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December 13, 2004
In This Hot Topics:
  • Living With HIV
  • HIV Drug Resistance & Switching Meds
  • Starting (or Restarting) HIV Treatment
  • HIV/HAART-Related Health Problems
  • Interactions With HIV Meds
  • Insurance & HIV
  • Hepatitis B & C
  • Mixed-Status Relationships
  • HIV Transmission
  • Strange but True
  •   LIVING WITH HIV

    Is My CD4 Count High Enough?
    I've been on a clinical trial for efavirenz (Sustiva, Stocrin), FTC (emtricitabine, Emtriva) and tenofovir (Viread) for more than a year now. I've had no side effects, an increasing CD4 percentage and an undetectable viral load. However, my CD4 count has never climbed above 521. My doctor says I shouldn't worry about it -- that this might simply be my normal CD4 count range. What do you think? Is there anything I can do to boost my CD4 count?


    Holistic Therapy for HIV
    I found out two weeks ago that I'm HIV positive; since then, I've been researching holistic measures for fighting HIV. I found some information on how glyconutrients can help, for instance. Do you have any insight on this subject?


    As a Long-Term Survivor, How Much Longer Can I Stay Healthy?
    What's the mortality rate for HIV-positive men under the age of 50 who have been living with HIV for a long time, but who are otherwise healthy? I've been HIV positive for more than 15 years, and started treatment after getting herpes zoster in 1994. My CD4 count is over 1,000 and my viral load is undetectable. I have slight lipodystrophy, but since I switched meds it has improved. What's my prognosis?

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      HIV DRUG RESISTANCE & SWITCHING MEDS

    If I'm Resistant, Why Shouldn't I Just Stop My Meds?
    I became resistant to my Combivir (AZT/3TC) and efavirenz (Sustiva, Stocrin) regimen after four years. My doctor then switched me to atazanavir (Reyataz), ritonavir (Norvir) and Trizivir (AZT/3TC/abacavir). After three months on this regimen, there was no improvement in CD4 count or viral load. A resistance test showed I was also resistant to this regimen, but my doctor said I should keep taking it until my next appointment with him in a month. Why should I keep taking these meds if I'm resistant to them?


    Adding Epzicom to a Regimen Containing 3TC
    My doctor just added Epzicom to my existing regimen of 3TC, ddI and efavirenz because my CD4 count dropped below 200 after slowly rising from 0 over the past five years. I don't know anything about Epzicom; what can you tell me about it? Did my doctor put me on it because I'm developing resistance to my other meds?


    ddI Dose Reduction When Taken With Tenofovir?
    I was diagnosed with HIV two years ago. I was briefly on Kaletra (lopinavir/ritonavir), but once the doctor received my resistance test results, he took me off of it. Now I'm taking ddI (didanosine, Videx), nevirapine (Viramune) and tenofovir (Viread). Within two months of starting treatment, my viral load went from 20,000 to undetectable. However, my CD4 count went from 700 up to 1,100, then sharply dropped below 300 a year ago. My doctor was perplexed; I have taken the regimen religiously, I take good care of myself and have had no HIV-related illness or symptoms. My doctor decreased my ddI dose to 200 mg, saying that he heard ddI can sometimes inhibit the bone marrow from being productive. Since he decreased my dose, my CD4 count has risen to 398. Do you have any idea why I responded this way to treatment?
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      STARTING (OR RESTARTING) HIV TREATMENT

    Are You Sure I Need to Start Now?
    It's getting time for me to start treatment and I am petrified. I know the alternative, so I'm willing to do what I need to in order to stay alive, but I'm freaked out. I found out I was positive in 1993 and my CD4 count has slowly fallen ever since, although my viral load has never been over 4,000. In my last two lab tests, my CD4 count was 328 and 380, respectively, and my viral load was 745 and 2,040. Can I wait longer to start treatment? Should I take time off work when I start my meds?


    Trusting My Doctor's Decision to Delay Treatment
    I was diagnosed three weeks ago; I was most likely infected within the last six months. My CD4 count is 386 and my viral load is 9,700. My doctor, who has a large HIV practice, has recommended that I not begin treatment yet. Should I get a second opinion? Should I switch to a doctor who is a more widely recognized HIV specialist?


    Is It "Too Late" to Restart Treatment?
    My uncle was diagnosed with HIV in the 1980s. For many years he took medications, but he stopped a year ago. He recently found out that he has a CD4 count of 4. Is it too late for him to start taking medications again?

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     HIV/HAART-RELATED HEALTH PROBLEMS

    Treatment for Swollen Parotid Glands
    A friend of mine has horribly swollen parotid glands that are very disfiguring. The only thing I've heard can help is low-dose radiation treatment. Do you know anything else that can treat this -- massage, anti-inflammatories or maybe having them drained?


    Finding Cheaper Sources for Sculptra Treatment
    I started poly-L-lactic acid (Sculptra, New-Fill) treatment in July for facial wasting. The cost for the first treatment was high ($750), but livable. My second treatment cost double the first, however, and although I should have a third, I can no longer afford it unless I find a less-expensive source. Since I live relatively close to Canada, is there someone I can go to there? The low airfares to Europe ($275 round-trip to London) make it another possibility.


    Beyond Sculptra: Other Treatments for Facial Wasting
    What do you know about the effectiveness and cost of silicone injections (e.g., SilSkin) or implants (e.g., Advanta and Gore-Tex) to address facial wasting? Where can I learn more about treatments like these?

    Stool Color as an Indication of Liver Problems?
    I'm on week seven of efavirenz (Sustiva, Stocrin) and Truvada (tenofovir/FTC), and have noticed occasional pale-colored stools -- I would describe them as a light golden brown. I feel fine otherwise. Could my pale stools be an indication of liver dysfunction, or is it just a natural fluctuation?

