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July 27, 2004
In This Hot Topics:
  • Workplace & Privacy Issues
  • Starting Treatment
  • Other Treatment Questions
  • Mental Health & Quality of Life
  • Women & Pregnancy
  • HIV/HAART-Related Health Problems
  • HIV Testing & Transmission
  • Strange but True
  •   WORKPLACE & PRIVACY ISSUES

    Disclosure at Public HIV Testing Sites
    I was recently tested at a local public clinic. An employee recognized me and told my brother I had gone there. This is a major violation of my privacy. What should I do?


    When Employers Refuse to Meet Disability Requirements
    I recently quit my job at a large company following severe harassment that I think was in retaliation for my filing of an Equal Employment Opportunity Commission complaint against them. Now I'm HIV positive, on medications and with no health insurance. What can I do? I filed my complaint because the company refused to accommodate my request to reduce my working hours to 12 per day or 60 per week. Now the company insists it never even received the paperwork for my complaint, even though I personally had it delivered it to them and have proof that they signed for the package.

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      STARTING TREATMENT

    Confusion Over First-Line Treatment Recommendations
    I'm 44 and, since my diagnosis five years ago, haven't had any need to start treatment. My last CD4 count was 358 and my viral load was 153,000, which is higher than it's been before but was taken during a stressful time. I have, however, discussed starting treatment with both my original HIV physician and, since I moved recently, with my new doctor. At first, this new doctor suggested I take efavirenz (Sustiva, Stocrin) and Combivir (AZT/3TC), although my previous doctor had suggested Trizivir (AZT/3TC/abacavir). Then, at my most recent office visit, my new doctor suggested that I also consider a number of other regimens that could work for my lifestyle. Frankly, now I'm confused. What type of treatment is the best? I can adhere to whatever regimen is necessary.


    Best Option for Avoiding Protease Inhibitors?
    For those who want to avoid taking protease inhibitors as a part of their first HAART regimen, it seems that a regimen of Combivir (AZT/3TC) and efavirenz (Sustiva, Stocrin) has always been an excellent choice. However, I'm hearing of more and more people starting with 3TC (lamivudine, Epivir), efavirenz and tenofovir (Viread) because it's simpler and seems to cause comparatively fewer side effects. Do you prefer this as a starting regimen as well, or has there not been enough research to determine its long-term efficacy?


    CD4 Is Dropping, and Concern is Growing
    Since I was taken off a study for treatment during acute HIV infection, my CD4 count has kept dropping (it's down to 403 from 900), but my CD4 percentage and viral load have stayed about the same. My doctors, like robots, continue to insist I have nothing to worry about and don't need to restart treatment. But how can I not worry? I'm getting frustrated with my doctors and my situation.

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      OTHER TREATMENT QUESTIONS

    Questions on Adherence and Altering Doses
    I've got a couple questions about adherence and med dosing: 1) I ran out of efavirenz (Sustiva, Stocrin) during the long July 4 weekend, and for three days took only the other drugs in my regimen. Am I likely to become resistant to the efavirenz now? 2) I've been taking only half the prescribed dose of my AZT (zidovudine, Retrovir) because I'm afraid of the side effects. Was this a bad idea?


    Making It Easier to Predict a Med's Success
    It is disturbing how much variation there seems to be in how people respond to HIV medications. Are there genetic databases of patients that will allow comparisons over time of what characteristics will make a person more or less likely to tolerate a particular medication?


    Should Successful Treatment Be Stopped?
    I was diagnosed with HIV while I was still seroconverting -- my HIV antibody test was still negative, but my CD4 count was 320 and my viral load was 750,000. My doctor advised to treat hard and fast, so I immediately started a combination of 3TC (lamivudine, Epivir), d4T (stavudine, Zerit) and efavirenz (Sustiva, Stocrin). After just three months, my viral load is now undetectable and my CD4 count is over 1,000. I'm 100% adherent, am exercising and eating nutritiously, and I don't drink or do drugs. My doctor thinks I'm doing so well that I should stop treatment within the next year. Should I change what's working well in order to avoid the risks of long-term side effects and developing resistance?

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     MENTAL HEALTH & QUALITY OF LIFE

    When an Antidepressant Doesn't Have an Impact
    I was diagnosed four years ago. Though I was initially distressed, I've learned to accept my situation and live my life with as much fulfillment as possible. I also still work full-time as a teacher. Lately, however, I've noticed a significant change in my mental health. I find myself profoundly sad and without hope. My HIV doc put me on 200 mg of Wellbutrin, but I'm not experiencing the changes in my outlook that I had hoped for. I'm presently on 3TC (lamivudine, Epivir), abacavir (Ziagen) and nevirapine (Viramune), and have an undetectable viral load and a CD4 count of about 380. My question is this: Are these particular medications associated with depression? If not, is there another drug, apart from Wellbutrin, that might help my emotional state?


