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July 6, 2004
In This Hot Topics:
  • Starting HIV Treatment
  • Viral Load Tests & Drug Resistance
  • Health Insurance & HIV
  • HIV/HAART-Related Health Problems
  • Hepatitis C & HIV
  • Living With HIV
  • HIV, Pregnancy & Adoption
  • Strange but True
  •   STARTING HIV TREATMENT

    Efavirenz: 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?


    Starting 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?

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      VIRAL LOAD TESTS & DRUG RESISTANCE

    How 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?


    Losing 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?


    Is "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?


    The 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?

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      HEALTH INSURANCE & HIV

    I 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?


    Managing 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?


    "Earning" 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 man?

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     HIV/HAART-RELATED HEALTH PROBLEMS

    Liver 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?


    CMV 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?


    Managing 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 and HIV?
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     LIVING WITH HIV

    Safety of Laser Eye Surgery for HIVers
    I want to get laser surgery to correct near-sightedness. Is this a safe procedure for people with HIV?


    Does HIV Progress Faster in Older People?
    Is there any research that sheds light on whether the progression of HIV to AIDS is more rapid in men who are first diagnosed in their late 50s?
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     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?

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     HIV, PREGNANCY & ADOPTION

    Once 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?


    HIV 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?
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      STRANGE BUT TRUE

    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?
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    Ask Dr. Conway About:
    MANAGING HAART SIDE EFFECTS

    Dr. Brian Conway

    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.

    ART FROM HIV-POSITIVE ARTISTS
    Image from the July 2004 Visual AIDS Web Gallery
    "Brooklyn Bridge Centennial," 1983;
    Bruce Cratsley
    Visit the July 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.