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March 1, 2004
In This Hot Topics:
  • Drug Resistance; Staying Undetectable
  • HIV Disclosure
  • HIV/HAART-Related Health Problems
  • Questions About HIV Treatment
  • Starting HAART
  • HIV Transmission
  • Strange but True
  •   DRUG RESISTANCE; STAYING UNDETECTABLE

    New 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?


    Importance 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"?


    The 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.

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      HIV DISCLOSURE

    Switching Health Plans
    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 jobs?

    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?
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      HIV/HAART-RELATED HEALTH PROBLEMS

    Regimens 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?


    Heavy 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.

    Solutions 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 my doctor?


    Hypersensitivity 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 protease inhibitors?

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      QUESTIONS ABOUT HIV TREATMENT

    When 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?

    Battling "Treatment Fatigue"
    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!

    Musical HAART Regimens?
    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?
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      STARTING HAART

    The Basics: When to Start
    What's the current consensus on the best time to start treatment?

    The 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?
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      HIV TRANSMISSION

    Shared 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?


    News 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 means protected!
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      STRANGE BUT TRUE

    Was 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?


    Old 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?
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    ASK DR. SHERER ABOUT:
    DRUG RESISTANCE
    Dr. Renslow Sherer

    Dr. Renslow Sherer, who has been a primary care physician for HIV-positive people since 1985, is now available to answer your questions about HIV drug resistance and keeping your viral load undetectable.

    ASK DR. LEE ABOUT:
    WOMEN & HIV;
    SWITCHING MEDS
    Dr. Sharon Lee

    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.

    ART FROM HIV-POSITIVE ARTISTS
    Image from the March 2004 Visual AIDS Web Gallery
    "Mass," 1998; Peter Madero III

    View the March 2004 Visual AIDS Web Gallery!