PI Perspective #48

March 2009     View PDF     En español

A person's modifiable risk factors nearly double their risk of non-AIDS death

Data from the D:A:D study showed that factors which people can change and influence nearly double the risk of non-AIDS death. These medical and lifestyle issues include smoking, high blood pressure and diabetes.

The D:A:D (Data collection on Adverse events of anti-HIV Drugs) is a large observational study examining the safety of HIV drugs and health outcomes of those on therapy. Just over 33,000 people were enrolled. Average age was 39, most were men (74%), 45% were white, more than half were either current smokers or had smoked, 34% had HBV or HCV disease, and 3% had diabetes. At the start of the study, about 3 out of 4 were taking therapy. Average CD4 count was 408 and average viral load was 1,000. The length of time on HIV therapy averaged just over 3 years.

People were evaluated from the time they entered the study until their last follow-up visit (or death) through October 2007. Body mass index (low weight), blood pressure, diabetes, smoking, use of therapy, and current CD4 counts and viral loads were studied.

A total of 2,192 deaths occurred during the period studied. Underlying causes of death included AIDS (32%), liver disease (14%), non-AIDS cancers (12%), heart disease (11%), bacterial infections (9%), non-natural deaths (9%), and other causes (13%.) The results showed the following:

• Lower CD4 counts were associated with a higher risk of death from all specific causes of death.
• Higher current HIV RNA was a risk factor for AIDS-related and liver-related deaths overall and doubled the risk due to AIDS.
• HIV levels above 400 when on therapy raised the risk of death from all causes while HIV levels above 10,000 when off therapy greatly raised the risk for all causes of death.
• Diabetes was associated with all specific causes of death except non-AIDS cancers.
• Smoking was a risk factor for heart disease and non-AIDS cancers.
• HBV and HCV co-infection were related to liver-related deaths, and HCV raised the risk of liver-related death nearly 4-fold.
• Low body weight correlated to a 3-4 times higher rate of death and non-AIDS cancers.
• Hypertension was a 2-3 times higher risk factor for liver-related and heart disease deaths.

Many of these, if not all, are not radically unknown risks for death in the general population let alone people living with HIV. However, the degree to which these factors increase the risk of death in HIV-positive people is striking. Given that people, with or without HIV, can make constructive changes to impact some of the issues that increase risk of death, it's important for people to take a proactive role in addressing what they can to prolong and improve their quality of life.

Changes that people may do to reduce risks include:

• Get tested for HBV and HCV. If you test positive for HBV or HCV, discuss your options with your health provider and follow through with a treatment plan.
• Get the HBV vaccine if you test negative and haven't already had the disease.
• Ensure your current HIV therapy is working as well as it can at keeping your CD4s as high as possible and your viral load undetectable for as long as possible.
• Get routine lab work done and go to scheduled appointments.
• Improve and maintain proper adherence to HIV drugs and meds for other infections.
• Explore smoking cessation programs and stop smoking.
• Eat a balanced diet low in saturated fats and sugars.
• Watch weight and nutrition with the same careful eye as CD4 counts and viral load. Any unplanned weight loss is undesirable (regardless of whether or not it's welcomed).
• If you're diabetic, keep diabetes under control with the proper medications and check-ups.
• Find ways to lower your stress level and to exercise at the level you can.
• If you have high cholesterol, consider lipid-lowering drugs or HIV therapy that has fewer documented effects on lipid levels.
• Consider ways to build more lean body mass.