|Living with HIV
May 14, 2006
Dear Dr. Bob,
I am from Brazil, 26 years old and a handsome gay man. Your words are always very inspiring for me. I got HIV around three years ago, when a condon failed with me. The beginning was not easy... after 1 year my cd4 was around 200 but I was healthy. I started to take my meds since 05.05.05. It was very boring the side effects of efavirenz+lamivudine+azt, but now it is not anymore. However my cd4 is still around 240, however, the cd4 percentage has climbed from ca. 20 to 30 %. I am indetectable since Aug '05. I never forgot any pill. Is these number ok? My doctor and me are planning to move on kaletra (once a day). Do you think it should be a better option? I am finishing my phd and would like to go to USA for a post-doc. Is it possible for me enter in The States being poz? How is the medical care? I am worried because I have full and free assistance in Brazil. Again, thank you very much for your very kind words at this site. Best regards,
Response from Dr. Frascino
Your current HAART regimen appears to have given you a good virological response (decreased viral load to undetectable levels), but only a suboptimal immunological response (minimal increase in absolute CD4 count from 200 to 240). I believe a switch from the non-nucleoside (efavirenz) to a protease inhibitor (Kaletra) is definitely worth a try.
Traveling to the US while being "virally enhanced" can be challenging! Despite absolute consensus among all experts that HIV travel bans are completely unnecessary (see http://www.iom.int/en/PDF_Files/HIVAIDS/UNAIDS_IOM_statement_travel_restrictions.pdf), the U.S. still shuts its borders to visitors with HIV. The United States Citizenship and Immigration Service (USCIS) sometimes grants a waiver for HIV-positive visa applicants, but usually it's for those wanting to stay 30 days or less.
There is no actual HIV-testing procedure at the airport, but travelers carrying HIV-related literature or HIV medications can be turned over to an immigration official for further investigation. If a determination is made by the immigration officer that the traveler is HIV positive and traveling without the proper HIV-waiver clearance, he or she can legally be barred from entry into the U.S. ( I find this policy shameful!) Before making definitive plans, I suggest you consult with an immigration practitioner who is familiar with the HIV-travel restrictions. (You can call AIDS Law Project at 215-587-9377 for a consultation.) I'm hopeful that once we have a regime change here and Bush and his anti-science cronies are finally removed form office, common sense and science will once again reign and we'll be able to change some of these nonsensical laws.
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