But there are also conditions, not caused by the medication, that occur more frequently in people with HIV than in other people. They are called comorbidities. These include cardiovascular disease, kidney and liver disease, diabetes, mental disorders, cancer and osteoporosis. People with HIV are at greater risk of developing these conditions, but that does not mean that everyone with HIV will get them. Extra vigilance is called for, though.
- HIV medication can cause side effects.
- People with HIV are more likely to have certain conditions, these are called comorbidities.
Side effect or comorbidity?
Some HIV medication causes certain complaints, these are called side effects. Click here for more about side effects. The difference between a side effect and a comorbidity is that a side effect is a complaint caused by medication, and a comorbidity is a complaint that – for another reason – occurs more often in people with HIV than in people without HIV.
Some conditions can be prevented, e.g. by healthy eating, quitting smoking or keeping the viral load very low. However, HIV does increase the risk of certain diseases. Of course, this doesn’t mean you will automatically suffer from them.
Osteoporosis (brittle bone disease) is a problem some people with HIV have to deal with. With complaints like this, it is always questionable what is causing it. Is it age related, is it the HIV infection, is it an HIV medication side effect, or is it a combination of these factors? Osteoporosis and the associated risk of bone fractures have received more attention in recent years. Osteoporosis is more common in people with HIV than in people without HIV.
There are a few risk factors for developing osteoporosis. There is nothing you can do about some of these factors. For example, osteoporosis is more common in women going through the menopause. Bone density increases in the first years of life, but then continues to decline. So old age is a risk factor.
For young people with HIV, the problem can be that peak bone density is lower than normal. This can lead to problems for them later in life, because they haven't built up a very big buffer. You can do something about the other risk factors. These include: body weight, smoking, alcohol consumption, use of opiates, low testosterone levels in men, vitamin D deficiency, lack of exercise and hepatitis C co-infection.
Certain cancers appear to be more common in people with HIV than in the general population. But don't panic: these diseases are rare in people with HIV as well. Lifestyle, old age, smoking, the low CD4 count you had in the past, your current CD4 count, and HIV itself are all factors. But their exact connection is not yet known.
HIV and cancer
Some types of cancer are more common in people with HIV than in people without HIV. These include anal cancer, cervical cancer, Hodgkin's lymphoma (cancer of the lymph nodes), liver cancer, melanoma (a form of skin cancer), throat cancer, leukaemia (blood cancer), colon cancer and kidney cancer.
HPV, anal cancer and cervical cancer
The human papillomavirus (HPV) can be transmitted by having sex. Many people are carriers of HPV but have no symptoms. There are 40 types of HPV that can infect the anus and genitals. HPV can then lead to cancer of the anus or cervix. These types of cancer are rare, but the risk of anal and cervical cancer is higher in people with HIV than in people without HIV. This may be because HPV takes advantage of the impaired immune system. The risk of HPV-related cancer is reduced by treatment adherence, an undetectable viral load, and a high CD4 cell count.
Very occasionally, HPV causes other types of cancer, like vulvar cancer, vaginal cancer, penile cancer, and cancer of the mouth and throat. HPV can also cause genital warts. Genital warts are one of the most common STIs.
Some variants of HPV can lead to anal cancer. People with HIV are at greater risk of anal cancer than people without HIV. The risk of anal cancer is greater for men with HIV than for women with HIV.
Anal cancer doesn’t always cause symptoms. The characteristics of anal cancer are: blood loss from the anus, itching or pain around the anus, swelling or lumps, feeling the need to defecate a lot, changes in bowel movements (constipation or diarrhoea). However, many of these symptoms also fit with other conditions, so discuss your symptoms with your specialised HIV doctor and perhaps get tested for haemorrhoids and other STIs.
The early stage of anal cancer is called AIN (anal intra-epithelial neoplasia). This is a disruption in the cell division of the mucous membrane in and around the anus.
AIN has three stages: AIN1, AIN2 and AIN3. The numbers represent which part of the cell layer the abnormal cells are in.
