The following slides and audio are taken from a public HIV health and treatments update forum held in Sydney,

Australia on 25 November 2008. The slides and audio have been edited for presentation on the web.

The speaker is Associate Professor Marilyn McMurchie, Department of General Practice, University of Sydney.

For more presentations from this event, visit the sponsor organisations’ websites:

HIV Treatment and Health UpdateHIV Treatment and Health Update25 November 2008

Part 2

Lifestyle and health monitoring

for the future

Reasons for not using AIDS

The World Health Organisation no longer uses AIDS as a classification

HIV infected people can get sick and die from other illnesses e.g. anal cancer

CD4 %age and number with CD4 nadir, VL and Rx history are used to communicate with ADIs (or ADEs) especially if advanced AIDS has occurred

Reasons for using AIDS

Largely bureaucratic e.g. Centrelink benefits are more easily accessed if there has been an AIDS Defining Illness diagnosis made

For me, there is the issue of honouring those who have gone before, particularly those who died from AIDS and their carers

Life expectancy issues

Prognoses or predictions are based on historical data

Science has moved faster in HIV than in any other illness

Concept of equivalence e.g. QALYs used in estimating how much resource society should allocate to a particular condition

Monitoring for the future

Fasting glucose and lipids (+/- insulin) Kidneys with dipstick & early morning urine Bone density (BMD) with DEXA scans Vitamin D blood level Sex hormone levels Rectal examination (prostate & anal cancer) PSA for men with LUTS (lower urinary tract

symptoms)

Rx failure

Treatment failure as a concept is useful only in that it focuses the mind towards the next regimen

Clinical trials often have their place here Doctors and their patients have to live with

the consequences of earlier treatment decisions

There are more treatment options now

Lifestyle

Stop smoking x n Get fit = walk 10,000 steps a day for fitness but 13-

15,000 a day to lose weight Waist measurement of >94 cm for men and >80 cm

for women is an independent CV risk factor Limit sugar intake: impaired glucose tolerance or

insulin resistance is measured by a glucose tolerance test

Limit fat intake

Cardiovascular health

New Zealand guidelines quantify the risk of a fatal or non-fatal heart attack in the next five years using the standard risk factors known for years = hypertension, diabetes, smoking, physical inactivity, obesity (BMI >30) and elevated lipids (cholesterol +/- triglycerides)

Waist circumference is an independent risk factor for cardiovascular disease

Australian dietary guidelines

Breakfast of complex carbohydrate (cereal) 2 serves of fruit & 5 of vegetables a day Drink more water and less caffeine Alcohol maximum is 4 standard drinks (men)

2 (women) on 4 days a week Dietician advice available

Take home Messages

Focus on health rather than on HIV, i.e. HIV infection is one facet of a person’s life

Science is a process not an end point

Tomorrow starts today, i.e. a prognosis is determined by decisions made now

For more presentations from this event, visit

www.napwa.org.au

or

www.acon.org.au