Better to Start With, or to Switch To?
My viral load has been around 150,000 since I was infected
one year ago. Now that my CD4 count is down to 350, my doc wants
to start me on treatment. My virus is resistant to most protease inhibitors,
but not Kaletra (lopinavir/ritonavir), so he wants my first
regimen to be Combivir (AZT/3TC) and Kaletra to get my viral load down,
and then wants to switch me to efavirenz (Sustiva, Stocrin) as soon as I'm undetectable.
But since Combivir and efavirenz also make a good first-line
regimen, why shouldn't I just take that right away, especially
since I'm not resistant to either of them?
Treatment "Too Early"?
A friend of mine asked his doctor to start him on HIV meds even
though he had a high CD4 count and low viral load. Does that make
sense? My CD4 count is 345 and my viral load is really low -- should I go on treatment?
LOAD TESTS & DRUG RESISTANCE
Late Can You Take a Dose?
I'm taking 3TC (lamivudine, Epivir), efavirenz (Sustiva, Stocrin) and
tenofovir (Viread) once a day at 6 a.m. I've heard that, with this
combo, you can't be any more than three hours late taking a dose
or you risk developing resistance. Is that true?
Faith in HAART
My doctor is ready to declare my latest regimen a failure.
I've been taking 3TC (lamivudine, Epivir), abacavir (Ziagen), T-20
(enfuvirtide, Fuzeon), tenofovir (Viread) and an experimental protease
inhibitor called tipranavir for the last four months, but my CD4 count is
still below 20, while my viral load has dropped from 87,000
to 21,000. I'm starting to feel a bit hopeless about taking meds,
and my doc has already said that any new regimen would not work
better than this one. Should I continue placing faith in
drugs which never seem to work?
"Undetectable" HIV Stronger?
If viral load tests can only detect more than 50 copies of
HIV in a milliliter of your blood, could the remaining less-than-50 copies
be more prone to becoming drug resistant and damaging
your immune system?
Importance of Viral Load Test Sensitivity
My doctor has been giving me the "ultrasensitive"
viral load test (which detects viral loads of 50 or greater) once every
three months since I started HAART right after I was infected about a year ago. But now he says the ultrasensitive test is no longer necessary
because my viral load is undetectable. He recommends switching
to a first-generation viral load test (which detects viral loads
of 400 or greater) and only testing every six months. Is that a
good idea, considering I've never even been tested for drug resistance?
• HEALTH INSURANCE & HIV
Feel Fine; Should I Drop the Health Insurance?
Is there any reason to keep paying $130 a quarter for
my health insurance when I'm in good health, have a CD4 count of more than 700
and have an undetectable viral load?
Finding a Private Insurance Plan When Your Company Won't Provide It
I'm about to switch from a job that provided full health insurance
to a job that offers none at all, choosing instead to reimburse
me for whatever private plan I sign up for. Since I have HIV, is
it even possible for me to find such a plan?
the Waiting Period Between Insurance Plans
I read on this site that the transition between health insurance coverage plans should be seamless when you switch jobs.
Yet my new company says I'll have to wait 60 days before I can sign
up for their insurance plan. I'm confused; is this true? What am
I supposed to do to remain covered during the interim?
AIDS Disability Benefits
I'm a grandfather with AIDS and I'm on disability. Some people
say that AIDS shouldn't be considered a disability anymore, but
I strongly disagree; I've worked hard all my life, and I feel
I deserve a break. How can anybody judge whether
someone with AIDS should be on disability until they know what it's like to pop countless pills a day and live with an immune
system like that of a 95-year-old
Enzymes and Stopping Treatment
How high a level do my liver enzymes have to reach before I'll be forced to
stop taking my HIV meds? Can I restart HAART after my liver recovers?
and AIDS Progression
I just read an article claiming that cytomegalovirus (CMV) infection,
when coupled with HIV infection, quadruples the chances of an HIV-positive
person progressing to AIDS. Is this true?
Diabetes and HIV
I was recently diagnosed with HIV and have had insulin-dependent
type I diabetes for over 20 years. I know that diabetes has some effect
on the immune system, but I'm not sure exactly what that effect is. What are
some of the key things I should ask my doctor concerning diabetes
• HEPATITIS C & HIV
Is Hep C Treatment Worth It?
I've had HIV and hepatitis C since at least 1988. I've been on many HIV meds since then -- and had side effects on all of them -- but have never been treated for my hepatitis C. Now, though I have minimal liver scarring, my hep C viral load is over 10 million. Since my HIV disease is under control, my liver doctor wants to start me on hep C treatment. I'm hesitant; I don't want to suffer more, horrible side effects and regret going on treatment. Should I go for it, or hold off and hope for the best?
Afraid to Give Hep C Treatment a Second Chance
I've tried hepatitis C treatment once before, but only made it three months before quitting because of severe depression. Now my hepatitis C viral load is up to 26.8 million. Is that too high? I don't feel I'm ready to try treatment again; can I afford to wait?
A Daily Drink vs. a Weekly Binge
Which is worse on the liver: having two or three alcoholic drinks every day or bingeing on nine or ten drinks once a week? Does having hepatitis change this?
PREGNANCY & ADOPTION
You Start Treatment, Can You Stop?
My wife, who is 14 weeks pregnant, just found out she is HIV positive.
I guess the only good news we've received is that this does not mean
our child will have HIV, and that I've tested negative for now. My wife's
CD4 count is high enough that she doesn't need treatment yet, but
once she does start taking meds to prevent our baby from becoming
infected, will she have to continue taking them after she gives birth?
Testing for Adopted Infants
I want to adopt an infant from outside the United States, but I don't
know what kind of HIV testing to request. What type of HIV test is best to use for babies, and should I try to find out the birth mother's status as well?
A Transsexual, a Dildo and a $200 Rejection
I recently went to see a beautiful transsexual escort, but because I'm too worried about HIV, we didn't do anything. She gave me back my $200 and told me to leave. During a previous encounter, though, she lubed up my dildo and inserted it into my butt. Do you think there's a chance that some HIV that had dried on her hand from a previous client could have gotten on the dildo, so that when she inserted it, the HIV rehydrated and I got infected?
Ask Dr. Conway About:
MANAGING HAART SIDE EFFECTS
Trying to figure out what to do about the side effects you're experiencing on your current HAART regimen? Dr. Brian Conway, an assistant professor at the University of British Columbia and Coordinator of Vancouver's Downtown Infectious Diseases Clinic, is one of several excellent physicians at The Body's "Ask the Experts" Forums waiting to answer your questions about managing the side effects of HIV treatment.
FROM HIV-POSITIVE ARTISTS
"Brooklyn Bridge Centennial," 1983;