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Ask the Expert Hot Topics
October 7, 2003

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HIV and Relationships I've had HIV since I was 18 (I am now 34). During most of that time I was in a monogamous relationship, but the relationship ended a few years ago. I've since met someone that I really like. We've been going out for three weeks and are approaching a point where the relationship is about to get sexual. I haven't disclosed my HIV status to this person yet because I wanted to get to know him first. Any advice? I am HIV negative but have an HIV-positive partner. It's a very loving relationship, but much to my frustration our sex lives have completely trailed off after the initial sexual honeymoon period. Is this common with HIV-positive people? My viral load was undetectable for six-and-a-half years after starting HAART. For reasons that no one can explain, though, my viral load has been between 300 and 36,000 for the last year. My lover (HIV negative) of more than two years and I ALWAYS use condoms. With my viral load bouncing around so much, I have said NO to any insertive action -- even with a condom. Am I being too harsh on us? Hi, Dr. Bob! I'm dating a guy who, like me, has been HIV positive for 15 years. His doctor told him he could have unprotected sex with a monogamous partner, provided we both have undetectable viral loads and normal CD4 counts. He said that in this case there would be a low risk of cross-infection. What do you think? Lipodystrophy and Metabolic Problems In your medical practice, have you seen people's lipodystrophy improve after they've switched meds? Considering liposuction for lipodystrophy? First make sure you don't have Madelung's syndrome (a rare disease that increases head/neck fat). If you do, the liposuction might spread the disease throughout your body. It's been two weeks since my New-Fill injections, and I still look the same. Is there anything I can do to help the treatment work? Could my smoking be interfering with the New-Fill? I'm an HIV-positive vegan who's been through three different treatment regimens. I've had high cholesterol, lipodystrophy and a "buffalo hump" for about five years now, regardless of the regimen I'm on. Is there anything I can do? Questions on HIV Treatment Is there any way to tell what the "best" first drug regimen is for somebody with HIV? A few months ago I started taking 3TC, Kaletra (lopinavir/ritonavir) and tenofovir soon after I was diagnosed with HIV. Now my doctor wants to switch the Kaletra (a protease inhibitor) with efavirenz (an NNRTI) to reduce the risk of side effects. Is this a good idea?		Other HIV/HAART-Related Health Problems I restarted therapy seven weeks ago after a three-month break. I'm taking 3TC (lamivudine, Epivir), nevirapine (Viramune) and tenofovir (Viread); my viral load is already sharply down and my CD4 is up. I've heard about potential liver problems in people starting nevirapine, though. Are there any warning signs I should be on the lookout for? Since I travel a lot for work, would it be OK to go to a clinic while traveling to make sure my liver's still in good shape? I have severe fatigue, impotence and my prolactin levels keep going up (a potential sign of a tumor in the pituitary gland). An MRI found no signs of a pituitary tumor; could this have something to do with my HIV status or the meds I'm on? Is it dangerous for somebody who's depressed, fatigued, forgetful and an insomniac to risk the psychiatric side effects of efavirenz (Sustiva)? Which HAART regimens are least likely to cause nausea and vomiting? Do you think fatigue is caused by adrenal insufficiency in HIV-positive people? Which do you think is better to get one's testosterone to rise: HCG (human chorionic gonadotropin, an injectable hormone) or AndroGel (a topical testosterone gel)? Mental Health and HIV I've been HIV positive for 20 years. The usual: lost a lover, friends, was hospitalized, got protease inhibitors, kept going. Two years ago I found out I'm also bipolar. I had a big life, but it's getting smaller and smaller. Ending my life is the last thing I have any control over. Can you give me one reason (besides God) to continue to stick around? I have intense anxiety; my doctor put me on Zoloft (sertraline), and when that didn't work, switched me to Lexapro (escitalopram oxalate) and Xanax (alprazolam). My symptoms are continuing to intensify and my shaking/trembling/fears are not subsiding. Am I being overmedicated? I'm taking two anti-depressants -- 30 mg of Remeron (mirtazapine) at night and 10 mg of Lexapro in the morning -- as well as Klonopin (clonazepam) for anxiety. But I've still been feeling incredibly depressed and physically drained, especially during the daytime. How could I be feeling so bad despite being on such strong anti-depressants? I've been HIV positive for so long (since 1985) I can't remember what it was like to be negative. Though my years being HIV positive have been good to me, I've had the fear of death, becoming ill, incapacitated, diseased, etc., always lurking in my emotions. I'm considering counseling; what advice can you give about finding someone good?
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