AIN1 is low grade and usually clears up all by itself. AIN2 and AIN3 are considered to be precancerous conditions of the anus and are called high-grade AIN. In high-grade AIN, the risk of developing anal cancer in five years is 1-5%. In AIN3 the risk of developing cancer in thirty years is 20-30%. High-grade AIN doesn’t always develop into cancer and is sometimes cleared up by the body itself. So most people with AIN do not develop anal cancer, even without treatment.
Some variants of HPV can lead to cervical cancer. Women with HIV are more likely to get cervical cancer than women without HIV.
Cervical cancer doesn’t always produce symptoms. The hallmarks of cervical cancer are bleeding during or right after sex, bleeding after the menopause, bleeding between periods, and unusual discharge. However, many of these symptoms also fit with other conditions, so discuss your symptoms with your Specialised HIV doctor and perhaps get tested for other STIs.
The precancerous condition of cervical cancer is called CIN (cervical intra-epithelial neoplasia). This is an abnormality in the cell division of the mucous membrane in and around the cervix.
CIN has three stages: CIN1, CIN2 and CIN3. The numbers represent which part of the cell layer the abnormal cells are in.
CIN1 is low grade and is usually cleared by the body itself. CIN2 and CIN3 are considered to be precancerous conditions of the cervix and are called high-grade CIN. It takes on average 10 to 15 years before HPV develops into cervical cancer. High-grade CIN doesn’t always develop into cancer and is sometimes cleared up by the body itself. So most people with CIN do not develop cervical cancer, even without treatment.
The current HIV medication has a small risk of neurological problems. A neurological problem is a malfunction in the brain, spinal-cord or nervous system. There are many different types of neurological problems, like forgetfulness, dementia, and tingling in the hands or feet (neuropathy).
New improved HIV medication has eliminated the major danger of dementia, but minor inconveniences remain. Milder forms of abnormal brain functioning still occur despite the improvement in HIV medication. In everyday life, this usually causes little or no problems.
In old age, neurological problems occur in all people more than they do at a younger age. Impaired memory, the body stiffens up, motor skills get weaker. But dementia is rarely a problem for people with HIV these days. In later life, this can change. Then Alzheimer's, the most common form of dementia, is unfortunately a possibility.
HIV and hepatitis B and C
There is a difference between hepatitis B and hepatitis C in terms of symptoms, transmission and medication. They are disorders that can be sexually transmitted (STIs) and they damage the liver. Hepatitis B or C can be silent killers because one often discovers the infection when it's too late.
Fortunately, this no longer applies to people with HIV who are already being treated. The vast majority of infections are detected in time, meaning hepatitis can be treated rapidly. This is because the specialised HIV doctor monitors the liver function every six months. And in the Netherlands hepatitis is also easy to treat. The risk of hepatitis is an additional reason for people with HIV to start HIV medication as early as possible, because it reduces the risk.
Hepatitis B usually causes symptoms rapidly: like fever, nausea and weight loss. In most cases, people are able to overcome this infection themselves, without using medication. However, some carriers do not manage this. They become chronic carriers of the hepatitis B virus. If they do not know this and the infection remains undetected, they can eventually develop liver problems and liver cancer.
Hepatitis B is not curable yet, but it can be prevented with a vaccination. There is also a good treatment for it and in this respect, it resembles HIV. In fact, some HIV medication also suppresses hepatitis B.
Hepatitis B can be sexually transmitted through semen and vaginal fluids. Men who have sex with men are the highest risk group for contracting it. They can get a free vaccination for hepatitis B to protect themselves from ever contracting it and transmitting it to others.
Flu and flu shot
People with HIV and other high-risk groups, such as the elderly and chronically ill, are offered a free flu vaccination once a year by their general practitioner. Generally, the flu shot is useful for people with weakened immune systems, COPD or chronic bronchitis. The flu virus mutates easily, so a flu shot is needed every year.
The vaccination doesn't always prevent all flu variants, so there are no guarantees you will not get the flu that winter. If you have any doubts about the need for the flu shot, discuss it with your general practitioner or specialised HIV doctor. If you are not offered one, ask your general practitioner about it.