HIV and sleep
Infection with HIV doesn’t increase the risk of insomnia, according to new research.
The study found that many HIV-positive people had problems with sleep, or were tired during the day. But rates were comparable to those seen in HIV-negative people.
Sleep is important to both physical and psychological wellbeing. Insomnia was identified as a complication of infection with HIV in the early days of the epidemic.
Some anti-HIV drugs, especially efavirenz (Sustiva, also in Atripla), have been associated with sleep problems, including insomnia. However, the overall prevalence of insomnia in people with HIV in the modern treatment era is poorly understood.
Therefore researchers in the US asked 193 HIV-positive people and 50 HIV-negative people (a control group) about their experiences of insomnia and sleepiness during the day.
The results showed that 46% of HIV-positive people reported insomnia – this was similar to the 38% prevalence seen in HIV-negative people.
Similar proportions of HIV-positive and HIV-negative people also reported sleepiness during the day.
Risk factors for insomnia in HIV-positive people included depression and increased waist size (a marker for being overweight).
However, no individual anti-HIV drug – including efavirenz – was associated with insomnia.
The researchers believe that the prompt diagnosis and treatment of insomnia could have benefits for mental health and quality of life.
Cardiovascular disease and vitamin D
Researchers found that low levels of the vitamin doubled the risk of narrowing of the coronary artery.
Low levels of vitamin D have been associated with an increase in the risk of several serious health conditions. Many people with HIV, especially those with dark skin, have low levels of this vitamin. Cardiovascular disease is an important cause of illness and even death in people with HIV, but the exact causes are uncertain.
US researchers wanted to get a clearer understanding of the relationship between low levels of vitamin D and narrowing of the coronary artery – a form of “silent” cardiovascular disease.
They therefore designed a study involving 674 HIV-positive African Americans.
Most of the people in the study were assessed as having a low ten-year risk of cardiovascular disease.
But 20% of the group had vitamin D deficiency and 10% had narrowing of the coronary artery.
The single most important risk factor for narrowing of this artery was vitamin D deficiency. Other factors included high cholesterol, elevated blood pressure, HIV treatment lasting longer than six months and cocaine use.
Vitamin D levels can be measured as part of routine HIV care, and supplements are available if needed.
HIV and extra-pulmonary TB
Worldwide, TB is the single most important cause of serious illness and death in people with HIV.
The infection usually affects the lungs – pulmonary TB – but it can also develop in other parts of the body. Extra-pulmonary TB can be harder to treat and is sometimes associated with poorer outcomes.
US investigators looked at rates and risk factors for extra-pulmonary TB since the introduction of effective HIV treatment in the mid 1990s.
They identified 320 cases, 48% of which were in people with HIV.
HIV-positive people with a CD4 cell count below 100 had an increased risk of more severe forms of extra-pulmonary TB.
The researchers suggest that early consideration of extra-pulmonary TB in severely immune-suppressed people and the prompt initiation of anti-TB therapy could reduce the risk of mortality.
Genital warts and cancer risk
Genital warts are a very common sexually transmitted infection. They are caused by some strains of human papillomavirus (HPV). In most cases they do not cause any serious long-term health problems.
However, other strains of HPV can cause cell changes that can lead anal cancer, cervical cancer, and other genital cancers, as well as cancers of the head and neck, and it is common for people to be infected with several strains of HPV at the same time.
Danish researchers looked at the medical records of approximately 50,000 people diagnosed with genital warts between 1978 and 2008. They compared rates of cancer in this group to those seen in the general population.
Their results showed that both men and women diagnosed with genital warts had an increased risk of anal and genital cancers.
Infection with genital warts also increased the long-term risk of cancers of the head and neck.
The risk of several other malignancies, including skin cancer, bladder cancer and lymphoma, was also increased.
The researchers believe that more research is needed into the association between genital warts and the risk of cancer. However, they think that their study could help guide sexual health screening and HPV vaccination strategies.