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Ask the Expert Hot Topics
June 2, 2003

Check out these hot topics at The Body's Ask the Expert forums:
Lipodystrophy and HIV I'm 54 years old, HIV positive for 20 years and in good health. My CD4 count is high and my viral load is undetectable thanks to a myriad of HAART combinations. About four years ago I started to lose body mass in my forearms, legs and especially my buttocks. I've managed to counter much of this loss with diet and exercise, particularly weight training -- that is, everywhere except my buttocks. I'm thinking of getting buttock augmentation. Is this a safe, effective surgery? I'm a relatively healthy 40-year-old male living with AIDS. I have been on 3TC (lamivudine, Epivir), d4T (stavudine, Zerit), indinavir (Crixivan) and ritonavir (Norvir) for quite some time. This combination works great, but my body hair has fallen out, I have a pretty significant buffalo hump, and the veins in my legs protude quite a bit. Being on disability (and without a rich husband), expensive treatments and Park Avenue plastic surgeons are probably not in my future. Is my only option to do nothing, and just feel grateful that I'm privileged enough to be able to take these life-saving medications? Structured Treatment Interruptions I'm in a structured treatment interruption study, and have been on and off meds several times in the past year. The last time I stopped treatment, my CD4 dropped extremely fast (from over 1,000 to 536 in just six months). Should I go back on meds before they plummet any further? Three years ago I was diagnosed with HIV. Thanks to ddI (didanosine, Videx), efavirenz (Sustiva) and tenofovir (Viread), my viral load has been undetectable for the last two years and my CD4 count hovers between 800 and 1,200. My new doctor has suggested I take a treatment interruption, but I don't think I agree. What do you think? Mental Health and HIV Insurance companies, ADAPs, Medicaid and Medicare are no longer paying for Valium because they say that diazepam is its generic equivalent. Lots of experts, though, have told me that the generic versions are at least a tiny bit different. If that's true, shouldn't Valium still be covered because it's not identical to diazepam? I'm the adoptive mom of a great little four-year-old boy whose biological mom had bipolar disorder. The boy was diagnosed with HIV at six months after a bout with pneumonia; he's now on 3TC (lamivudine, Epivir), AZT (zidovudine, Retrovir) and nevirapine (Viramune). How will the HIV -- or his meds -- affect his brain? He's bright, attentive and kind, but is there a chance he could develop his mother's mental problems? When will I begin to find out? Ask Dr. Ewald Horwath and therapist Michael Shernoff your questions about mental health issues for people with HIV! Starting HIV Treatment I found out I had HIV this week and started an aggressive treatment regimen the following day. How long should it take for my viral load to drop? I was infected with HIV 12 weeks ago. My CD4 is about 1,000 and my viral load is 19,000. Do you think I should start HAART now, because of the window of opportunity during this acute infection stage? Pregnancy and HIV Is there any risk of transmitting HIV to my baby if I get an amniocentesis done? I'm 29 weeks pregnant and was recently diagnosed with HIV. What's the best way to stop my baby from getting HIV?		Cancer and HIV My doctor stopped all my HIV drugs because I have a high lactic acid level. I'm halfway through a chemotherapy regimen (CHOP) for lymphoma. Should I start treatment again, or would the chemo interfere with my meds? My cervical cancer is in remission, but now that I've had it, am I at risk for developing other cancers (like breast cancer) or for my original cancer to metastasize? Does human papillomavirus (HPV) just mean anal warts? I'm doing well on efavirenz (Sustiva) and Combivir (AZT + 3TC), but I'm worried about what looks like a wart, or perhaps just a skin tag, on my penis. Could this be HPV? How can I find out? I've been on efavirenz (Sustiva) and Trizivir (AZT + 3TC + abacavir) for years now. My CD4 count is really high and my viral load is 40,000, but I'm still getting Kaposi's sarcoma. Why is this still happening, and what can I do about it? My friend has full-blown AIDS, aggressive stage IV lymphoma, a "life-threatening" fungal infection and pseudomonas pneumonia. What's his prognosis? Questions About HIV What's the relationship between HIV and other auto-immune disorders, like Crohn's disease? I have Crohn's, and it seems like even though I'm on meds and have an undetectable viral load, the disease is keeping my CD4 count very low. I tested negative for HIV last year. I was retested just over a year later and was told that not only was I HIV positive, but I had full-blown AIDS with a CD4 count of 97 and a viral load of 400,000. How is this possible? I thought it takes an average of 10 years to show a symptom of AIDS! My husband of 10 months just found out that he has full-blown AIDS with a CD4 count of 54. He's had HIV for more than 10 years, but I just found out five weeks ago. Will he survive? Is it paranoid for me to feel I need to get tested every 3 months? HIV and the Workplace I recently took a short-term disability leave due to a worsening of my AIDS-related condition. I never told my employer exactly what my disability was. When he asked me, I said that it was an ADA-defined disability and requested that any information concerning my leave be kept confidential and shared only with those who have a true need to know. Now I found out that one of my managers called a former employee and quizzed him about my medical condition; they also sent him an e-mail saying they think it's "sexually related," and they've cut off my network e-mail. Can they legally do all this? I've been a nursing assistant for 10 years and I love my job, but I was recently diagnosed with HIV. Do you think it's a good idea for me to change jobs? I would understand if a patient wouldn't want someone with HIV helping to give him/her a bath. Off the Beaten Trail A few years ago, I noticed that half my pubic hairs are white and half are brown. Is this an STD? Is there some drug I can take to make it better? Dear Dr. Frascino: As someone living with HIV after an accidental workplace exposure, do you ever find it difficult, even infuriating, to be bombarded with frantic questions from people whose exposure is highly improbable, yet who are nevertheless ecstatic to learn they won't have to worry about what you deal with every day?
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