Hiv Effects On The Circulatory System
Several things make your chances of heart-related problems go up. Because HIV affects your immune system, your body will be inflamed as it tries to fight the infection, like itâs on a constant simmer. This kind of inflammation has been linked to heart disease.
Some drugs you take for HIV can also make heart disease more likely. They can cause insulin resistance, which makes you more likely to get diabetes, and problems breaking down fats. Diabetes, in turn, raises your risk of heart disease. You might need medicines to control your blood sugar and cholesterol.
If you smoke, quit. Eat a variety of vegetables and fruits, plenty of whole grains, and foods with omega-3 fatty acids. Choose lean cuts of meat and low-fat dairy products. Exercise, like taking a brisk walk, for 20 to 30 minutes most days of the week.
If you’re carrying extra weight, losing as little as 5 or 10 pounds could make a big difference.
Treating Hepatitis C Together With Hiv
If youre HIV positive and have hepatitis C infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.
Due to the new direct-acting antiviral drugs, people living with HIV and hepatitis C co-infection can be treated with most of the same hepatitis C drug regimens as HIV-negative people. Research has shown that cure rates are the same.
Unlike treatment for HIV, hepatitis C treatment is not for life. New drugs to treat hepatitis C only need to be taken for up to 3 months.
Data Management And Analysis
Out the 237 patients that filled the survey and provided samples for analysis, 108 were not part of the analysis for the following reasons: on a prescribed supplement and complementary medication provided incomplete information on use of alcohol, smoking, and trado-medicine and age > 55 years . A total of 129 data were managed in Microsoft Excel 2016. The obtained ALT, AST, and ALP values were categorized into normal and abnormal levels . The dataset used in this study was deposited in the Harvard Dataverse repository .
The cleaned data were analyzed using the STATGRAPHICS centurion CVI version 16.1.11 and Statistics Package for Social Science . The descriptive statistics were performed for continuous data and represented as mean while frequencies represented the categorical data. Fisher’s Chi-square analysis evaluated the sex-associated differences in the distribution, and test of mean differences in the liver enzyme levels. The confidence level was set at 95%, and a P< 0.05 was considered significant.
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What Consult Service Or Services Would Be Helpful For Making The Diagnosis And Assisting With Treatment
If you decide the HIV patient has liver disease, what therapies should you initiate immediately?
Hepatitis A
No specific treatment exists for hepatitis A. Symptomatic treatment of nausea or dehydration may be warranted.
Hepatitis B
Indication for treatment of hepatitis B depends on level of HBV replication, live enzyme elevation and presence of cirrhosis. Patients with cirrhosis are immediate candidates for HBV therapy independent from other markers. Cirrhotic patients should be referred for variceal assessment, have regular monitoring for hepatocellular carcinoma and be referred early for transplant assessment. Patients with liver cirrhosis and low CD4 counts require careful surveillance in the first months after starting HAART in order not to overlook immune-reconstitution syndrome and subsequent liver decompensation. Patients with elevated liver transaminases and levels of HBV-DNA > 2000 IU/ml should also be offered HBV therapy, whereas patients with normal transaminases and low level viremia can be followed with regular monitoring, but without treatment. HBV-infected patients requiring HAART, particularly with advanced liver fibrosis , should receive tenofovir +3TC or FTC.
Figure 1.
Treatment of chronic HBV infection in HIV-positive individuals.
Hepatitis C
Figure 2.
Duration of treatment of chronic hepatitis C with peg-interferon and ribavirin.
Hepatitis D
Hepatitis E
Atypical mycobacteriosis
CMV hepatitis
Strengths And Limitations Of This Study
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The study retrospectively collected 11-year records of HIV/AIDS patients on antiretroviral treatment and involved in larger samples than several other similar studies.
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Cumulative ART duration does not increase the risk of liver damage.
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Monitoring and management of liver damage among patients on ART are still important in clinical therapy.
