HIV-infected people are at high risk of cardiovascular disease, and must stop smoking
[의약뉴스]
Now is the time to pay attention to the chronic diseases of HIV-infected people.
It has been 40 years since the first human immunodeficiency virus (HIV) was discovered.
In the past, HIV was considered a deadly virus that, once infected, eventually led to the development of Acquired Immune Deficiency Syndrome (AIDS) and death.
However, after the introduction of Highly Active AntiRetroviral Therapy (HAART), which can inhibit HIV proliferation in the mid-1990s, even if infected with HIV, it does not lead to AIDS and it is possible to enjoy life expectancy while maintaining immune function. was opened
In particular, in the 2000s, Single Table Regimen (STR), which enables high-intensity antiretroviral therapy with one tablet a day, appeared, maximizing the treatment effect by increasing medication compliance.
As a result, HIV-infected people are also aging. Many of the new patients are still in their 20s and 40s, but as long-term survival becomes possible, the proportion of patients in their 50s or older is increasing.
This means that HIV-infected people are now at a higher risk of comorbidities such as cancer and cardiovascular disease than AIDS.
In particular, if co-morbidity such as hypertension or diabetes occurs in HIV-infected persons, it can be more fatal, so more active management is needed.
Among them, Severance Hospital Infectious Disease Professor Choi Jun-yong is promoting an anti-smoking campaign for HIV-infected people with Gilead, a global leader in the field of HIV treatment.
Although smoking itself can be fatal to HIV-infected persons and can increase the risk of comorbidities, the smoking rate among HIV-infected persons is higher than that of non-infected persons.
The purpose of this anti-smoking campaign is to publicize the dangers of smoking to HIV-infected people and encourage them to quit smoking.
In this regard, Medicine News met with Professor Junyong Choi to hear his opinions on the change in the HIV treatment paradigm, the dangers of smoking, and the anti-smoking program.
◇HIV-infected people die from chronic diseases more often than from AIDS
About 1,000 new HIV-positive patients occur each year in Korea, and among them, 80% are in their 20s and 40s, but about 50% are also in their 50s or older.
In addition, as treatments that can effectively suppress the virus have emerged, the life expectancy of HIV-infected people has also increased, and the proportion of the elderly is rapidly increasing.
Professor Choi pointed out that the importance of aging and consequent chronic disease management has already been highlighted in overseas countries where there are many HIV-infected people, and that Korea should also prepare for the aging of HIV-infected people.
He said, “In 2021, when Corona 19 was prevalent, the number of newly infected people with HIV slowed down for a while and showed a tendency to decrease, but in 2022, it recovered to the 800 level.” It is not known exactly whether the number of infected but undiagnosed people is increasing, but the current average number of new infections is around 1,000,” he said.
“In the past, in the 1980s and 1990s, AIDS was considered a fatal disease, but today, HIV can be treated at the same level as a chronic disease.” However, if diagnosed early and treated well, AIDS-related deaths do not occur as in the past.”
“According to overseas studies, it was predicted that by 2030, 70% of people living with HIV will be in their 50s or older,” he explained.
However, he emphasized, “There are still factors that threaten the health of HIV-infected people,” and “comorbidities such as cancer and cardiovascular disease.”
For example, “Studies have shown that people living with HIV have a much higher risk of cancer and cardiovascular disease than the general population,” he added. did.
In particular, Professor Choi explained that HIV-infected people have a higher risk of chronic diseases due to the nature of the disease itself and the side effects caused by the treatment.
“The reason why HIV-infected people have a higher incidence of cancer or cardiovascular disease compared to the general population can be divided into the characteristics of the HIV disease itself and the effects of taking medications,” he said.
“Due to the nature of the disease, HIV-infected people are prone to various chronic inflammations in the body even if they take treatment well, and these chronic inflammations in the body can cause arteriosclerosis and lead to cancer,” he said. The altered gut microbiome has an impact on the development of cancer and cardiovascular disease.”
