cancer Epidemiology, Biomarkers and Prevention, the study [ http://cebp.aacrjournals.org/content/early/2011/11/18/1055-9965.EPI-11-0777.abstract?sid=5134a395-412a-4cdf-b8b1-bf5d5beee14f ] found that immunodeficiency was positively associated with all cancers examined except prostate cancer. The authors recommended starting antiretroviral therapy earlier to maintain high CD4 levels.

 Mental illness - Studies show that the prevalence of mental illness among HIV-positive in-patients and out-patients in the US ranges between 5 and 23 percent compared with 0.3-0.4 percent in the general population.

 According to the World Health Organization (WHO) [ http://apps.who.int/gb/ebwha/pdf_files/EB124/B124_6-en.pdf ], apart from the psychological impact of HIV, the virus has direct effects on the central nervous system, leading to neuropsychiatric complications, including HIV encephalopathy, depression, mania, cognitive disorders, and dementia.

 Studies also show that depression can lead to high-risk behaviour [ http://www.ncbi.nlm.nih.gov/pubmed/21078150 ], including transactional sex, partner abuse and low condom use.

 However, depression is frequently overlooked [ http://plusnews.org/report.aspx?ReportID=94410 ] by healthcare providers; a severe shortage of mental health professionals in developing countries means patients often suffer in silence.

 Kidney disease - Known as HIV-associated nephropathy [ http://www.nephrologyrounds.org/crus/nephus_0809_07.pdf ], kidney disease is relatively common in people living with HIV. The virus interferes with the kidneys' ability to function correctly, particularly in people with advanced HIV who have a low CD4 count and a high viral load, as well as older people.

 Poorly functioning kidneys can cause other health conditions, including cardiovascular disease, nerve damage, bone disease, and anaemia.

 Certain ARVs, tenofovir in particular, have also been associated [ http://journals.lww.com/jaids/Fulltext/2010/01010/Impact_of_Tenofovir_on_Renal_Function_in.10.aspx ] with a decline in renal function.

 Liver disease - A leading cause of morbidity and death among HIV-positive individuals [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62001-6/fulltext#bib3 ], it is mainly caused by co-infection with hepatitis B or hepatitis C, alcohol abuse, insulin resistance or side-effects of medicines.

 Experts say early identification and proper management of liver disease in HIV-infected people are crucial to improve long-term outcomes.