    Crystal Meth, Brain Damage and Libido
    I've been using crystal meth for about 15 years, although I did so more heavily when I was younger than I do now. I'm gay, have HIV and hepatitis C, and am on HAART and antidepressants. I'm starting to get really worried about what the meth is doing to my mind; I recently had a three-day-long psychological breakdown after injecting. I want to stop, but without meth I completely lose my sex drive, and I don't want to do that to myself or my partner. What can I do?


    One Person's Story: Treatment Success
    I don't really have a question, but I did want to share the good news I got from my doctor today: My CD4 count is 550 and my viral load is below 50! I've been HIV positive since at least March 1989, and have been on Combivir (AZT/3TC) and nelfinavir (Viracept) since 2000. This is the highest CD4 count I've had since I started treatment. I'm extraordinarily fortunate, and am doing all I can to stay that way.
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     WOMEN & PREGNANCY

    Strategies for Conceiving When You're Both Newly Diagnosed
    My partner I were recently diagnosed; his viral load is higher than mine, but neither of us has started HIV treatment. We want to conceive children while we are still healthy. Should we both start treatment and have undetectable viral loads before trying to conceive, or should we start trying to conceive right now? How dangerous is it for us to have unprotected sex if we have the same strain of HIV? Can my viral load increase if we have unprotected sex, since he has a higher viral load?


    Should HAART Be Stopped During the First Trimester?
    My wife is HIV positive and four weeks pregnant. She's been taking 3TC (lamivudine, Epivir), d4T (stavudine, Zerit) and nevirapine (Viramune) for the past year, and her CD4 count is above 400. We're thinking of stopping the regimen -- or at least the nevirapine -- for the next 10 weeks so the meds won't affect the baby's development. Is this a wise move?
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     HIV/HAART-RELATED HEALTH PROBLEMS

    Steroids to Help Offset Muscle Wasting, Weakness
    I used to be toned and muscled, but since starting my latest HAART regimen I've lost my stamina and started feeling weak. I'm thinking of introducing some steroids into my workout to help regain the muscle I've lost and boost my energy level. What, if anything, do you recommend I take? Are there any steroids that might interact with my HIV meds?


    Prognosis for Non-Hodgkin's Lymphoma of the Brain
    My friend's partner of 18 years has been diagnosed with non-Hodgkin's lymphoma in his brain. He had stopped taking HAART three years ago, and when he was diagnosed with NHL his CD4 count was only 25. He restarted HAART three months ago and his CD4 count is up to 144, but he has slurred speech and crossed eyes, and one side of his body seems to be drooping. He's about to start radiation therapy, but I've read that even with radiation he can survive only three or four months. Will he be able to pull through, or should he start making end-of-life choices?



    Clarification of Colon-Rectal Cancer Statistics for Gay Men
    I see statistics reported over and over again regarding the incidence of colon-rectal cancer among U.S. men: 0.9 out of 100,000 for all men; 35 out of 100,000 for gay, HIV-negative men; and 70 out of 100,000 for gay, HIV-positive men. When human papillomavirus infection is added to the discussion, comments in the gay community border on hysteria. But I've been following these statistics for years, and I haven't seen what I would call an epidemic of colon-rectal cancer here in New York City. What do we really know about how reliable those statistics are?

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     HIV TESTING & TRANSMISSION

    Three Months or Six Months: When Is Testing Conclusive?
    Dr. Bob, I've heard you say that you should get tested at three months if you think you were exposed, but to get tested at six months if you know you were exposed. Why the difference? If I got tested at five months, do I need to get another test?


    My Doctor Says HIV is Not a Heterosexual Disease
    My doctor says there is no risk of contracting HIV through unprotected heterosexual sex. He claims that Magic Johnson and his wife have been having unprotected sex for the past 13 years and she's just fine, and that the vagina just isn't a preferred point of entry for HIV, though the anal cavity is. How do you respond to that?


    When Was I Infected?
    Can a doctor use CD4 and viral load tests to figure out how long ago I was infected with HIV?
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      STRANGE BUT TRUE

    The Case of the Hole-y Underwear
    Every day I notice tiny holes developing in the crotch area of my underwear -- almost like something is eating them. I wash daily and always wear clean underwear. What could this be?


    HIV in My Salad
    A friend of mine, who's in medical school, insists that HIV can survive in salads, on a doctor's hands and on cash. Is that true, or is he just yanking my chain? What does it really mean, medically speaking, when you say that HIV "cannot survive outside the body"?
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    Ask Ms. Breuer About:
    WORKPLACE, PRIVACY AND
    INSURANCE ISSUES

    Nancy Breuer

    Highly knowledgable and devoted to helping people with HIV, Nancy Breuer is one of three outstanding experts in The Body's "Workplace & Insurance Issues" forum. For questions on everything from ADA to HIPAA (and what those acronyms mean), as well as privacy/disclosure concerns and switching health insurance plans, Nancy and her colleagues have the answers to your questions.

    ART FROM HIV-POSITIVE ARTISTS
    Image from the July 2004 Visual AIDS Web Gallery
    "Stay Stay Stay," 1995;
    Joe De Hoyos
    Visit the July 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.