HIV treatment education for people living with HIV/AIDS (PLWAs) and their care providers has long been central to ACRIA's mission. Relatively early in our existence as a community-based clinical research site, our patients were telling us that they desperately wanted to learn more about the health issues that were impacting their lives. ACRIA responded by developing a program that could provide culturally and linguistically appropriate information for PLWAs and care providers.
As more people with HIV live longer these days, liver disease is becoming a larger health threat than the usual opportunistic infections. In the emotionally charged world of organ transplantation, giving livers to HIV-positive people has been controversial.
When I was diagnosed HIV+ in 1990, my only thought was, "What do I need to do to stay alive?" The first and foremost thing I had to do was to free myself from my use of illegal drugs. That wasn't easy for a person like myself who had been a substance user/abuser for most of my adult life. But I was able to move from every day, all day drug use to sobriety by way of a harm reduction technique - a methadone program.
Throughout the course of the AIDS epidemic, many co-factors have been investigated as possible causes of faster disease progression. But recent studies have suggested that there may be a co-factor that actually benefits people with HIV.
Hepatitis B has been nothing short of a global-health catastrophe - approximately two billion people in the world today have, at some point in their lives, been infected with the hepatitis B virus (HBV). Of these, 400 million people have chronic hepatitis B, which remains the leading cause of liver cancer and kills more than one million people around the world each year. Closer to home, the U.S. Centers for Disease Control estimates that 80,000 people were infected with HBV in 1999 (the most recent available data) and that there are more than one million people living with chronic hepatitis B in the U.S., resulting in 5,000 deaths every year from cirrhosis of the liver and/or liver cancer.
In the fall of 1987, at the age of 25, I went to be tested for HIV. In the elasticized lengthening of time between then and Halloween when I would get my results, I had convinced myself that my test would come back negative and that I would get on with my life. I was unprepared to hear the words that I was HIV-positive and reacted with a sort of disassociative dance, as if I were watching all this from outside, shocked but disconnected. After a couple of cathartic phone calls to people close to me, I retreated into a certain level of denial and went three and a half years before seeking medical attention for HIV.
As more people with HIV are living longer, co-infection with hepatitis C virus (HCV) has emerged as a significant concern. Serious illness and death from hepatitis C-related liver disease are increasing in HIV-positive people. In the United States, about one-third of people with HIV are co-infected with HCV; the rates vary by area because up to 90% of people who got HIV through injection drug use are also infected with HCV.
The liver is the largest internal organ and is responsible for some 500 bodily functions. It processes almost everything we ingest, breathe, or absorb through the skin. It plays an important role in digestion and metabolism, regulating the production, storage, and release of sugar, fats, and cholesterol. The liver produces a variety of important proteins, including enzymes, hormones, blood proteins, clotting factors, and immune factors. Finally, the liver plays a role in detoxification. It filters infectious organisms, alcohol, heavy metals, drugs, and other poisons from the blood, and also processes and eliminates toxic byproducts of normal metabolism.
The benefits of combination therapy that have led to dramatic decreases in opportunistic infections and AIDS deaths over the past several years are accompanied by drawbacks, not the least of which is drug side effects. Some of these side effects are hepatotoxic - the scary sounding term for something that can harm the liver.
We realize that this issue of ACRIA Update might cause unease for some of our readers - yet more viruses to worry about, the possibility that anti-HIV drugs could affect the liver, and lots of unfamiliar words, many of them beginning with "hepa." But, we know that the following discussion can be important to your health.
People with HIV often take micronutrient supplements, but the research has not yet proven what the most useful dosages are for these individuals. Certain nutrients may directly influence the immune system s ability to fight infection.
Eating a Healthy Diet Your food choices can have a significant impact on your health. Part of good health is eating a well-balanced diet. Make sure you regularly eat healthy, nutritious foods that are high in fiber, contain vitamins and minerals, and are low in fat (fruits, vegetables and whole grains).
Anya Romanowski, MS, RD, CDN & Lisa Zullig, MS, RD
Research on drug therapies is traditionally given a higher priority than research into nutrition due to profit potentials. Put simply, protease inhibitors generate significantly more profits than bananas.
It s hard to say what s more frustrating - the fact that we still don t know what causes lipodystrophy, or the fact that we still don t know how best to treat it.
Evidence-based medicine provides the framework for decisions around clinical practice and treatment guidelines in HIV disease. There is growing pressure in the field of nutrition to make recommendations, especially with regards to supplementation, using this rigorous method of evaluating the evidence.
If I had been asked in the months following my diagnosis whether what I ate and whether I exercised could somehow control the HIV in my body I would have said, No. Looking back, though, my behavior suggested a different answer.
There s a lot more to life than viral load and CD4 counts. And increasing evidence shows that taking a few extra supplements a day may help in a variety of ways. Vitamins and Minerals All the food we eat to stay alive and healthy is made up of various chemicals.
Concerns about medication toxicities and side effects run high in the HIV community. Multiple medications are being prescribed not just for HIV infection, but also for prevention and treatment of other infections, high cholesterol and fat accumulation, diabetes, heart, liver, kidney, and digestive diseases, cancer, hormonal deficiencies, pain syndromes, and mental health concerns.
This edition of ACRIA Update covers nutrition issues of importance to the health and well-being of people living with HIV/AIDS (PLWAs). Even though we ve come a long way in developing HIV treatments over the past several years, nutrition has remained of key relevance to the care of this disease.
This information is designed to support, not replace, the relationship that exists between you and your doctor.