|Correction to your response re increasing viral load
Nov 24, 2010
You are incorrect that a multi-vitamin will not interact with antivirals. In fact, if the multivitamin contains polyvalent cations such as magnesium and calcium it can cause problems with absorption of and cause the regimen to fail. The new viiv integrase inhibitor GSK-572 suffered a 70% loss in concentration in blood plasma when taken together with antacids containing magnesium and or calcium. Isentress is similarly affected and this could be the cause of his rising viral load. Experts recommend taking any supplement containing a polyvalent cation to be taken at least 4 hours apart from any integrase inhibitor.
Response from Dr. Frascino
Correction (or at least clarification) to your correction! Magnesium and calcium are not vitamins! The questioner asked about GNC Men's Sport Multivitamins, which contain a proprietary blend of green tea, ginkgo blob, key amino acids, B-vitamins, antioxidants, zinc and chromium.
It is true that polyvalent cations, such as magnesium, calcium and iron can bind integrase inhibitors and interfere with their activity against integrase. Pending further investigation, antacid medicaments and other agents with polyvalent cations should be used cautiously with and taken separately from raltegravir (Isentress). Of note, there is no effect of proton pump inhibitors on integrase inhibitor concentrations.
I generally don't put this level of detail into my responses, as it tends to cause confusion and is often misinterpreted. My response to the questioner, based on the information provided and contents of his specific multivitamin, remains correct as stated. Please also note I did recommend he work more closely with an HIV specialist physician to evaluate the cause of his rising viral load. That physician should be well versed in these types of drug-supplement interactions. He should be able to evaluate the questioner's problem in much greater detail than I can provide over the Internet with only limited information.
Viral Load Increase (CHOOSING AN HIV SPECIALIST, 2010) Nov 23, 2010
I was diagnosed June of 2009 with HIV with a high viral load, and right away they put me on medication because I was extremely fatigued, and I quickly became undetectable. Once I started the medication, it totally jump started my immune system and gave me a ton of energy. I started with Sustiva and Truvada, was switched to Atripla, but changed to Truvada(1 a day) and Isentress(2 a day) due to some side effects I was having. My last three viral load tests have come back with the following results: 6 months ago, I went from undetectable to showing 50 copies of the virus, then 3 months ago, it went from 50 to 116 copies of the virus, and most recent, it went from 116 to 700 copies, and my most recent CD4 count was 770. Now I have been taking supplements like 100mg of Flax Seed Oil, 1000mg of Fish Oil with Vitamin D3(one of each), and the GNC Mens Sport Multi Vitamin once a day. Can any of these be interacting with my medications?I am really concerned and every time I contact my doctors office about this, I don't get return phone calls or any answers as to why this has happened. Also, I have been experiencing numbness and tingling in my lips, hands, feet, and legs. I went to the Neurologist, and apparently I was told that everything was normal, but I am still feeling these symptoms and sometimes its a burning sensation in my legs and feet. I don't know what to do, but I feel like my situation is being ignored. When I go to my doctors office, they are always looking at each other like as to say "he is here again". I know how I feel, and I am the one with HIV. They're not. Any suggestions on what I should do or how I can get this taken care of? I am extremely tired all the time, and I am feeling like I was before I even started taking medication the first time. What can I do? Thanks...
Response from Dr. Frascino
1. Flaxseed oil, fish oil, vitamin D and GNC Men's Sport Multivitamins do not interact with your antiretrovirals.
2. Your progressively increasing viral load (undetectable to 50 to 116 to 770) could indicate the development of resistance to one or more of your antiretrovirals. A resistance test (genotype/phenotype) would be helpful in determining if this indeed is the case. If so, a switch in your regimen would be warranted. There are other potential causes for rising HIV plasma viral loads, such as noncompliance with dosing, improper dosing, drug-drug interactions, occult concurrent infection, etc. Your HIV physician specialist should be working with you to determine why your viral load is rising. If you are not communicating well with your HIV specialist or if he is not willing to work with you, you should consider finding another HIV specialist physician. See below.
3. If you've been evaluated by an HIV-knowledgeable neurologist and a physical cause of your tingling and numbness could not be determined, you should consider a psychological cause. Anxiety is a common cause of tingling and numbness.
4. Regarding HIV-associated fatigue, there are many potential causes. Often there are multiple causes working simultaneously. Common causes of HIV-associated fatigue include anemia, hormonal imbalances (low thyroid hormone, low testosterone, adrenal insufficiency), psychological causes (depression and anxiety), drug side effects/toxicities, and occult infection or malignancy. You can read more about these as well as many not-so-common causes in the archives of this forum. We have an entire chapter devoted to this topic. Once again, your HIV physician specialist should be working closely with you to evaluate and manage this problem.
just tested positive (CHOOSING AN HIV SPECIALIST 2010) Jan 25, 2010
iknow i got infected on jan 5th 2009,three weeks after that a had a throat infection.3-4 months after that i develop a lympnode in my neck,both side,arm pit,groin area.8- 9 months after that had a slight night sweat which goes on and off. till date after testing positive i have not done any test to see if i need medication. in how much danger am i putting myself
Response from Dr. Frascino
Without more sophisticated testing (CD4 cell count, HIV plasma viral load, etc.), it's impossible for me to ascertain how much damage has been done to your immune system. Close clinical monitoring and routine laboratory assessments are strongly recommended for all HIVers. What are you waiting for? I urge you to establish care with an HIV specialist physician without further delay. Your health and well being are at stake. See below.
