September 22, 2009
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HIV & BODY SHAPE CHANGES


 Finding a Regimen That Doesn't Cause Body Shape Changes
I have been on a drug "holiday" for the past 18 months, after 12 years of HIV therapy. I stopped my meds with a high CD4 count of 1,100 and an undetectable viral load. I stopped therapy even though I felt great, because I had significant facial wasting and redistribution of fat to my abdomen. Now, after 18 months off treatment, my CD4 count is 450 and my viral load is 50,000, so the vacation is over. My doctor has recommended Epzicom (abacavir/3TC, Kivexa), raltegravir (Isentress) and either maraviroc (Selzentry, Celsentri) or etravirine (Intelence). Is this combo relatively free from fat wasting and fat redistribution problems? I hate to seem vain, but quality of life is as important to me as lab values.


JUST DIAGNOSED


 Can Someone Recently Diagnosed With HIV Have a Normal Life?
I was diagnosed with HIV four months ago. I believe I was infected eight months ago maximum. My numbers are fine -- CD4 count of 542 and viral load of 10,000. My CD8 count went from 550 to 750, 35 percent to 41 percent. I'll see the results from my resistance test next week. Meanwhile, I wanted to ask you: How normal will my life be with this infection? Will it really involve only taking one or two pills a day or is my life going to change dramatically because of HIV medications, side effects, etc.?


 Just Diagnosed at Age 41 With CD4 and Viral Load Dropping
It's ironic that I work in HIV. I have kept myself negative for all my 20s and 30s until a condom broke and I was unable to get PEP (post-exposure prophylaxis). My CD4 count dropped from 489 to 389, but my viral load also dropped from 38,333 copies to 33,000. My question is: When should I begin taking HIV medications?


 How Long Do Acute HIV Infection Symptoms Last?
I was told I was HIV positive two weeks ago. I'd been running a fever and having other symptoms since the end of June and thought I had the flu, but I tested negative for flu. My doc said I had acute HIV infection. Now, eight weeks later, if I don't take ibuprofen three times a day my temperature still goes up to at least 100, I feel fatigued and sick and I don't sleep well. My question is: How long are these symptoms supposed to last? Have my symptoms gone on longer than normal for acute HIV infection?


Also Worth Noting: STD E-Cards: Partner Notification Made Easier

inSPOT

Were you recently diagnosed with a sexually transmitted disease (STD)? Telling past sexual partners that they may have been exposed isn't always easy -- but a new Internet tool from inSPOT can help. Send e-cards to any sexual partners you had previous to your STD diagnosis and let them know what's happened. inSPOT will link them to STD testing resources in their areas. The service is available in several U.S. states, Canadian cities -- and international locales.
COINFECTIONS & COMPLICATIONS OF HIV/HIV MEDICATIONS


 HIV and Vision Loss
I have had the virus since 1992 and within the last three months I have started to experience serious vision loss. I love to read, but lately I cannot read anything in regular print size due to the blurred vision. Three years ago, my vision was tested and it was 20/20. What can I do about my vision loss? I am taking the same HIV meds that I was taking three years ago.


 Is Bloating a Side Effect of Atripla?
I was diagnosed with HIV six months ago. My CD4 count is 44 and my viral load is 185,000. I've been on Atripla (efavirenz/tenofovir/FTC) for six weeks. I feel much, much better now but I have recently had problems with my stomach bloating. Is this a side effect of Atripla?


 Which Is Worse: Hepatitis B or C?
I'm HIV positive and my doctor says I probably have hepatitis -- I'm awaiting the hepatitis labs. Is one type of hepatitis worse than another? If you have both, are you "dead" on diagnosis?


HIV IN THE WORKPLACE


 HIV-Positive Recent Graduate Entering the Workplace
I just graduated college and found out I was HIV positive. I am currently on no medications, but I do see a doctor for labs and such. This is covered by my current insurance through my parents. However, this insurance will expire in March 2010. I am currently unemployed and am seeking a job. I'm somewhat concerned because of the lack of positions in my field and wonder if I am going to need to apply to Starbucks or Home Depot, which offer general insurance for employees, to keep coverage. The other option is to pay the COBRA fees for my parents' insurance ($800 a month) or just rely on Ryan White. I noticed there is a pre-existing condition clause that applies for about 60 days when transitioning between jobs. Does this also apply when switching from parents' insurance?