In addition, “HIV-infected people experience direct and indirect toxicity and side effects while taking treatment.” It can raise cholesterol levels and cause cardiovascular disease.”
Furthermore, he emphasized, “As such, HIV-infected people have a higher risk of developing comorbidities such as cancer and cardiovascular disease than the general population, and if they smoke, the risk of occurrence is much higher, so special attention is needed.”
◇Smoking reduces the life expectancy of HIV-infected people
Smoking is regarded as the source of all diseases for everyone, but it is especially fatal for people living with HIV.
Indeed, in the United States, it has been reported that male HIV-infected men over 40 who are receiving antiretroviral treatment are 10 times more likely to die of lung cancer than AIDS if they smoke.
In addition, smoking has been the leading cause of death for HIV-infected people in the United States and Europe over the past decade, with 75% of HIV-infected smokers reporting suffering from myocardial infarction.
Regarding this, Professor Junyong Choi explained, “The reason why smoking is particularly dangerous for HIV-infected people is that it amplifies the risk of comorbidities such as cancer and cardiovascular disease.”
Specifically, “According to the Framingham Risk Score, which evaluates and predicts an individual’s risk of cardiovascular disease within 10 years, the risk of cardiovascular disease increases as diabetes, obesity, high blood pressure, and smoking act in a complex way. Among them, smoking has the greatest impact,” he said. “Since other risk factors, such as diabetes, obesity, and high blood pressure, also appear at a high frequency in HIV-infected people, smoking here inevitably increases the risk of cardiovascular disease.”
Even if he received antiretroviral treatment, he said, “There was a US study that showed that HIV-infected men aged 40 years or older who smoke are 10 times more likely to die of lung cancer than AIDS.” While the rate of suffering from HIV is 25%, it has been investigated that 75% of HIV-infected smokers suffer from myocardial infarction.”
In addition, he emphasized, “There is also a study that shows that even infected people who continue to receive antiretroviral treatment lose more than 8 years of life expectancy if they smoke, so quitting smoking is very important to expect a positive treatment prognosis.
According to Professor Choi, he is meeting quite a few patients who are in a fatal situation due to smoking in actual clinical settings.
He said, “There is a patient who was diagnosed with HIV in his 20s. At the time of diagnosis, he was young and did not know the dangers of smoking, and continued to smoke even after diagnosis. He was diagnosed with a stroke in his mid-30s.” Even though I needed it, I even smoked, which made my condition worse.”
He continued, “If this patient had been able to control his cholesterol and blood pressure and quit smoking, he would not have had a stroke in his 30s.”
As such, smoking has a more fatal effect on HIV-infected persons than non-infected persons, but rather, it is known that the smoking rate of HIV-infected persons is higher.
According to the results of a survey conducted by the HIV-infected community ‘Love for One’, 41.7% of 199 respondents answered that they usually smoke, and 7% said they had a history of smoking. This is more than twice as high as the national standardized smoking rate of 19.3% reported in national statistics in 2021.
It is an analysis that the main cause of smoking is that HIV-infected people have negative thoughts about the disease themselves.
In fact, people living with HIV do not make smoking cessation a priority, thinking that they will eventually die of HIV (AIDS), the survey found.
Professor Junyong Choi said, “According to domestic and international research results, it is known that the smoking rate of HIV-infected persons is two to three times higher than that of the general population.”
“I think the reason why the smoking rate of HIV-infected people is particularly high is the stress and depression caused by frustration with the fact of infection, negative perception of HIV, and discrimination,” he said. As my daily life, including my work life, becomes unstable, I experience a lot of stress.”
Furthermore, he said, “Actual statistical surveys also showed that HIV-infected people had a higher frequency of depression and anxiety and a higher suicide rate compared to the general population.”
◇Life expectancy increases after smoking cessation for HIV-infected persons…Need a program tailored to the characteristics of HIV-infected persons
As smoking has been reported to have a fatal effect on HIV-infected persons, the effect of quitting smoking is also evident.
