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Ask the Expert Hot Topics
September 9, 2003

Check out these hot topics at The Body's Ask the Expert forums:
HIV and Insurance How can I get my insurance company to reimburse me for plastic surgery to treat facial wasting from HIV meds? I was recently laid off and kept my insurance coverage through COBRA. A new company that may hire me offers coverage with the same health insurance company. However, I noticed on the application that this insurance company can reject someone because of a pre-existing condition. I'm HIV positive; how should I proceed? I have been out of work for the last six months on a medical leave of absence, and my termination date is approaching. I'm concerned about what will happen to my life insurance policy after the termination date. My doctor has informed me that I may die soon, and I'd like to leave my partner with something. Do you have any suggestions? Understanding Your Labs I tested positive in May (I believe I was infected earlier this year) and have had three labs done each month since. Although my viral load is low, my CD4 count is rapidly dropping. I have friends with high viral loads and CD4 counts in the thousands. Isn't the CD4 count a measure of immune performance? I'm concerned that my immune function seems so vulnerable. I tested positive in July; my doctor believes I was recently infected. A month later I was told my CD4 count was 1,230 and my viral load was 56,000. I had a cold when the tests were taken. My doctor wants me to start treatment, but another doctor feels that HAART won't benefit me at this time. What's your opinion? I'm 39 years old and was diagnosed a couple of months ago. My blood tests show a CD4 count of 84 and a viral load of 553,000. Is it strange that I don't feel all that bad? The only things I'm experiencing are periodic extreme fatigue (probably due to depression) and sore muscles. I had somewhat discouraging news today: My CD4 dropped to 416 from 430, and my viral load rose to 60 from less than 50 (undetectable). I don't think the percentage changed much (it may have been 26). Although this isn't a big shift, up until now my numbers have been improving. What's going on? I understand that in some people HIV progresses very quickly, while in other people it appears not to progress at all or progresses very slowly. But I read recently on another well-respected HIV/AIDS Web site that the CD4 counts of people with untreated HIV decline by an average of 50 to 100 cells/mm³ per year. Is this accurate? HIV/HAART-Related Health Problems You mentioned in a recent response that most people have few or no side effects from HAART. When I read The Body's "Ask the Experts" forum on side effects, though, I get a dramatically different impression. Can you clarify your position? Assuming I'm not resistant to any meds, which potent HAART regimens would you recommend that would be the least likely to cause nausea, vomiting, diarrhea and physical weakness? Are there any, or is HAART like chemotherapy in that people have to endure some unpleasant side effects due to drug toxicity? I was diagnosed in 1999; my CD4 count is over 500 and my viral load is undetectable. Within the past two months I've developed psoriasis on my legs, elbows and navel. I have an appointment with a dermatologist, but I'm afraid he may not have much experience in HIV. Can you provide some guidance on what would be a safe treatment option?		Questions on HIV Treatment Once my viral load is undetectable, can I use fewer HIV medications? I heard that nelfinavir (Viracept) and indinavir (Crixivan) are no longer recommended for HIV treatment. Is this true? I wanted to provide a positive testimonial to anyone who's terrified about the side effects of starting treatment. When I started on Combivir (AZT + 3TC) and efavirenz (Sustiva) a couple of weeks ago, I was frightened too. I was also armed with a strong anti-anxiety prescription, Benadryl, anti-nausea meds, a six-pack of ginger ale and a lot of emotional support. Everybody is different, and I know many have a tough entry into treatment. But I've done really well! If a hypochondriac like me can get through four days feeling pretty good, my sense is that a lot of you can as well. I've been HIV positive for two years. My CD4 count and viral load had been relatively stable, though my CD4 was drifting lower. My last tests were dramatically different, though: my viral load jumped from 50,000 to 700,000 and my CD4 count dropped from 280 to 203. I'm repeating the tests, but have been advised to think about starting treatment. Is once-daily 3TC/efavirenz/tenofovir a viable option, or should I aim for a twice-daily regimen? My partner and I were recently diagnosed with HIV (I became infected in late June 2003). My doctor put me on atazanavir (Reyataz) boosted with ritonavir (Norvir), tenofovir (Viread) and FTC (emtricitabine, Emtriva). My partner's doctor is considering prescribing 3TC (lamivudine, Epivir), efavirenz and tenofovir. Is it odd that we're taking different HIV medications? Do I Have HIV? I'm a physician and last fall I went to a "lingerie model." Although we didn't have intercourse, I have ordered all the standard HIV tests; they came out negative, but my CD4 count is unusually low. What do you think? I recently had a possible exposure to HIV: insertive oral sex with a condom on. I got tested after 16 weeks (negative), but I was sick with HIV-like symptoms for about five months -- some of the oral symptoms have even hung around an entire year. Do you think I need to get tested again? I'm 17 years old; eight weeks ago I received unprotected oral sex. I'm pretty sure I'm now infected with HIV, but no one believes me. Here's why I think I was infected. Strange But True We recently discovered that a member of my factory staff, who has AIDS, has been leaving his own semen secretions and blood in places where other members of the staff may come into contact with them: door handles, bathroom taps, etc. Since discovering this several of my staff are concerned they might have picked up the virus. What should I tell them?
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