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     INTERACTIONS WITH HIV MEDS

    Interferon (for Cancer Treatment) and HAART
    I was recently diagnosed with melanoma (1.77 mm) on my right thigh, and my doctors recommend I begin interferon therapy to treat it. I'm 62 years old and I've been living with HIV for more than 20 years. My viral load is undetectable, my CD4 count is 300 and I have no history of opportunistic infections. I'm taking FTC (emtricitabine, Emtriva), nevirapine (Viramune) and tenofovir (Viread). What side effects can I expect by taking interferon along with my HIV meds?


    Can Marijuana Smoke Be a Danger for People on Efavirenz?
    I'm a 33-year-old HIV-positive man who is attached to another HIV-positive guy. I'm not taking any meds, but he's on Combivir (AZT/3TC) and efavirenz (Sustiva, Stocrin). I smoke marijuana, and am concerned that the second-hand smoke might be having a psychiatric effect on him -- he gets moody whenever I smoke. What do you think?

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     INSURANCE & HIV

    Health Insurance Enrollment and Pre-Existing Conditions
    Do health insurance policies have any sort of pre-existing condition exclusions dealing with HIV? What should I look for, and avoid, when selecting a policy?


    Life Insurance Payouts for AIDS-Related Expenses
    I have had life insurance through my employer for the last three years. I was diagnosed with HIV after I enrolled in the plan. I know I can keep the insurance when I stop working for the company, but will the insurance pay for my expenses if they're AIDS-related?


    Burial Expense Coverage for People With HIV
    I'm looking for a life insurance company that will cover burial expenses for a person with HIV. Can you help?
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     HEPATITIS B & C

    Epoetin Alfa Before Hepatitis C Treatment?
    Do people ever take epoetin alfa (Epogen, Procrit) before they begin hepatitis C treatment, to help prevent the lower energy levels that hepatitis C treatment can cause?


    Hepatitis C and Menopause?
    I was diagnosed with hepatitis C in 2001 at the age of 43, and haven't had a period in the past 18 months. Can hepatitis C cause a woman to go into early menopause? I don't really have money to do all the testing; I have no insurance, and have been receiving all my checkups from a nurse practitioner at a local family planning clinic. If it's not menopause caused by hepatitis C, what's causing my hot flashes and sweats?
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     MIXED-STATUS RELATIONSHIPS

    Freedom, Commitment, Guilt and Risk
    I have been HIV positive for a long time. I knew when I started seeing my HIV-negative partner that it would be a chronic worry, yet we have been together for 10 years now. And I was right: My fear of infecting him has been a constant source of worry and guilt for me. We have an "open relationship," which lately has meant that I have sex with other HIV-positive men. I love the freedom this gives me -- the lack of fear that I will be the one to infect them. (And yes, we all know about the risks of reinfection, and make our informed choices about that.) So what's the problem? Well, now I feel guilty that the sex I have with other men is more satisfying than it is with my partner. What's the way out? The way I feel now, I'd rather just jerk off and not have sex with ANYbody.


    My Girlfriend Was Just Diagnosed; What Do We Do Now?
    Less than a month into our relationship, my girlfriend's ex-husband called her to say he was HIV positive. It was scary for both of us, especially since we'd had unprotected sex several times. She got tested for HIV and it came back negative; I was too scared to get tested. Three months later, though, she took the ELISA test again, and the results came back positive. This was horrible, shocking and unexpected news. We are so much in love and our relationship was so perfect. She is such a strong and wonderful person -- her only concern is for whether or not she passed this on to me. I'm terrified of getting tested. How high is my risk, and what are the chances that her test was a false positive?
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     HIV TRANSMISSION

    Necessary Measures After Possible HIV Exposure?
    I've had a few encounters with an HIV-positive partner: oral sex twice and protected anal sex where I was the top (the condom broke, but I noticed right away and started anew with a fresh one). Five days later, I went to a doctor; he gave me an expensive HIV RNA test, and put me on a post-exposure prophylaxis regimen of efavirenz (Sustiva, Stocrin) and Trizivir (AZT/3TC/abacavir). After reading The Body, though, I'm starting to think this doctor is a quack. The expensive test he took appears to have been a few days premature, and I'm worried that I'll have serious side effects from these meds. What should I do?
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      STRANGE BUT TRUE

    Dizzying HIV Risk Question From a Transgendered Person
    An online friend of mine is a "trannyfag" -- a transgendered person who identifies more with being male than female, but who is into guys. He recently had an encounter with another guy, and is wondering if the unique sexual situation he's in puts him at any risk for HIV.


    Your Average, Everyday Maxi-Pad Sniffer
    I'm just an average guy, but I had a compulsion recently to go into a women's bathroom and sniff a used maxi-pad while sticking out my tongue. Now my nose is runny and when I pass gas, it smells kind of like the maxi-pad. Could I have gotten HIV or hepatitis from it?
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    Ask Dr. Young About
    STARTING HIV TREATMENT

    Dr. Benjamin Young

    Dr. Benjamin Young has been answering questions on our site since 2000. He's one of our most dedicated physicians. He not only does research on HIV treatment, but is also an attending physician at the Rose Medical Center in Denver and a clinical instructor in the Department of Medicine at the University of Colorado Health Sciences Center. He's one of three outstanding doctors available to answer your questions in The Body's "Ask the Experts" forum on starting HIV treatment.

    ART FROM HIV-POSITIVE ARTISTS
    Image from the December 2004 Visual AIDS Web Gallery
    "It Is Beautiful There," 1992;
    Arnold Fern
    Visit the December 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.