Also Worth Noting: Online Survey: How Do You Rate Your Medical Care?
Take this new survey by HIV-positive scientist and clinician Dr. Rupert Whitaker and detail how you would rate your medical care. The survey is available in English, Spanish, French and German.
YOU & YOUR LABS


 Do I Have End-Stage HIV?
At my last doctor visit my viral load was 150 and my CD4 count was 170. My doctor says I have end-stage HIV. I am not sure what that means. My CD4 count has never gone above 170 since I was diagnosed with AIDS. I don't know what to expect from here on. Is this the end? My T-cell (CD4) count has been as low as 59 but it's back up to 170 -- is that good? Please help!


 Viral Load Blips: How High Can a Blip Go?
For around four and a half years while on Atripla (efavirenz/tenofovir/FTC), my viral load has been undetectable. Then four months ago (May 2009) it went up to 2,920. But as of a few days ago (September 2009) it's gone back to undetectable. I felt very discouraged after that detectable result, as I've never missed a dose, not even once, although sometimes my dosage times vary by a few hours. I was tested for resistance in 1998 and it was found that I had 184V, the one for 3TC (Epivir, lamivudine). I'm pleased that I've returned to an undetectable viral load, with a CD4 count now at 655, but I'm worried about whether this viral load blip is presaging some sort of weakening of my HIV therapy.


HIV TRANSMISSION


 My Boyfriend Found Out He's HIV Positive and I'm Nervous About Sex
My boyfriend recently found out he's HIV positive. He says he was infected about six months back when he knowingly had unprotected sex (this was before I met him). He anticipated that I would leave him, but I really do love him and have chosen to stick with him. However, whenever we're about to have sex, I start getting scared and lose my erection. We've educated ourselves on the precautions of being a "magnetic" couple," but I know that sex will never feel 100 percent safe. I start getting scared a condom will break or that he'll have cuts in his mouth. It's affecting our relationship. Am I just being paranoid or is this a legitimate response to his HIV status?


 Semen on an Irritated Anus: Do I Need PEP?
I recently had sex with a guy (mid-20s, unknown status). We were lying in bed with my ass quite close to him and he was jerking himself off. No penetration. I got some of his ejaculate on my anus. Seconds later I realized the skin around my hole was irritated and (possibly) cut. A bit of his semen could have slipped into the rim of my hole or membrane. How would you describe my risk? I went to hospital about 20 hours later and lied about a slipping condom to be given post-exposure prophylaxis (PEP).


Also Worth Noting: Connect With Others
Newbie From Singapore -- Hoping to Connect
(A recent post from the "Gay Men" board)

Hi, 29-year-old guy here from Singapore, was diagnosed four years ago after I was hospitalized. This is my first post, and I'm hoping to connect with people because it can get so isolating sometimes not having people around to understand or talk to.

-- Darian

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NEWS & VIEWS


 How I Beat Cigna: A Note About Long-Term Disability Cancellation
This is a remark on a recent "Hot Topics" question someone asked about his/her long-term disability benefits being cancelled by Cigna. After receiving long-term disability benefits from Cigna for nearly 15 years, I received a letter from them stating that I was no longer considered disabled. I was dumbfounded, as I had been deemed disabled in 1994, and had been receiving social security along with Medicare benefits since that time. I contacted an attorney who advised me to include in my appeal letters from friends and family about how they have seen my health deteriorate over the years. I also included every detail of my HIV/AIDS-related health issues and how they affect my wellbeing. With the economy going in a downward spiral, it is my belief that insurance companies such as Cigna are looking for loopholes in records to get out of paying long-term benefits. To make a long story short, I am happy to say my appeal was successful. Not only were my benefits paid retroactively, but they ended up offering me a lump-sum settlement. Cigna cannot begin to fathom the mental distress of a person living with this disease.


STRANGE BUT TRUE


 HIV Risk in a Dog-Eat-Barf World
If my dog eats an HIV-positive person's vomit, can he get HIV?



Public Service Announcement



Activist Central

 At National Equality March, Equality To End AIDS Rally to Re-Engage LGBT Community


 Learn How to Participate in the White House's HIV/AIDS Community Discussions on the National HIV/AIDS Strategy


 Tell Sen. Majority Leader Reid to Take Action on Syringe Exchange


 Re-Authorize the Ryan White Act -- Care for People Living With HIV/AIDS


 Action Alert: Easy Steps to Impact U.S. HIV/AIDS Policy!