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Ask the Expert Hot Topics
November 24, 2003

Check out these hot topics at The Body's Ask the Expert forums:
HIV/HAART-Related Health Problems Will taking a laxative interfere with my HIV meds? Since starting Combivir (AZT + 3TC) and efavirenz (Sustiva, Stocrin) five weeks ago my previously flagging appetite has returned with a vengeance. I'm constantly hungry and eat a lot, yet my bowels only move every three or four days! I'm supposed to start taking atazanavir (Reyataz), but have been dependant on Xanax (an anti-anxiety medication) for several years to treat panic attacks and depersonalization. I just read that Xanax and atazanavir can cause problems when taken together. Can you tell me more about this? I'm a long-term HIV survivor (12 years), but was diagnosed with HIV encephalopathy long ago. In 1991 my doctor put me on 10 mg of Dexedrine per day to help with my slowed cognitive functioning. Other than AZT (zidovudine, Retrovir) -- which I am resistant to -- and attaining an undetectable viral load, are there any promising treatments that improve cognitive function, or is the damage permanent? I had been on indinavir (Crixivan) and d4T (stavudine, Zerit) since I was diagnosed five years ago, but because of wasting in my legs and arms my doctor just switched the d4T for Combivir (AZT + 3TC). However, the most embarrassing part is the wasting in my face. I was referred to a plastic surgeon. He gave me two costly solutions: one where tissue is taken from cadavers and inserted in the face, and another where fat is liposuctioned from my stomach/waist and injected into my face. I'm currently taking Juven (a nutritional supplement), and have also heard of New-Fill as a solution. Will any of these options -- or anything else -- help? HIV and the Workplace My latent hepatitis B (HBV) infection has become active and I have to start taking medication for it. I currently work for a large chain drug store and they require that employees get their prescriptions filled at one of their stores. Should I follow the rules -- and risk my employer and coworkers finding out -- or should I get my prescriptions filled at another drugstore, and pay out-of-pocket? My employer is now offering long-term care (LTC) insurance with an open enrollment period. I recently contracted HIV and began treatment a couple of months ago. How significant are long-term care costs for HIV patients and what's your opinion regarding HIV-positive people obtaining LTC insurance? The cost wouldn't be much (maybe $15-$20 a month) and the group policy would be portable. Safe Sex & HIV Transmission I had unprotected sex (anal intercourse) with a friend -- he penetrated me. I have known him for many, many years; when this happened 48 hours ago we were both very intoxicated. He says he didn't realize what he was doing. I assumed he was HIV negative as he hadn't told me anything and we had shared our HIV results several times over the last 15 years. Today he told me he is actually HIV positive and has been for the last two and a half years. What do I do? Have any studies been done regarding HIV transmission from positive persons with undetectable viral loads? Are the risks lower for unprotected anal intercourse if the HIV-positive person pulls out before ejaculation?		Questions on HIV Treatment Reading these forums, I get the impression that a lot of people start treatment within one or two years after infection. This seems odd, since it takes an average of seven to 10 years before AIDS develops. Are these early starters a small minority, or are most people with HIV really on treatment within a few years after infection? My doctor wants to start me on meds. I've been positive for over 12 years; my last labs showed a CD4 count of 315 (19 percent) and a viral load of 4,500. My doctor gave me eight different choices for an initial regimen; which one do you think is the best? If you were given the following three options for initial therapy, which would you choose, if any? 1) Lopinavir/ritonavir (Kaletra) and efavirenz (Sustiva, Stocrin); 2) lopinavir/ritonavir and two NRTIs; or 3) efavirenz and two NRTIs. My doctor and I agreed in March of 2002 that I could take a drug holiday. My viral load was undetectable and my CD4 count was 700. Now my viral load is 100,000, my CD4 count is 570 and I'm experiencing a bad itch in my hands and feet. Should I start meds again? Before my holiday I was taking 3TC (lamivudine, Epivir), d4T (stavudine, Zerit) and efavirenz (Sustiva, Stocrin). My doctor and I have discussed restarting with 3TC, abacavir (Ziagen) and nevirapine (Viramune). What do you think? Is it common for people just starting meds to feel really tired? I was recently infected with HIV, and diagnosed last spring. I was treatment naive until I started lopinavir/ritonavir (Kaletra), tenofovir (Viread) and FTC (emtricitabine, Emtriva) five weeks ago. I exercise daily -- have for years -- am in good shape and quit drinking and drugs (including cigarettes) back in 1985. HIV and Relationships I was infected in Africa through an affair I had with a married man while I was working there. We continued the relationship and were making plans to reunite; he was getting a divorce and looking into a student visa. Last weekend, he died suddenly while still in Africa. I am sad about my lost future with him. I am also confused about what to do with the knowledge that I alone have of his HIV-positive status -- like whether I have a responsibility to tell his family, who don't understand his sudden death. His wife may not know about his status or have been tested for the virus. Strange but True A group of us were wondering if taking an occasional sip of wine and swishing it around in the mouth during oral sex could help prevent HIV infection. Is this just a really stupid question, or could a little "wine with dinner" be effective? Dear Dr. Bob: I have been obsessing about possibly having HIV and you are not helping me! Stop being so damn witty. I need to move on! How can I not log on when you crack me up every day? It's like trying not to read your favorite cartoon in the funny pages! So here is what I suggest: Lose the sense of humor, start acting like a true doctor and become boring. This way I can move on with my life. I check your "Safe Sex" forum like I check my e-mail.
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