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Confounding factors such as smoking, alcohol consumption, and other opportunistic infections besides hepatitis B virus/hepatitis C virus could not be estimated and ruled out.
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Lack of information about further progression of liver diseases such as hepatocarcinoma and liver dysfunction-related mortality limits our findings to be associated with clinical outcomes.
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Treatment Of Hepatitis C
Unlike hepatitis A and B, there is no vaccine available for hepatitis C. Fortunately, both acute and chronic hepatitis C infections are curable.
Current hepatitis C treatments involve taking two or more medications known as direct antiviral agents, or DAAs. This combination of medications prevents HCV from replicating until the virus is no longer present in the body. Treatment usually takes 6 to 24 weeks but can take longer.
However, people who have both HIV and HCV need individualized treatments because the medications used to treat HCV infections can interact with HIV treatments.
A doctor will recommend a treatment plan based on the individualâs:
- hepatitis C genotype
The Impact Of Hiv On Hepatitis C
The interaction between HIV and hepatitis C affects the transmission and natural history of hepatitis C.13 People who do not receive HIV treatment are less likely to spontaneously clear their hepatitis infection, have higher hepatitis viral loads and experience more rapid hepatitis disease progression than HIV-negative people.
They may also belong to groups that are criminalised and stigmatised, meaning they are likely to experience barriers to accessing health services.14On the other hand, antiretroviral treatment taken to treat HIV helps keep hepatitis C under control. Hepatitis outcomes are better in people who receive HIV treatment. Whereas response to the older generation of hepatitis C treatments was poorer in people with HIV, this is not the case with modern therapies.
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How Is Nafld Diagnosed
Unless it progresses, most people with mild NAFLD are not diagnosed.
A blood test is often an important signal if liver enzymes are increased. Routine HIV monitoring includes these liver enzyme tests.
However, NAFLD can be present even when these tests are normal.
When NAFLD is suspected, imaging scans can be more accurate. These include ultrasound, CT and MRI scans. A Fibroscan can show how much fibrosis is present. Biopsy is only recommended when there is a high risk or uncertain diagnosis. This is when a sample of liver tissue is removed and looked at under a microscope,
Hiv Effects On The Digestive System
More than half of people who have AIDS report digestive symptoms as the virus or an opportunistic infection targets the walls of their intestines. Diarrhea is the most common one. Over time, the virus can change how your digestive tract works and even how it looks.
Liver
Some HIV medications can damage your liver. Many people with HIV also have a form of inflammation called hepatitis.
Limit how much alcohol you drink, and don’t use recreational drugs. Having diabetes, high cholesterol, or triglycerides and being overweight can lead to fatty liver disease, so keep an eye on the carbs, fats, and calories you eat each day.
Talk to your doctor about getting the hepatitis A and hepatitis B vaccines. Thereâs no vaccine against hepatitis C, but you should get tested for it.
Get regular blood tests to catch any liver problems early.
Mouth
Your mouth might be one of the first places where you notice signs of HIV. Things like dry mouth, fungal infections, gum disease, cold sores, and canker sores can make chewing or swallowing painful. If they go on too long, you might not be able to take your HIV medication or get the nutrients you need.
Good dental habits can help prevent these issues, so brush and floss regularly. See your dentist for checkups, and tell them if youâre having problems. Most mouth conditions tied to HIV are treatable.
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What Is The Treatment For Individuals With Hiv And Hepatitis
Doctors primarily treat HIV with antiretroviral therapy. This effective treatment helps stop HIV from progressing to a later stage disease called AIDS.
With the exception of HAV, most hepatitis infections are treated with medications called antivirals. Treating HBV and HCV early is important in preventing liver diseases and cancers, some of which may be fatal.
HCV is treated with antiviral medications taken over the course of 8 to 12 weeks. The HHS says that this treatment has a 97 percent cure rate, including in people with HIV.
While HBV is also treatable, medications work to suppress the virus. They cant get rid of it entirely. Similar to HIV, treatment for HBV may be lifelong.
