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Dear Debbie

Spring 2005

Dear Debbie,

I started dating someone who told me (after 4 weeks) that he has had herpes for 26 years. By the time he told me, we had had oral sex on several occasions and I had swallowed semen. He has not had a breakout in 18 months. Can I only catch herpes from him when he is broken out ... or is he contagious 100 % of the time? Please help. I can't find this answer.

Thank you so, so much.

L

Dear L,

Genital herpes is the most common cause of genital ulceration in United States. Herpes (HSV) type 1 is usually found on the mouth (cold sores) and HSV 2 is generally found on the genitals (but not always). Infection with HSV is lifelong because the virus lives in the nerve root ganglia (that is why it always infects the same spot). There are antibody tests that can be done, but they really serve no purpose, because either you have it or you don't! (unless you are pregnant) Transmission generally only happens when there is direct contact with an infected lesion or secretions, but new studies suggest that transmission can also happen during asymptomatic viral shedding (the virus is present, but there isn't an ulceration present). So the important thing is to always protect yourself by using a condom. 20-25% of sexually active young adults in the US are infected with HSV-2 with approximately 5-8 outbreaks per year in the beginning and then decreasing to less than two per year after 5-8 years. The time it takes from the exposure to an outbreak can be a few days to a few weeks and can last 3-5 days. A treatment is available, Acyclovir and it can be used for both a treatment or to prevent outbreaks. I hope this helps. Thanks for writing.

DJ

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Dear Debbie:

I have been researching a paper on ethical issues involved in offering in vitro fertilization services to couples with HIV and have not been able to find much information on the topic. What information I have found has been either old or not from reliable sources. I hope you can help me answer some of the following questions, or direct me to where I might. The CDC web site has not been that great of a source, believe it or not. All the in vitro clinics I have contacted refuse to return my e-mails.

Debbie's Response

There is very little information available about artificial in vitro fertilization, mostly because of the fear of HIV infection. My understanding is that Japan probably has the most advanced research on this subject and have the transmission rate down to 1:3 million. The fear is that if the woman becomes pregnant (and she is HIV-) and also becomes HIV+, the baby has a higher probability of also becoming HIV+ because of the high viral replication that occurs when a person is going through Seroconversion (HIV- TO HIV+). In the State of California, it is against the law to conduct in vitro fertilization between Sero-Discordant couples and yet in New York there is one in vitro fertility clinic that is offering services at a very high rate of $10,000 dollars or more. It is a very delicate subject and that is probably why you have not heard back from anyone. More information is becoming available in the last several years about In vitro fertilization and HIV transmission. In one study reported in the American Journal of Perinatology. 20(6):305-11, 2003 AUG. Out of 25 discordant couples who underwent in vitro fertilization there were no documentation of seroconversion in either mom or babies at 3 months. The clinics which provide Assisted Reproductive Technology (ART) are guided by general guidelines set forth by The American Society for Reproductive Medicine and its Ethics Committee.

What is the latest estimate of rate of transmission between an infected pregnant woman and her child? I have read between 1% and 4%.

Before ART, the transmission rates ran between 19 and 43% depending on the cohort or article you read about. The transmission rate with ART is down to about 2-4%, in other words the mother has about 98% chance of having a healthy, non-HIV infected fetus. New data about pregnancy also discusses that if the HIV RNA can be decreased to <1000 in a women within controlled viral replication, that there is a significant benefit.

With the latest drugs now in use, what is the life expectancy of a child prenatally infected with HIV? Is it the same as an adult, about 20 years? I have read some articles which say it is shorter because HIV interferes with the growing up processes, especially during adolescence.

I can tell you that even before all of the current drugs that are available, many children born with HIV are now young adults thinking about getting married and having children. The exact number of years is still unknown, I have read some literature that suggests >30 years if the patient takes their ART and remains undetectable. Certainly there are less medications available for children than adults, but it is slowly changing. It is dealing with the difficulties of trying to get a young child to take their medications every day that is the most complicated.

Do you know if in vitro clinics in the USA offer their services to HIV infected couples? (It is usually one or the other, I have never heard of both parents being infected and seeking IVF). Do you know if the technique developed overseas called sperm washing has been approved for use here in the USA? That technique along with Intro Cytoplasm Sperm Injection are said to bring the risk to the uninfected mother down to about zero. Do you know if any health insurance companies, the few who offer limited coverage of IVF, allow HIV positive couples to seek IVF?

There have been cases of two HIV infected males trying to find a surrogate woman who would consider becoming pregnant, but there again is not a lot of information. Sperm washing has to do with the assumption that HIV is located in the cells around the sperm, not the sperm themselves. So you wash as much of the surrounding cells amd fluid away from the sperm as can be done with the assumption that the risk of HIV transmission becomes less of a risk. Yes, sperm washing is being done in the United States; again it depends on the state and the law around HIV & in vitro fertilization.

Again the Japanese are much more advanced then we are here in the United States.

