Ask the Doc: Hepatitis C and Heart Health
In this edition of Ask the Doc, Dr. Peter Meacher, MD FAAFP AAHIVS, takes a look at some of the risks of contracting Hepatitis C, which is higher among people living with HIV. Some recent research suggests that HIV-negative men who have sex with men (MSM) may also be at increased risk.
He also looks at the increased risk of heart attacks among people who are HIV-positive and on ARTs. Both being HIV-positive and the ART drugs themselves appear to increase heart disease even after factors such as age, gender, race, and smoking are taken into consideration.
Do I Need To Get Tested for Hep C?
Q: I'm HIV-negative on PrEP -- do I need to get checked for Hepatitis C?
A: While anyone may be at risk for contracting Hepatitis C (HCV), some people are at an increased risk, including people living with HIV. Therefore, regular screening is recommended. Researchers don't know whether sexual transmission of HCV is the result of something specific to HIV or whether certain factors that are more common among the HIV population facilitate such transmission.
However, research at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) suggests that HIV-negative men having condomless anal sex are also at significant risk.
Researchers looked at the HCV test results of 375 HIV-negative men who have sex with men (MSM) who enrolled in the Amsterdam PrEP demonstration project presented. In addition to the number of condomless anal sex acts, chemsex (or use of any combination of drugs that includes crystal methamphetamine, mephedrone and/or GHB/GBL by MSM before or during sex) was associated with testing positive for Hepatitis C.
Much like STDs, PrEP does not protect against infection with Hepatitis C, so it is important to get tested. If you test positive, curative treatment is now available. We'll discuss Hepatitis C in more detail in a future column.
ART and Your Heart
Q: I have heard that both people with HIV and those who are taking ART are at higher than average risk for heart attacks. Why is that, and is there anything I can do to lower my risk?
A: It is true that people who are HIV-positive have a higher rate of heart disease than people who are HIV-negative. Some factors may not be able to be changed, including a strong family history, for example. However, much of this increased risk is due to what we refer to as 'modifiable risk factors'; in other words, factors that you can control. The three main ones are (no big surprise here) cigarette smoking, high blood pressure, and high cholesterol.
After adjusting for factors such as age, gender and race, eliminating any one of these would prevent about 40 percent of these heart attacks and eliminating all three would prevent more than 80 percent. For myriad reasons, smoking is far more common among people living with HIV than in the general population, with up to 40 percent of people living with HIV in the U.S. smoking, and many of them heavily.
We know that smokers are much more likely to have a heart attack than those who never smoke. However, a study released this year at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) showed that by quitting smoking, the risk of cancer and heart attacks declined sharply among people living with HIV, so this is perhaps one of the biggest ways you could lower your risk.
In addition, a review of your HIV medicines might be worthwhile as some are thought to contribute risk more than others. Always discuss concerns like this with your healthcare provider.
Peter Meacher MD is a Board Certified Family Physician and credentialed as an American Academy of HIV Specialist (AAHIVS). He has been the Chief Medical Officer of Callen-Lorde Community Health Center since 2013.
He completed residency at Montefiore's Department of Family Medicine where he was then Chief Resident and Faculty Development Fellow. He worked for 14 years as an HIV and Primary Care Provider, becoming the Medical Director of a federal qualified health center in the South Bronx developing programs in HIV & transgender care before joining Callen-Lorde.
He was on the NY/NJ Board of AAHIVM, works with NYSDOH AIDS Institute Clinical Guidelines Program, serves on the AIDS Institute Mental Health Guidelines Committee and chairs the HIV/HCV/STD QI sub-committee of CHCANYS.
This story is part of our special report titled "Ask the Doc." Want to read more? Here's the full list.
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