HAV is an acute infection. It can resolve on its own, or it can last up to 6 months, according to the . Rest and fluids are standard treatments, but more severe cases may require hospitalization.
HIV-hepatitis coinfections are treatable when detected early, according to the HHS.
Some people may take separate medications for HIV and hepatitis, like in the case of HCV. However, you can sometimes treat both viruses at the same time with the same medications. It may be helpful to find a doctor whos also experienced with treating both viruses.
Risk factors for contracting HIV or hepatitis may include:
- sharing needles, razors, or syringes
- having sex without a condom or other type of barrier method
- transmission during childbirth
Why Might People Infected With Hiv Have A Higher Risk Of Some Types Of Cancer
Infection with HIV weakens the immune system and reduces the body’s ability to fight viral infections that may lead to cancer . The viruses that are most likely to cause cancer in people with HIV are :
- Kaposi sarcoma-associated herpesvirus , also known as human herpesvirus 8 , which causes Kaposi sarcoma and some subtypes of lymphoma
more advanced at diagnosis, delays in cancer treatment, or poorer access to appropriate cancer treatment.
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Stages Of Hiv Infection
About a month after you get HIV, you might feel like you have the flu. This is the first stage, called primary or acute HIV infection. Symptoms include:
- Fever
- Fatigue
- Swollen lymph nodes
The next stage is called clinical latency, or chronic infection. You might have no symptoms, or only mild ones, for 10 years or more.
Without treatment, as HIV keeps multiplying inside your body, youâll move into the third stage, which is AIDS. A person who has HIV is diagnosed with AIDS when they have fewer than 200 CD4 cells per cubic millimeter of blood or when they get whatâs called an AIDS-defining condition.
AIDS-defining conditions are certain cancers and illnesses called opportunistic infections.
Respiratory And Cardiovascular Systems
HIV makes it hard to fight off respiratory problems such as the common cold and flu. In turn, an HIV-positive person may develop related infections, such as pneumonia.
Without treatment for HIV, advanced disease puts an HIV-positive person at an even greater risk for infectious complications, such as tuberculosis and a fungal infection called pneumocystis jiroveci pneumonia .
PJP causes trouble breathing, cough, and fever.
The risk of lung cancer also increases with HIV. This is due to weakened lungs from numerous respiratory issues related to a weakened immune system.
According to available research , lung cancer is more prevalent among people with HIV compared to people without it.
People with HIV are more likely to develop high blood pressure. HIV also raises the risk of pulmonary arterial hypertension . PAH is a type of high blood pressure in the arteries that supply blood to the lungs. Over time, PAH will strain the heart and can lead to heart failure.
If a person has HIV with a low CD4 count, theyre also more susceptible to tuberculosis .
TB is an airborne bacterium that affects the lungs. Its a leading cause of death in people who have AIDS. Symptoms include chest pain and a bad cough that may contain blood or phlegm. The cough can linger for months.
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What Laboratory Studies Should You Order And What Should You Expect To Find
Results consistent with the diagnosis
Liver enzymes
An initial step in detecting liver damage is to determine the presence of liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, they spill into the blood stream. Among the most sensitive and widely used of these liver enzymes are the aminotransferases. They include aspartate aminotransferase and alanine aminotransferase . The ACTG grading of liver enzyme elevations is listed in Table I.
The prevailing pattern of lab abnormalities allows to further differentiate different causes of liver disease. Acute cytolytic damage is characterized by high ALT or ALT/Alkaline phosphatase greater than 5, whereas acute cholestatic damage shows high AP or ALT/AP less than 2. A mixed pattern shows high ALT and AP or ALT/AP between 2 and 5.