Reference Abstracts

  1. Establishing a clinical program for HIV Seropositive men to father seronegative children by means of In Vitro fertilization with Intracytoplasmic Sperm Injection. AM J OBSTET GYNECOL. 2002 OCT; 187(4):1121
  2. Reproductive Assitance to HIVDiscordant Couples -- The German Approach. EUROPEAN JOURNAL OF MEDICAL RESEARCH. 6(6):259-62, 2001 JUN27.
  3. Infections in IVF: Review and Guidelines. HUMAN REPRODUCTION UPDATE. 6(5):432-41, 2000 OCT-SEPT.
  4. Gestational Surrogacy for HIV Seropositive Sperm Donor: What Are The Ethics? JOUR OF THE AM MED WOMENS ASSOC 58(3):138-40, 2003 SUMMER.
  5. Obstetric Outcomes of HIV Serodiscordant Couples Following Vitrofertilization with Intracytoplasmic Sperm Injection. AM JOUR OF PERINATOLOGY? 20(6):305-11, 2003 AUG.

I hope this helps you answer some of the questions, There is a lot of controversy over this subject and a state to state difference on what is available and where.


Dear Debbie,

How can you tell if you have overdosed on Vitamin B6 and what can you do about it?

N

Dear N:

Pyridoxine (vitamin B6) is not safe in large doses. Large doses can cause a peripheral neuropathy (pain, numbness or tingling in your feet or hands) despite the fact that vitamin B6 is a water-soluble vitamin (the body doesn't store vitamin B6, what you don't use is cleared out of the kidneys). In a study done in 172 women of whom 60% had neurological symptoms, which disappeared when B6 was withdrawn and reappeared in 4 cases when B6 was restarted. The symptoms were paraesthesia (numbness), hyperaesthesia (pain, tingling), bone pains, muscle weakness, numbness and fasciculation (fine muscle spasms), most marked on the extremities and predominantly bilateral (in both feet) unless there was a history of previous trauma to the limb. Vitamin B6 is usually given along with the TB medication ionized (IHN) but in lower doses of 10-50 mg per day.

The majority of vitamin B6 toxicities occurred in individuals who were taking 90-100mg or more over time. B6 is essential in preventing neuropathies when taking INH, but taking too much can also be bad and cause neuropathies. I hope this helps? Let me know if you need further information.

Debbie

Hi Debbie,

I've been HIV-positive for 18 yrs and just started to take meds in April 2002. I had something called the Burning Mouth Syndrome, and thought it had to do with having HIV, come to find out it's part of being pre menopausal ... but it did make me go on meds anyway ... I shouldn't have waited so long, but I felt great ... until the menopause kicked in ... ((sigh)). My t-cells were 27 and I felt horrid. I am also going though my changes ... I went 16 months without a period, and then had it for 2 months in a row for 6 days. Now it's been 3 months and no period again ... My question is ... Why my sex drive is down ... I am very dry in the vaginal area and it's hard for me to have sex. In fact, I don't even crave it ... I was wondering if it's the meds or going though menopause. I want to be sexual with my partner again, but haven't the urge ... What do I do to change that???

Thank you,

Dead In Bed

Dear Dead in Bed,

I know how you feel; going through menopause can be pretty tough. As your hormones change, so does your vaginal moistness and sex drive. The jury is still out in regards to offering hormone replacement due to the recent findings in a large clinical trial. The results of the study suggests there is an increase risk of developing breast cancer in those women who took hormone replacement (estrogen/progesterone). At this point in time, the arm using only estrogen replacement in women who have had hysterectomies is still ongoing. But for those of us who still have our uterus, using estrogen without progesterone is not an option. Estrogen only can increase the risk of developing endometrial cancer (sometimes we just can't win). There are a couple things that you can do, the first would be to use a vaginal cream with estrogen to help treat/prevent vaginal atrophy or use a water based lubricant each time you have sexual intercourse (with a condom).

There have been several reports that suggest that women who are HIV infected may have more problems with their menses and/or may experience early menopause. Menopause is not a side effect of your antiretroviral therapy, but I think as time moves on and we learn more about women and HIV, ARV may contribute to changes in our hormones. But at this time there isn't any literature that I know of that supports ARV causing hormone imbalance in women. There is more and more literature that suggests that HIV and possibility ARV may adversely affect men and their ability to sexually function, but there is little information about women and HIV.

Lastly, many women experience a dip in libido while their hormones are changing. Talk to your healthcare provider and ask them about some of your options. If you need to gain weight, you may think about a low dose of nandrolone (male hormone which has less 2nd sexual side effects). Nandrolone at 50-100mg every 2 weeks can increase your libido and help you to gain muscle mass. Other suggestions include taking care of yourself, eating good balanced meals, take a vitamin once a day, decrease your stress, exercise, stop smoking and be compliant with your ARV. I hope this helps. Let me know what you decide to do and how it works.

Debbie

**Distribution of information is funded by the County of Los Angeles, Department of Health Services, Office of AIDS Programs & Policy, but such funding implies no endorsement of treatments or verification of the medical or scientific accuracy of the information.**

Click here for a form to ask Debbie questions.





  
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This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.
 

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