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<ul><ul><li>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. </li></ul></ul><ul><ul><li>The speaker is Associate Professor Marilyn McMurchie , Department of General Practice, University of Sydney. </li></ul></ul><ul><ul><li>For more presentations from this event, visit the sponsor organisations’ websites: </li></ul></ul>

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HIV Treatment and Health Update 25 November 2008 Part 2 Lifestyle and health monitoring for the future

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Reasons for not using AIDS <ul><li>The World Health Organisation no longer uses AIDS as a classification </li></ul><ul><li>HIV infected people can get sick and die from other illnesses e.g. anal cancer </li></ul><ul><li>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 </li></ul>

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Reasons for using AIDS <ul><li>Largely bureaucratic e.g. Centrelink benefits are more easily accessed if there has been an AIDS Defining Illness diagnosis made </li></ul><ul><li>For me, there is the issue of honouring those who have gone before, particularly those who died from AIDS and their carers </li></ul>

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Life expectancy issues <ul><li>Prognoses or predictions are based on historical data </li></ul><ul><li>Science has moved faster in HIV than in any other illness </li></ul><ul><li>Concept of equivalence e.g. QALYs used in estimating how much resource society should allocate to a particular condition </li></ul>

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

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Rx failure <ul><li>Treatment failure as a concept is useful only in that it focuses the mind towards the next regimen </li></ul><ul><li>Clinical trials often have their place here </li></ul><ul><li>Doctors and their patients have to live with the consequences of earlier treatment decisions </li></ul><ul><li>There are more treatment options now </li></ul>

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Lifestyle <ul><li>Stop smoking x n </li></ul><ul><li>Get fit = walk 10,000 steps a day for fitness but 13-15,000 a day to lose weight </li></ul><ul><li>Waist measurement of >94 cm for men and >80 cm for women is an independent CV risk factor </li></ul><ul><li>Limit sugar intake: impaired glucose tolerance or insulin resistance is measured by a glucose tolerance test </li></ul><ul><li>Limit fat intake </li></ul>

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Cardiovascular health <ul><li>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) </li></ul><ul><li>Waist circumference is an independent risk factor for cardiovascular disease </li></ul>

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Australian dietary guidelines <ul><li>Breakfast of complex carbohydrate (cereal) </li></ul><ul><li>2 serves of fruit & 5 of vegetables a day </li></ul><ul><li>Drink more water and less caffeine </li></ul><ul><li>Alcohol maximum is 4 standard drinks (men) 2 (women) on 4 days a week </li></ul><ul><li>Dietician advice available </li></ul>

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Take home Messages <ul><li>Focus on health rather than on HIV, i.e. HIV infection is one facet of a person’s life </li></ul><ul><li>Science is a process not an end point </li></ul><ul><li>Tomorrow starts today, i.e. a prognosis is determined by decisions made now </li></ul>

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<ul><ul><li>For more presentations from this event, visit </li></ul></ul><ul><ul><li>www. napwa .org.au </li></ul></ul><ul><ul><li>or </li></ul></ul><ul><ul><li>www. acon .org.au </li></ul></ul>