Living with HIV: how to make it easier.

HIV: yet another health issue we now know has unique effects on women. But thanks to intense research over the last 10 years, our understanding of this dreadful disease has grown significantly. However, if you're living with HIV, you may feel there's so much more you need to learn.

For example, you need to know how to manage your disease beyond medication. As with any chronic health condition, lifestyle choices can make a huge difference in your health. They can work with medication to strengthen your immune system and reduce side effects.

Specifically:

1. Quit smoking. Maybe you think that since you're sick anyway, it doesn't matter if you smoke. Well, it does. A study on men (there's one on the way about women) found that HIV-positive people who smoked were more likely to develop respiratory symptoms, chronic obstructive pulmonary disease and bacterial pneumonia than HIV-positive men who didn't. (17) Doesn't your body have enough to deal with without adding tobacco to the mix?

2. Talk to someone. There's a misconception out there that just because we now have fairly effective therapies for HIV/AIDS, those living with the disease have an easier time of it emotionally. One of the few studies to look at the psychological state of HIV-infected women taking retroviral therapies, however, found most were still very distressed and having significant difficulties adjusting. I urge you to find a therapist, support group, a friend, a spiritual leader--anyone--who will listen to your concerns with empathy. Many clinics offer such counseling for HIV-infected people on a sliding-scale or free basis. (18)

3. Seek help for depression. In a woman with HIV, one study suggests that the worse the depression, the higher the amount of virus in your blood and the less likely you are to take your medications. (19) If you're feeling depressed, talk to your health care professional. A combination of counseling and/or antidepressant medications may help.

4. Try to see an HIV or infectious disease specialist. Studies show that women are more likely to receive recommended antiretroviral therapy from these specialists than from other doctors. (20)

5. Get regular Pap tests. If you have HIV, you're more likely to develop cervical lesions that could lead to cervical cancer. In fact, the development of cervical cancer is now considered a sign of AIDS for women with HIV. The U.S. Centers for Disease Control recommends a Pap smear upon diagnosis and six months later. If neither show any problems, you should have one every year thereafter if you don't have symptoms, every six months if you have HIV symptoms, prior abnormal Pap smears or signs of HIV infection.

6. Follow a low-fat, high-fiber diet. You have a higher risk of developing high cholesterol, most likely because of the antiretroviral therapy. Saturated fat--found in whole-fat dairy and other animal products--is one of the major culprits when it comes to high cholesterol levels.

Meanwhile, fiber is important, because people taking certain antiretroviral medications tend to develop lipodystrophy, a condition in which fat accumulates in the back of the neck and around the abdomen. These medications may also increase your risk of diabetes. There's some evidence, however, that a high-fiber diet can reduce some of this fat accumulation and the risk of diabetes. Try a Mediterranean diet, which includes lots of whole grains, vegetables, fruits and healthy oils, like olive and fish oil, and small amounts of animal protein. (21)

7. Hit the weight room a couple of times a week. Building muscle is important in this disease, in which "muscle wasting" may occur. It can also help prevent insulin resistance, reduce triglycerides and shrink abdominal fat if you have lipodystrophy. And don't forget regular aerobic exercise, like walking, running on a treadmill, riding a bike or swimming. Talk to your health care professional before beginning any exercise program.

By Pamela Peeke, MD, MPH

NWHRC Medical Advisor

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Dr. Peeke is a Pew Foundation Scholar in Nutrition and Metabolism, and Assistant Clinical Professor of Medicine at the University of Maryland in Baltimore. She writes about health and lifestyle issues important to all women.

References

17 Crothers K, Griffith TA, McGinnis KA, et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIVpositive veterans. J Gen intern Med. 2005 Dec;20(12):1142-5.

18 Siegel K, Karus D, Dean L. Psychosocial Characteristics of New York City HIV-Infected Women: Before and After the Advent of HAART. American Journal of Public Health. 2004; 94(7): 1127.

19 Cook JA, Grey D, Burke J, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004 Jul;94(7):1133-40.

20 Gardner LI, Holmberg SD, Moore J, Use of highly active antiretroviral therapy in HIV-infected women: impact of HIV specialist core. J Acquir Immune Defic Syndr. 2002 Jan 1;29(1):69-75.

21 Shah M, Tierney K, Adams-Huet B, et al. The role of diet, exercise and smoking in dyslipidaemia in HIV-infected patients with lipodystrophy. HIV Med. 2005 Jul;6(4):291-8.