Bilirubin
Bilirubin is measured to diagnose and/or monitor liver diseases such as cirrhosis, hepatitis, or cholestasis due to gallstones. Bilirubin which is bound to glucuronide to form conjugated bilirubin is called direct bilirubin. Unbound bilirubin is also referred to as indirect bilirubin. Jaundice may be noticeable in the sclera of the eyes at levels of about 2 to 3 mg/dL and in the skin at higher levels. Increased total or unconjugated bilirubin may be a result of hemolytic anemias.
Alkaline phosphatase
International normalized ratio
Albumin
Results that confirm the diagnosis
Viral hepatitis testing
Hepatitis A
Fatty Liver Disease In People With Hiv
Fatty liver disease has not been as extensively studied as other causes of liver disease in people living with HIV. Some research shows that people with HIV are more likely to develop fatty liver disease than HIV-negative people. For example, one recent large study found that a third of people with HIV had NAFLD. The main risk factors were being overweight and having conditions related to metabolic syndrome. Fatty liver disease is even more common in HIV-positive people who have hepatitis C co-infection.
Some older HIV medications, including zidovudine and stavudine , could cause serious steatosis and liver enlargement as a side-effect related to mitochondrial toxicity. This is generally not a concern with modern anti-HIV drugs. However, some studies suggest that efavirenz may be more associated with fatty liver disease than other drugs.
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Whats The Outlook For People Who Have Hiv And Hepatitis
HIV-hepatitis coinfections are treatable, but there are differences in the overall outlook depending on the severity and type.
For example, HCV may be cured within months, while HBV often requires lifelong treatment. If youre living with HIV, youll also need lifelong treatment for HIV, too. Complications may include cirrhosis or liver cancer.
Theres no medication available for HAV infections. If youre living with HIV and receive an HAV diagnosis, your doctor will monitor your condition carefully for complications, such as liver failure.
With treatment, HIV can become undetectable. When the virus is undetectable, it cant be transmitted to other people.
If youre living with HIV without a current hepatitis infection, your doctor may recommend regular testing to help detect hepatitis early on, depending on your risk factors. The earlier hepatitis is diagnosed and treated, the better the outcome.
Improving Access For Key Populations
For people from key populations, stigma and structural barriers continue to hinder access to diagnosis, treatment and care for hepatitis C.44 .
To ensure equitable access and engage key populations, clinical services for hepatitis C will need to better adapt their models of care. They may need to provide outreach services, be flexible around appointment requirements, train staff, and consult civil society- and community-led organisations .45
Buyers clubs
Buyers clubs pool resources to buy DAA medicines via the internet. There are many buyers clubs around the world enabling people to access treatment who would otherwise be unable to receive it. They exist as a stopgap response to the failure of public health systems to ensure equitable access to hepatitis C treatment.
However, there are concerns that compromise other important aspects of treatment, including treatment monitoring and management of co-infection.46
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Hiv Effects On The Skeletal System
People who have the virus tend to lose bone faster than people who donât. Your bones may get brittle and can break more easily. Your hips, especially, may hurt and feel weak.
Things that might cause this include the virus itself, the inflammation it causes, the medicines you take to treat HIV or related illnesses , and an unhealthy lifestyle. It might also be from a vitamin D deficiency, which is common in people who have HIV.
To help keep your bones in good shape:
- Make sure you get plenty of calcium and vitamin D.
- Exercise in ways that put weight on your bones, like walking or lifting weights.
- Don’t smoke, and limit how much alcohol you drink.
- Ask your doctor to check your vitamin D level.
Talk to your doctor about supplements or other medications to help your bones.
Substance Use Highly Active Antiretroviral Therapy And Liver Enzymes: Evidence From A Cross
- 1Department of Pharmacology, Faculty of Basic Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria
- 2Department of Human Anatomy, Faculty of Basic Medical Sciences, Niger Delta University, Amassoma, Nigeria
- 3Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Kampala, Uganda
- 4Department of Public Health Science, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
- 5Human Anatomy Department, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
- 6Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
- 7Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- 8Novel Global Community Educational Foundation, Hebersham, NSW, Australia
- 9AFNP Med Austria, Wien, Austria
- 10Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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