HIV Positive and pregnant (CHOOSING AN HIV SPECIALIST 2009) Nov 2, 2009
I tested positive in 2006 and haven't gone for any check up's to check my cd4 count and now I'm pregnant and still afraid to go for a check up. My husband is also positive and we still have sex without a condom, what are the chances that our baby will be infected, when do i start taking medication to prevent my baby from being infected and is it safe to take arv's when you are pregnant because i hear you sometimes get sick when you take them for the very first time?
Response from Dr. Frascino
I find it terribly unfortunate and a bit sad that fear has prevented you from getting appropriate monitoring and treatment for your HIV disease. I hope you realize that by not getting the care you need, you are allowing the virus to replicate unchecked in your body and in turn slowly destroy your immune system. It is imperative that you establish care with an HIV specialist physician and HIV-knowledgeable obstetrician immediately. Certain antiretroviral medications can be taken during pregnancy and they significantly decrease the risk of mother-to-child HIV transmission. Without treatment, the chances your child will be HIV infected will be dramatically increased. Also, if you don't get appropriate care and treatment, the chances you'll be around to see your child grow up are slim to none. I can tell you if I had been too afraid to get treatment when I became HIV infected in January 1991, I wouldn't be here today to respond to your question.
I'll reprint some information below about finding an HIV specialist.
Good luck. Don't let fear keep you from getting the care you need!
Just found out... (CHOOSING AN HIV SPECIALIST) Sep 20, 2008
Well, doc, the feelings came and went and I got the nerve to test. It was positive... I don't know what to do now and I don't even know if I have long left cause of how bad I had the ARS and weight loss...
I want to live... I want to live a long happy life... I live in Texas, am I screwed? I'm a student in a grad school, so I'm poor, but what can I do? How do I move forward?
Response from Dr. Frascino
Only those of us who have been through it really understand the full impact of hearing the words "your test came back positive." Many of us feel scared, wondering if we will soon get sick or die. We fear that we will be shunned, lose our jobs or maybe our housing; that we won't be able to have children; that we'll never be able to date, get married or have sex again. None of these things are, in reality, true.
The virus found me while I was working over 17 years ago! Back then, the prognosis for HIVers was about 10 years max. We've made remarkable, in fact miraculous, improvements in treatment of HIV/AIDS, which have dramatically decreased both morbidity (illness) and mortality (death) as demonstrated by the fact I'm still here answering your question rather than pushing up daisies. It is true we do not have a cure, but for many of those lucky enough to have access to antiretrovirals and expert (or at least competent) HIV medical care, "virally-enhanced," healthy and fulfilling lives are truly attainable. Here in the U.S., even for those who don't have or can't afford private health insurance (this includes undocumented immigrants, by the way), it is possible to get quality HIV care and support in most areas of the country.
Now that you know you are HIV positive, I would recommend two simple first steps:
1. Consult an HIV specialist. She will be able to assess the severity of your HIV disease and also help you access the health care system based on your health insurance or lack thereof. To locate an HIV specialist in your area, check the American Academy of HIV Medicine's Web site at www.aahivm.org. There you will find a roster of certified HIV specialists listed by locale. (I'll also print some information below from the archives that discusses choosing an HIV specialist.)
2. Get informed! Learn as much as you can about HIV and its treatments. This Web site is an excellent place to accomplish that. Begin by reviewing the information in the "Just Diagnosed" chapter that can be easily accessed on The Body's homepage under the Quick Links heading. Start with the articles found under the "Just Diagnosed Basics" subheading.
Finally, as far as living in Texas, well, yeah, that kinda sucks, but it really shouldn't impact negatively on your HIV disease.
Start learning more about HIV and get evaluated by an HIV specialist. I'm here if you need me. Let's get through this together, OK?
Need a Private doctor Aug 14, 2008
I am HIV Positive living in Seattle area. I currently don't have one and i am looking urgently in a private clinic? Do you know a good one? I asked this question earlier & was told about Peter Shalit who is fully booked until end of year. Please let me know if you have a good one in mind. Thank You.
