RESISTANCE; STAYING UNDETECTABLE
Research on Drug Resistance?
Were there any new recommendations offered by researchers at last month's big HIV/AIDS conference on how to address drug resistance?
Should triple-NRTI regimens be avoided?
Blips, Resistance and When to Switch
After two and a half years with an undetectable viral load,
I had a blip last fall, and my doctor did a resistance test. To
our surprise, it turns out I am slightly resistant to efavirenz
(Sustiva, Stocrin). My doctor wants me to switch to another drug,
but another doctor I consulted for a second opinion says I should
stick with efavirenz. What's your opinion?
of an Undetectable Viral Load
I've been on a combination of abacavir (Ziagen), d4T (stavudine,
Zerit), ddI (didanosine, Videx) and ritonavir (Norvir) for over
two years and my viral load has never been undetectable -- it zigzags
between about 540 and 1,300. Would you recommend a change of therapy
in order to achieve the magical "undetectable"?
Consequences of Missed Doses
My wife lives in a small village in northern Thailand. Last
week she had a problem getting her meds on time. As a result, she missed
them four days in a row. Up until now, she's been 99%
adherent; how significant are these missed doses? Her last viral
load (in December) was undetectable and her last CD4 count was 70.
|• HIV DISCLOSURE
I have heard that healthcare companies are supposed to keep HIV
status confidential. If I transition from one healthcare program to
another without a break in my coverage, will I still be completely
covered? Is there anything I should be wary of as I search for new
HIV Notification and Teachers
During a recent parent/teacher phone conference, a parent notified
me that her child was HIV positive with a CD4 count of 150. She was
surprised to find out that the teachers hadn't been informed. She
particularly wanted me to be aware that her child did not have cytomegalovirus
(CMV), since I am currently pregnant. She was quite open about the
status of her children. Should my administrators have passed on her
disclosure to me? What are the laws governing this issue?
That May Avoid Lipodystrophy
Assuming there is no existing resistance to current meds, what
combination do you recommend for treatment-naive patients who want
to avoid gaining or losing body fat due to lipodystrophy?
Use of Pain Medications
How normal is it for people who have had HIV for a long time to
take a large number of pain medications? I've had HIV since 1984,
and in addition to a multitude of HIV meds I am taking many narcotics for headaches, back pain and other ailments. I don't
like taking them, but my immune system is not strong, so they have
become the only way I can get around every day.
for Severe Lipoatrophy
After almost three years on HAART, my lipoatrophy has gotten so bad I'm
almost skin and bones. Small veins I never knew existed have appeared
in both arms, and it's hard for me to sit on a hard surface for
more than 15 minutes. I've been undetectable for more than two and
a half years now, and my CD4 is at 450. My first HAART regimen was
3TC (lamivudine, Epivir), d4T (stavudine, Zerit) and boosted saquinavir
(Fortovase), but I quickly switched to 3TC, efavirenz (Sustiva) and tenofovir
(Viread) two years ago after developing lipoatrophy. I
feel like I need to either change my meds again or take a holiday
to recover some of my fat. What would you recommend if you were
Rash and Protease Inhibitors
I've tried four different protease inhibitors, but developed
a bad rash while taking each. Can someone ever be desensitized to
ABOUT HIV TREATMENT
Your CD4 Count Won't Budge
I've been on Combivir (AZT + 3TC) and efavirenz (Sustiva) for five years,
with an undetectable viral load for four and a half of them, but my
CD4 count won't rise over 300. I've had only one opportunistic infection
(back when I started treatment) and almost no side effects. I exercise,
take vitamins and almost never get colds. Why isn't my CD4 count higher?
I was diagnosed in 1992, and after several failed treatments began
a seven-drug rescue regimen in July of 2003. My viral load
is now undetectable, my CD4 count has slowly risen from 0 to 61 and I'm 100% adherent,
but I'm suffering from major "treatment fatigue" and ready to
bail. This regimen is seriously compromising my quality of life --
personally and socially -- and I'm on the brink of a mental meltdown.
I need a break, bad!
I'm not trying to be a wise guy by asking this, but what's wrong with
switching meds every six months so you don't become resistant to them
-- kind of like rotating insect poisons for roaches? Also, why would
docs want to use more potent drugs if their side effects will ruin
a person's quality of life? Is quantity of life considered
more important than quality?
Basics: When to Start
What's the current consensus on the best time to start treatment?
Speed of Undetectability
I was diagnosed last November, and was found not to be resistant to
any HIV meds. I'm now in the second month of my first HAART regimen:
3TC (lamivudine, Epivir), efavirenz (Sustiva) and tenofovir (Viread).
My results are great, according to my docs: Although my cholesterol
is rising, I started with a CD4 count of 193 and a viral load of 876,000,
and after just 26 days of treatment, my CD4 count was up to 247 and
my viral load down to 2,270. When do you think I will become undetectable?
HIV Strains and Unprotected Sex
My boyfriend and I know we have the same strain of HIV. How dangerous
do you think it is to have unsafe sex together?
Flash: Condoms Work!
I am in a serious relationship with an HIV-positive partner. We
have had wild sex nonstop for a year and, even though we use a condom
every time, I figured I would have HIV by now. But I got tested and
I am negative! Condoms really seem to do the job. She was with someone
for eight years before me and he is also negative. Before I was tested
I was nervous, but now I am totally at ease knowing that protected
This Little Monkey Tough Enough?
After going several months without sex, I recently found myself
in a movie theater pumping the monkey for a long, long time. Well,
the monkey got pretty raw and red (no bleeding, just sore), and then
along came a guy who went down on it for 15 seconds. Now my mind is
running away with me, thinking this guy might have just done somebody
else and passed HIV on to me through the irritated skin on the
monkey. What would the odds of that be?
Sex, New Worries
I had unprotected oral sex around 17 years ago, and I'm now beginning to experience HIV-like symptoms -- you know, shortness of breath, depression, anxiety, insomnia, thrush, night sweats. Do you think I might have been infected back then and it's just kicking in now?
|ASK DR. LEE ABOUT:
WOMEN & HIV;
Dr. Sharon Lee, an HIV physician
and researcher and the founder of the Kansas City HIV Women's Coalition,
is now available to answer your questions about women, pregnancy
and HIV. Dr. Lee also staffs our forum on switching HIV medications.