SIDE EFFECTS FROM HEAD to TOE

Mental Health
Poverty, drug abuse, sick family members, other chronic illnesses: All these are enough to put the strongest HIV-positive woman on the verge of, if not a nervous breakdown, then a serious case of the blues. And that's nothing to take lightly-or be ashamed of. Depression can put women at higher risk for getting infected and makes it more likely that they won't be able to stick to their medication schedule if they do become positive. Advice from the frontlines: Find peer support-whether it's another positive friend, a group, or an Internet chat room.

Anemia
Tired of trying to figure out why you're tired all the time? You might have anemia, a decrease of hemoglobin in the blood. HIV-positive women are twice as likely as their negative counterparts to suffer from this debilitating condition, which affects both quality of life and long-term survival. Look at your labs: hemoglobin of less than 12 g/dL spells anemia. Recent research shows a once-weekly injection of epoetin alpha may work wonders.

Lipodystrophy/Fat Resdistribution
There are no easy answers when it comes to lipo. It is an umbrella term for a fat distribution and metabolic disorder that causes some women to gain body fat in their bellies and breasts but lose it in their faces, arms, and legs. Lipodystophy is marked by sky-high levels of lipids and triglycerides (fats in the blood) that may increase the risk of heart disease, as well as changes in blood-sugar tolerance, which may lead to insulin resistance and diabetes. Because the syndrome is so complex, the only rule is to pinpoint the problem before you try to treat it. To figure out what's going on, try glucose tolerance and fasting lipid tests, and consider a waist-to-hip ratio and hormone workup. The good news is, women may be less likely than men to have abnormal lipid profiles. Discuss current strategies to counter lipodystrophy with your doctor.

Lactic Acidosis
The new need-to-know medical term: lactic acidosis, a buildup of acid in the blood that's linked to AZT, ddI, and the rest of the NRTI class of drugs. It's the same condition that afflicts marathon runners and other endurance athletes. But for people with HIV, it's not a good sign to feel this burn. Lactic acidosis is often linked to hepatic steatosis, or fatty liver, a serious, potentially fatal condition, and women may be at higher risk than men. One troubling FDA study found that 83 percent of lactic acidosis cases occurred in women, 50 percent of whom were overweight. It's also hard to diagnose: Liver expert Dr. Douglas Dieterich of New York University says, "Probably the only real pattern is that lactic acidosis does not get better and worse, just steadily worse." Symptoms can include extreme muscle aches, fatigue, nausea, abnormal breathing, and, in some cases, abnormal heart rhythms. There are no approved therapies to counter lactic acidosis. Anecdotal reports suggest that over-the-counter nutritional supplements such as Co-enzyme Q, riboflavin, and L-carnitine may be helpful.

Hormones & Menstrual Function
Talk about spotty flow: Data on how HIV relates to women's periods, hormones, and pregnancy still trickles in slowly. Last year brought the news that the ovulatory cycle effects viral load, and the ups and downs of the monthly cycle may also shift blood levels of anti-HIV medications. A handful of plans are under way for studies of hormone replacement therapy and HAART. HIV itself can upset the body's delicate balance, resulting in fatigue, loss of sex drive, or changes in skin texture and vaginal moisture. It may take some arm- twisting to get your doctor to check levels of estrogen, progesterone, and testosterone, but the results can be well worth it. Women who don't have regular periods may also be at higher risk for insulin resistance. If your period stops, it may also signal insulin resistance.

-EB

MINDING THE GAP
News but no answers about gender differences in viral load and CD4 T-cell counts A recent Dutch study found that women developed AIDS and died at higher CD4 T-cell counts than men. This fits with past research showing that HIV-negative women have, on average, about 100 more T-cells than their male counterparts. Correct diagnoses and treatment choices hinge on knowing normal levels of CD4 T-cells, and mismeasuring womens' cell counts could delay diagnosis of AIDS.

The gender gap has been widely reported in viral load counts too. It looks as if women may get sick at lower viral loads than men do. At a recent meeting on the topic in San Francisco, an international panel of experts agreed the issue warrants close attention. It's not all bad news, though. All the studies to date have been done in the absence of treatment. Add in antiretroviral therapy and these numbers may work in women's favor: If women's viral loads are lower to begin with, they may respond better to treatment. Could it be that higher CD4 T-cells will help women live longer too? More research is needed to figure out exactly what's going on. For now, viral load and CD4 T-cell counts-also known as surrogate markers or indirect measures of HIV infection-are the best tools to monitor health. Federal treatment guidelines aim to keep viral load down and T-cell levels up. But some people can be healthy with high viral loads and lots of T-cells, or sick with low viral loads. Tracking these numbers is important, but what counts even more is becoming an expert on your own ups and downs, rather than relying on official guidelines.