Response from Dr. Frascino
I would suggest you consult the American Academy of HIV Medicine Web site (www.aahivm.org). There you will find a list of certified HIV specialists arranged by locale. There are a number of well-qualified HIV specialists in the Seattle area. Be sure you hook up with one that you trust and with whom you can easily communicate. Your health insurance plan may have some restrictions, so remember to check this out as well. I'll repost some information below from the archives pertaining to locating an HIV specialist.
Choosing an HIV Care Provider
July 18, 2007
Why Is Choosing an HIV Care Provider Important?
Treating HIV disease is very complicated. There are choices to consider at every stage of the disease. It's best if you and your health care provider work together as a team. That makes it easier to choose and stick to your treatment plan. "Care provider" means a doctor, a physician's assistant, or a nurse practitioner.
There are several issues you may want to consider in choosing an HIV care provider. You might decide to have them be your "regular doctor" for all of your health issues. You might use a different care provider for most health issues and use your HIV provider as a specialist. If your regular provider isn't an HIV specialist, be sure they regularly get expert advice on HIV issues.
Training and Experience
Many people with HIV/AIDS get their care from physicians who are specialists in infectious diseases. However, especially now that people are living longer with HIV, it's important to deal with all of your health issues. You might prefer to have a family practitioner or a specialist in internal medicine as your primary physician.
No matter what their specialty, you will get better HIV care from providers who have experience treating people at all stages of HIV disease. Be sure to ask how many patients with HIV they have treated, and how many they currently see. HIV patients do better when their physicians have more experience treating HIV disease.
Do You Have Similar Ideas About Treating HIV?
Some providers are conservative. They prefer "tried and true" methods. Others are more aggressive. They are willing to try new and experimental treatments. Some are optimistic by nature, and focus on the hopeful or positive side when they talk about test results or future prospects. Others are more realistic. Some are pessimistic.
Some providers are comfortable suggesting "complementary and alternative" therapies such as massage, acupuncture, or herbs. Others stick strictly to Western medicine.
If you want a lot of emotional support, you probably won't be comfortable with a health care provider who only talks about test results. The more comfortable you are with their approach to HIV treatments, the easier it will be for you to get the kind of health care you want. Talk to providers and their patients before you make your choice.
The Provider-Patient Relationship
Many patients do better when they take an active role in planning their own health care. These patients do a lot of reading on their own, and bring information to their providers. They work together to make health care decisions.
Other patients are more comfortable with the provider making important decisions. Decide how you want to work with your provider. See if that fits with the way the provider likes to work with patients.
Help Your Provider Help You
Make sure that your provider has all the information needed to give the best advice about your treatment. This starts with your medical records, which may have to be transferred from another office. When you start working with a new provider, they will probably do a lot of tests to collect "baseline" information. This helps you see how well you're doing as time goes by.
Be sure your provider knows how you feel about using medications, and about your illness. Some people don't mind taking a lot of pills. Other people would rather take as few as possible. Are you willing to change your diet, or the amnount of exercise you do? Your provider should also know about other treatments you are using or want to try, including non-medical ones.
Be honest about your lifestyle. Your eating, sleeping, and work patterns can make a difference for your health care. So can your sexual practices and use of recreational drugs. If your provider seems too judgmental, try to change providers. It's better to have a provider who really knows you instead of holding back information.
Let your provider know about the important people in your life: the people who will support you if you get sick, or will help you make important medical decisions.
The best care provider won't do you any good if you can't get in to see them. Ask them (or their receptionist) how long it usually takes to get an appointment. Find out how well they usually stay on schedule during the day.
The type of insurance you have could limit your choice of a provider. Maybe the provider isn't on the list for your health maintenance organization (HMO) or insurance plan. Be sure to find out how you will be able to pay for their services.
Remember, you don't need an HIV specialist to help you with most of your health care needs. If a good HIV provider is hard to find, or if it's hard to get an appointment, use a non-HIV care provider for your general health care. Just be sure that when you are dealing with HIV issues, you see an experienced HIV provider, or one who consults with an expert in HIV.
Some people are very concerned about keeping their HIV status private. You might choose to get your HIV care from a provider in another town to protect your privacy. You will need to find your own balance between confidentiality and convenience.
Your health care needs might change as time goes by. Also, your ideas about treatment could change. Although you will probably get better medical care from a provider who has known you for a long time, you always have the right to stop seeing one provider and change to another.
To Find a Health Care Provider ...
You can get help finding a care provider from your case manager or from your local Department of Health. You can also ask other people living with HIV. The American Academy of HIV Medicine has a web page to help you find a doctor at http://aahivm.org/web/index.php?option= com_comprofiler&task=usersList.
The Bottom Line
HIV medical care is very complicated, and changes quickly. This makes it important to find an HIV care provider who works with HIV/AIDS patients and is committed to staying up to date. Your relationship with an HIV provider will be better if you are comfortable with each other's personal style and approach to dealing with health issues in general, and HIV in particular.
Viral Load Increase (CHOOSING AN HIV SPECIALIST, 2010)
Husband tested poz
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