WHAT TO DO ABOUT HIV DOUBLING HEART DISEASE RISK?

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Since having HIV increases the risk of heart attack or stroke by factor of 1.5-2 maybe we should test them earlier than HIV negative people. The risks are from having chronic inflammation even if the virus is undetectable, risk factors (the strongest are smoking and diabetes), and a smaller risk from the medications (some of them increase the bad cholesterol or lower the good cholesterol). Some recommend a treadmill test which gets your heart beating fast enough for the cardiologist to see changes in the electrocardiogram or the blood pressure. Other recommend a Cat Scan looking at the calcium in the arteries supplying the heart.

CLEAN SEMEN
HIV level in semen dropped faster if the men were taking Elvitegravir (in Stribild®) or rilpiverine (in Complera® and Odefsy®) than if the men were taking Darunavir (Prezista®) with ritonavir.

DEATHS FROM ALZHEIMER’S UP
The death certificates listing Alzheimer’s disease are way up. This stems from several reasons: Alzheimer’s is diagnosed more frequently now so patients and providers are aware of the disease as a contributor of death, people are dying later of the regular causes (e.g. heart disease and cancer) so Alzheimer’s has as chance to show up, and maybe it is increasing in its attack rate. All we can do to possibly postpone it is to live a healthy lifestyle (organic diet, minimizing meats–especially red meat, and lots of exercise.

CHONDROITIN SULFATE HELPFUL?
Chondroitin is the powdered cartilage from animals. This European study used a trustworthy source of chondroitin, celecoxib (in the ibuprofen family), and placebo. Please recall that most supplements which are not medicines rarely contain the amount or even the chemical that the label says they do. The celecoxib and the chondroitin were better at controlling arthritis than the placebo, but the chondroitin contained too much manganese which may reach poisonous levels.

PRECISION MEDICINE INSTITUTE STARTING
The funding came from the President Obama era and now all is ready to start. They looked at the gene information bank on 1.7 million people and found that there is a low number of non-Europeans in the data base; this group seems more suspicious of genetic testing so there are less samples from them.

OPIOD PRESCRIBING GOING DOWN
With all the deaths from opioids (Norco®, morphine, fentanyl), states have started more monitoring programs like California has had for many years. The rates for opioid prescribing are about double in these states with no program compared to states with the program. Some states require pain clinics to register with the state and these clinics must be owned by a physician; the thinking is that companies looking for a profit might encourage overprescribing by the providers they employ. We refer patients who seem to need more and more of these meds and those who need more than a certain amount per month to pain clinics.

TOO LONG ON OMEPRAZOLE?
This medication along with its sister drugs that end in -prazole are famous acid-reducers. Many seem to be on them for life and some are started in the hospital for a specific situation, hoping that the primary provider will wean them off. Over the long term they can increase the risk for kidney disease, Clostridium difficile diarrhea, and hip fractures—especially in the elderly. If you have been on one of these for more than 4 weeks, consider dropping down to a safer medication like famotidine or taking it as needed.

SHOULD YOU LOOK FOR CANCERS FOR OLDER PEOPLE?
Dr. Sei Lee found that doing certain tests do not help people if they are older. E.g. if a lady is 75 then doing a pap smear may not help her live longer. And the pap smear is uncomfortable and may lead to more screening which is more uncomfortable and finds nothing of importance anyway.
In the same way, Dr. Lee has made life-expectancy calculations for many tests and has arrived at an age for each of them for which screening is not helpful. Back in the late 1980s patients had the same thinking: they would tell me they did not want to screen for colon cancer since they were going to die of AIDS soon anyway and they were about to take a trip to Europe with the money they received from cashing in their life insurance.
Finding or controlling certain conditions which have different speeds in your body to cause enough harm to make the intervention worthwhile. Controlling blood pressure for 1.5 years has a great benefit. You have to control blood sugar intensively for 8 years to see a benefit. Taking a medication, such as atorvastatin, to lower your bad cholesterol needs 3 years. Screening for colon or breast cancer: 10 years.

Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Member, Coachella Valley Clinical Research Initiative.
REFERENCES: Medscape®

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