Non-AIDS defining illnesses

There are some opportunistic infections that people with HIV can get even if your CD4 count is still high enough for you not to be considered as having AIDS. These are known as non-AIDS defining opportunistic infections and are more likely to occur the lower your CD4 count becomes. We talk about what opportunistic infections are in the section on how HIV works.

Some non-AIDS defining opportunistic infections can go on to develop into AIDS defining illnesses if not treated or if your CD4 count continues to fall. We talk about these in the next section on AIDS defining illnesses.

Certain mouth problems are more common in people with HIV with low CD4 counts. Thrush, for example, causes painful white patches in the mouth but is easily treated with anti-fungal drugs

Another condition known as oral hairy leukoplakia, or OHL, also causes white patches in the mouth usually seen as ridges along the side of the tongue. This can also be quite painful but can be treated with Aciclovir.

If you have herpes, a flare-up is more likely to occur when your CD4 count is low. As with OHL, the blisters can be treated with Aciclovir.

Mouth ulcers can also be more common. A good mouthwash can help to manage these. Your dentist should be able to advise you about any oral problems you may be experiencing, especially if he or she knows you have HIV.

Certain eye problems can also occur if you have a low CD4 count. Pain, seeing spots, blurred vision and blind spots can be a sign of certain infections and should be checked out by your doctor straight away.

It’s important to remember that all of these conditions normally clear up once your CD4 count rises again after starting anti-HIV treatment, or changing to a combination that works better for you.

Cardiovascular disease
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Having HIV can put you at a higher risk of developing cardiovascular problems (problems with your heart and circulation). A major factor is the side effects associated with long term use of certain anti-HIV drugs. These can increase the amount of blood fat (called lipids) and cholesterol, both of which may lead to heart and circulatory diseases. Your doctor at your HIV clinic will be monitoring levels of blood fat and cholesterol and so if problems do start to occur they should be spotted early on so that steps can be taken to address the problem.

As with everyone though, you can really help to avoid cardiovascular problems by looking after your general health. You will greatly lower the risk of problems like these if you are not overweight, stop smoking, exercise and eat the right foods.

You can read more about taking care of your health in the section on looking after yourself.

Cancers
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It has been shown that there is an increased risk of anal [1], lung [2], liver [3], testicular [4] and skin cancers in men living with HIV, as well as increases in lymphomas.

The Human Papilloma Virus (HPV), which responsible for anal warts, is the virus that can lead to anal cancer. However, there are many different strains of HPV so just because you may have had anal warts, this doesn’t mean that you will develop anal cancer.

Smoking is the obvious cause of many of the cases of lung cancer, and it has been shown that smoking is considerably more risky if you have HIV than if you were HIV negative [5].

Increases in cases of liver cancer may be due to increased numbers of people with HIV also being infected with hepatitis B or C. You can be tested for these two different viruses and it is possible to completely cure some people of Hepatitis B or C with current treatments. It’s always a good idea to be checked for Hepatitis so that something can be done about it. There’s also a vaccine against Hepatitis B so, if you don’t have Hep B and you haven’t been vaccinated, you should ask for the vaccine at your HIV or GUM clinic.

The reasons behind a possible rise in cases of testicular cancer are unknown. This type of cancer is easily treated if caught early so check yourself regularly, and if you notice any unusual lumps go to see your GP as soon as possible. The same applies if you notice any dark lumps, patches or lesions appearing on your skin as this could be a sign of skin cancer.

References
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1 S. Jack Wei , MD. Anal Cancer: The Basics. The Abramson Cancer Center of the University of Pennsylvania, 2004.
2 Ricaurte JC et al. Lung cancer in HIV-infected patients: a one-year experience. International Journal of STDs and AIDS 12(2): 100-102, 2001.
3 Clifford GM et al. Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma. AIDS 22:2135 – 2141, 2008.
4 Goedert JJ et al. Spectrum of AIDS-associated malignant disorders. Lancet 351(9119): 1833-1839, 1998.
5 Tirreli, U., Spina, M., Sandri, S., Serraino, D., Gobitti, C., Fasan, M., Sinicco, A., Garavelli, P., Ridolfo, A.L., & Vaccher, E. (2000). Lung carcinoma in 36 patients with human immunodeficiency virus infection. The Italian Cooperative Group on AIDS and Tumors. Cancer, 88, 563-569.