-EB

Smear Campaign
Decoding GYN Lab Results
A Pap smear is used to detect cervical cancer and is a standard part of a gynecological exam. It involves inserting a long cotton swab into the vagina and "swabbing" cells from the cervix, which are then examined under a microscope. Depending on what the doctor or lab technician sees, the cells may be classified as normal or abnormal. If abnormal, the Pap results may use one of the technical terms defined below. The problem with Pap smears is that between 15 and 30 percent of their results are read as "false negatives," meaning that tests that come back normal are classified, upon subsequent examination by colposcopy and biopsy, as abnormal.

The problem of false negative Pap smears has led some health care providers to suggest colposcopy as a more accurate screening procedure. During this exam, a flexible magnifying tube called a colposcope is inserted into the vagina. This can provide a better diagnosis, but, when coupled with a biopsy, may cause discomfort or bleeding and can only be performed by a colposcopy specialist.

Pap Plus Speculoscopy is a promising new screening tool that recently gained government approval. It is almost as sensitive as colposcopy plus biopsy but is less painful and does not require a specialist. Pap Plus uses a chemical light called a Speculite and a tingly-feeling vinegar wash to whiten abnormal cells. The new test is becoming widely available in clinics, such as Planned Parenthood.

WOMEN'S TREATMENT CHECKLIST Upon diagnosis with HIV, see an HIV physician and get viral load and T-cell tests done (see "Uncle Sam Says"), along with complete blood work, including tests for liver function, cholesterol, and blood-sugar levels. Repeat these tests regularly. HPV DNA testing on diagnosis of HIV. If you've had HPV and you're diagnosed with HIV, a baseline colposcopy is recommended. Pap smears with follow-up colposcopy every six months for women with HPV; colposcopy should also be offered every year for HPV-negative women and for positive women whose Pap smears show abnormalities. Routine screening for anemia. An anti-HIV drug regimen that works for you: Discuss all side effects with a doctor or nurse, as well as straegies to help you adhere to the regimen. Birth control options that work with your meds: Several medications interfere with the effectiveness of oral contraceptives. Other tips: Consider using resistance tests (phenotypic or genotypic) if your drug regimen is failing. A good diet, exercise, and a daily multivitamin can help you stay healthy. Consider seeing a nutritionist and discuss nutritional supplements to help restore lost nutrients. Whatever the test, the results come in medical-ese. Here's a glossary of abnormal GYN screening terms*. Atypia "Atypical" cells with minimal changes. Also known as Atypical Cells of Undetermined Significance, or ASCUS. May be "atypical" due to a vaginal infection, the use of oral contraceptives, or because the person who did the Pap smear did not handle the cells correctly. Dysplasia Means "abnormal development." Dysplasia is a precancerous condition classified in several stages, from mild to severe, using CIN 1-3 and CIS (below). Squamous intrepithelial lesions, or SIL SIL is another term used to describe dysplasia. It refers to lesions in the thin cellular layers of the vaginal tract. SIL also suggests a precancerous condition. Cervical Intraepithelial Neoplasia 1, or CIN 1 CIN means abnormal growth or tumor in the tissue covering or surrounding the cervix. CIN 1 means that one-third of the sample has dysplasia or precancerous cells. It indicates mild dysplasia. CIN 2 CIN 2 means two-thirds of the sample has dysplasia. It indicates moderate dysplasia. CIN 3 CIN 3 means the entire sample shows cells with dysplasia. It indicates severe dysplasia. Carcinoma In Situ, or CIS On a Pap smear, CIS means the same thing as CIN 3: The entire sample shows dysplasia, but there is no sign of invasive cancer. - EB * Source: Glossary and test information adapted from GYN Conditions in Women with HIV, a fact sheet from Project Inform. For a complete copy of screening guidelines or other Project Inform materials, call 800-822-7422, or log on to www.projectinform.org. Taking the Long View How harmful is long-term use of anti-HIV drugs? The Steering Committee for the Evaluation of Metabolic Complications of HAART aims to find out. It recently rolled out its research plans, which include watching 15,000 people for two years for signs of HAART-related heart trouble. But that may be too short a time; it can take many years for high cholesterol or insulin to cause clinical problems. Still, advocates agree that this and other farsighted studies offer exactly the perspective that's needed on prolonged use of HAART. - EB