Dear Dr Laura,
My partner has got HIV and is undetectable on treatment. His clinic tells him to get vaccinated against flu and pneumonia but because he is well he says he doesn’t need them. He smokes a lot and I’m worried about his health. Please advise.
Assuming your partner continues to stay undetectable on HIV treatment he can look forward to a normal life expectancy. However, we also know that people with HIV, even if it’s well controlled on medication, are at a higher risk of other medical conditions including heart disease, bone thinning and kidney disease – these all become more common as we age but are more common in people with HIV compared to HIV negative people. There are a number of possible reasons including HIV drug side effects, minor immune system changes that persist on treatment and lifestyle factors (there are higher smoking rates in people with HIV for example).
Heart, bone and kidney disease get a lot of attention in HIV research and we regularly include monitoring for these in HIV clinics. However, we don’t routinely measure lung health despite the fact that some lung diseases, including lung infections, are more common in people with HIV. I covered influenza (flu) in a recent column; people with HIV are more likely to have severe flu or complications requiring admission to hospital. HIV treatment improves this but the risk of severe flu is still higher than in HIV negative people and similar to the higher risks seen in other people for whom flu vaccination is recommended (such as older people, people with other lung disease and people with diabetes). This is why we still recommend annual flu vaccine for all people living with HIV, regardless of their immune health or whether they are on treatment.
Another vaccination recommended for people with HIV is against a bacteria called pneumococcus. Pneumococcus can cause different infections including ear and sinus infections, lung infection (pneumonia) and bloodstream infection. Like flu, although effective HIV treatment has reduced the risk of serious infection, people with HIV are still at a higher risk than the general population, so vaccination is recommended. There are two different types of vaccine and each one only needs to be given once – your partner’s HIV clinic can provide more information and his GP can give the vaccine.
There is some new research from the UK looking at why people with HIV get more lung infections. The Medical Research Council (MRC) Centre for Inflammation found that people with HIV who are taking HIV drugs and have had undetectable virus for many years still had abnormalities in their lungs. These changes were related to a type of immune cell that helps fight infection called a macrophage. In this study, lung macrophages from people with HIV did not work as well as they should and this is a possible explanation for the higher rates of infection we see despite effective HIV treatment. The researchers say that their findings should encourage people with HIV and their health care providers to monitor lung health more closely. The team concluded that health officials also need to raise awareness about lung health in HIV patients, from encouraging this group to quit smoking to getting vaccinated ahead of flu season, as examples. As I mentioned before, the number of people with HIV who smoke is greater than the general public (more than double the number!).
So, back to your partner. At the moment, although the MRC findings are important, we don’t know how to change this. It may be in the future that we find different treatments to target HIV-related lung changes, but until then this research should be used to further encourage people with HIV to take care of their lungs. The most important change your partner can make is to stop smoking. Smoking is associated with lung disease, heart disease, several cancers, bone thinning and other poor health outcomes. My favourite website, NHS Choices, has got lots of advice and can signpost him to services that can help. Switching to a vape can be a very good way to stop smoking and is considered much safer than traditional cigarettes.
Other things that can help protect your lungs include (where possible) avoiding pollution and avoiding second-hand smoke. Maintaining good general health through diet, exercise and drinking within recommended limits are all important too. Getting a pneumococcal vaccine and annual flu vaccine are recommended. Encourage him to talk to his HIV clinic or his GP. Finally, taking his HIV treatment every day to ensure his viral load stays undetectable will mean a normal life expectancy and a much lower risk of medical problems, including lung infection, than not being on HIV treatment. Encourage him to stop smoking (buy a vape for his birthday!) and help him LOVE HIS LUNGS!
Dr Laura Waters is an HIV and sexual health consultant at the Mortimer Market clinic and the Boyz Doc. Dr Laura answers your questions every two weeks in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org.