AIDS Treatment News - Issue Number 377, January 25, 2002
John S. James

As we enter 2002 many lives are being lost in the U.S. and around the world because opportunities to save them are being neglected or squandered, often due to lack of followup. The system does not work by itself. Problems fester indefinitely unless advocates push for attention and solutions. New activism is now emerging. But we need to understand what creates opportunities for activists, and how the process can work better.

This article will outline some AIDS treatment issues, to show people who want to help how to find more information, and to help them find people and organizations they can work with. To get a better sense of what is happening, we watched the emails and papers crossing our desk this month. The issues are endless; this article cannot touch 10% of what is going on. We had to omit many areas -- including the biggest of all, Africa and the world, where the epidemic kills 8,000 people every day. The global pandemic and global response need separate articles, and cannot be summarized meaningfully. It is hard to report because of uncertainty on the most central issue: how much are countries and people, rich and poor alike, finding the will to deal seriously with the epidemic after two decades of neglect?

Heart Disease Prevention

Though it can take years for official statistics to become available, clearly we are hearing of more heart attacks and deaths among young people who would not previously have been considered at high risk. While some antiretroviral drugs contribute to risk factors, long-term prospective studies have shown increased risk and death from cardiovascular disease before the protease inhibitors and modern combination treatment became available.1 We strongly suspect that antiretroviral treatment is increasing cardiovascular disease in two very different ways -- by side effects of the drugs themselves, but also by keeping people alive longer so that have more chance to develop long-term effects of AIDS.

Much can be done:

• Cardiologists have found conditions that predict much greater risk of death in persons with HIV.1 Often these can be treated.
  
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• Cardiovascular risks are cumulative. Even when some are unavoidable due to HIV or the treatments currently available, others can be reduced by following standard guidelines published for the general population.
  
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• Risk can be reduced by lifestyle changes such as better diets, exercise, quitting smoking, and probably by drinking a glass of red wine a day (for some patients).
  
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• On diet, more evidence is showing that trans fatty acids (found in partially hydrogenated oils used in commercially baked goods and fast foods -- but also found in products from ruminant animals) seem to be associated with seriously increased risk of heart attacks.2,3 A recent New York Times editorial noted that the U.S. FDA "has estimated that honest disclosure of trans fats on package labels could prevent 2,100 to 5,000 deaths from heart disease each year" ("Foot- Dragging on Fat," New York Times, January 26, 2002). Apparently industry pressure has so far stopped the FDA from requiring this disclosure.
  

The AIDS community can educate itself and others about this heart risk and how to avoid it.

• Nutritional approaches still considered experimental include measuring homocysteine in the blood and using certain supplements to help reduce it if necessary.
  
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• When nutritional and lifestyle changes are not enough, prescription drugs are already used in HIV treatment to help control abnormal lipid levels or other metabolic changes that increase cardiovascular risk. These drugs are widely used in the general population. They can have side effects and should be closely monitored, especially for persons with HIV.
  

Almost certainly, cardiovascular illness and death of people with HIV could be significantly reduced if everybody could see an HIV specialist, and when needed an HIV-knowledgeable cardiologist, with the different doctors able to work together, and with enough time to work with their patients. In practice almost nobody gets ideal medical care.

What activists can do is to help make sure that both standard, and credible experimental, medical information on reducing the risk become more widely available in the AIDS community. We need to pay more attention to this issue, and to the many lifestyle and medical options for dealing with it. We can educate ourselves, distribute information, and work to assure that HIV patients can see HIV specialists -- and cardiologists when necessary.

References

1. Barbaro G, Fisher SD, Pellicelli AM, and Lipshultz SE. The expanding role of the cardiologist in the care of HIV infected patients. Heart 2001 Oct;86(4):365-7.

2. Oomen CM, and others. Association between trans fatty acid intake and 10-year risk of coronary heart disease is the Zutphen Elderly Study: a prospective population-based study. Lancet 2001 Mar 10;357(9258):746-51.

3. Aro A. Complexity of issue of dietary trans fatty acids. Lancet 2001 Mar 10;357(9258):732-3.

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