In fact, according to a study reported in the United States, a 40-year-old HIV-infected person who quit smoking while starting HIV treatment increased life expectancy by 4.6 to 5.7 years even if ART was not taken appropriately.
Smoking cessation has also been reported to lower the risk of at least 12 types of cancer, including lung cancer, and erectile dysfunction.
The change after quitting smoking is also clear, immediately after quitting smoking, the smell from the body disappears and the sense of taste and smell is restored.
From 12 hours after quitting smoking, the amount of oxygen in the blood increases and the amount of carbon monoxide in the body decreases, and in the first year of quitting smoking, the risk of heart disease is reduced to half that of a smoker.
Furthermore, HIV-infected people reported that after quitting smoking, the burden of HIV-related symptoms, depression and anxiety decreased, and life satisfaction increased.
Regarding this, Professor Choi said, “Overseas HIV treatment guidelines recommend smoking cessation as a basis.” “In addition, detailed guidelines for treatment and management of accompanying diseases such as osteoporosis, liver disease, cardiovascular disease, and hypertension accompanying HIV-infected persons are also provided. It is prepared,” he said.
In Korea, various anti-smoking policies and programs are provided to all citizens.
If you register at the ‘Health Center Smoking Cessation Clinic’, you will receive 9 face-to-face and non-face-to-face counseling services for 6 months from the date you decide to quit smoking.
In addition, nicotine supplements are provided to current smokers within 12 weeks per person per year, depending on the amount of cigarettes smoked per day and the level of nicotine dependence.
In order to provide systematic smoking cessation services to students, office workers, and the elderly who have difficulty visiting public health centers, the ‘Visiting Smoking Clinic’ is being implemented.
In addition, various programs such as telephone counseling and 1:1 chat counseling with professional counselors are supported.
However, Professor Choi hopes that it is necessary to prepare a specialized smoking cessation program in consideration of HIV-infected people who have a severe stigma for the disease.
He said, “Since the stigma of HIV is severe, there are not many people who can openly talk about their situation as an infected person. Therefore, a smoking cessation program that can understand the stigma of HIV is needed, and A smoking cessation program suitable for the smoking cessation should be created, and education, publicity, counseling, and medication prescription on smoking cessation should be organically conducted.”
As an example, “There is a ‘medical institution infected person counseling project’ operated by the Korea Centers for Disease Control and Prevention among the systems targeting HIV-infected people in Korea.” We are providing counseling on obesity and depression, and if necessary, we also provide programs in conjunction with other institutions. It would be effective if these counseling nurses lead the smoking cessation program.”
In addition, “In actual medical treatment, it is extremely rare for an infected person to actually quit smoking, even though smoking is a physical condition that really needs smoking.” Smoking cessation aids and treatments should be prescribed,” he said.
Furthermore, Professor Choi points out that now is the time to shift the focus of HIV/AIDS-related policies to chronic disease management.
He said, “The prevalence of HIV infection in the US, Europe, and Australia is far ahead of Korea.”
On the other hand, “Korea’s HIV/AIDS control measures have focused only on suppressing the virus, and there has been a lack of preparation for other accompanying diseases,” he said. “The measures against the disease have not yet been properly prepared,” he pointed out.
In response, he emphasized, “Now that the population of infected people is aging, synergy can be created when policy preparations on how to manage and prevent accompanying diseases are accompanied by education and publicity.”
Lastly, Professor Choi urged HIV-infected people, especially young patients, to be aware of the risk of accompanying diseases and to stop smoking and take care of their health.
He said, “Recently, the proportion of HIV infection in adolescence or early 20s is significantly increasing, and the smoking rate is also high. “I hope people infected with HIV realize that they are at high risk for cancer or cardiovascular disease, realize the importance of smoking cessation and health care, and practice it,” he said.
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2023-05-01 17:21:28
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