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December 28, 2004
In This Hot Topics:
  • Pregnancy & HIV
  • HIV Drug Resistance
  • HIV Treatment
  • Fatigue & Anemia
  • Other Health Problems
  • Insurance & HIV
  • Hepatitis B & C
  • Strange but True
  •  PREGNANCY & HIV

    Efavirenz and Pregnancy: Is It Truly a Risk?
    I'm hoping to become pregnant in the near future and have questions about efavirenz (Sustiva, Stocrin). I've been taking efavirenz with AZT (zidovudine, Retrovir) and ddI (didanosine, Videx) for over 6 years, and it works well for me: no side effects, CD4 count over 900, viral load undetectable. I've been advised to stop taking efavirenz, but I read that women are giving birth to healthy babies while taking efavirenz, and I'm reluctant to stop taking something that works. No one seems to be able give me real figures on how many babies have been born with deformities to women on efavirenz. What do you think?


    If We're Pregnant, How Come We're Not Positive?
    My husband has HIV, but I don't. We conceived our first baby without knowing his status, and he got another woman pregnant last year, but neither of us were infected. How is this possible?
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      HIV DRUG RESISTANCE

    A Good First Regimen for NNRTI-Resistant People?
    I was diagnosed in June and found to have resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs). My viral load is over 100,000 and my CD4 count is 391. What do you think about starting treatment with atazanavir (Reyataz) and Truvada (tenofovir/FTC)?


    Experimental NNRTIs for People With Resistance
    Are there any new non-nucleoside reverse transcriptase inhibitors (NNRTIs) in the works that can be used by people who are resistant to the current set of NNRTIs?
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      HIV TREATMENT

    Can CD4 Counts "Blip"?
    My 18-year-old daughter was diagnosed with HIV in May. Her CD4 count suddenly dropped from 549 in August to 292 in October, but then went back up to 515. When my daughter's CD4 count first dropped, her doctor recommended she enter a clinical trial for a new drug. We're not sure what to do. Although my daughter and I don't want to lose the opportunity of trying out the new drug, we also don't want to start treatment until we feel it's necessary.


    Epzicom vs. Truvada for First-Line Therapy
    I've been doing a lot of research into first-line HAART regimens, and now that it's time for me to start treatment, I suggested to my doc that I take efavirenz (Sustiva, Stocrin) and Truvada (tenofovir/FTC). My doc, however, blew off my suggestion, saying something vague about resistance that I didn't really understand. He wants to put me on efavirenz and Epzicom (abacavir/3TC), but I'm worried about being one of the people who has a severe allergic reaction to the abacavir (Ziagen). What's your opinion?


    Is Simplification Alone a Reason to Switch From 3TC + d4T to Epzicom?
    My HIV doctor is extremely well known, but he doesn't spend time with me talking about diet or quality-of-life issues. He simply reviews my lab results, checks me out for less then 10 minutes and is gone. I'm currently taking 3TC (lamivudine, Epivir), d4T (stavudine, Zerit) and Kaletra (lopinavir/ritonavir), and experiencing some weight and fat loss, but nothing big. My numbers are relatively good: I'm not undetectable, but my CD4 count is in the 400s. My doc wants to discontinue the 3TC and d4T and start me on Epzicom (abacavir/3TC). When I asked him why, he said it was for convenience -- no other reason. But I've never had trouble adhering to my current regimen. Am I right to be concerned about switching?

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     FATIGUE & ANEMIA

    Can Anemia Lower CD4 Count?
    Although I've had HIV since 1985, I've never been on meds. Until recently my CD4 count had always been between 300 and 500, but lately it's been dropping -- it's now 262, and my viral load is 808. My doctor just told me I'm anemic. I'm taking iron supplements now. In addition, I'm scheduled to have gastric bypass surgery. Could the anemia be causing my CD4 count to drop?


    Sudden Onset of Fatigue
    I recently switched to a HAART regimen of Combivir (AZT/3TC), fosamprenavir (908, Lexiva, Telzir) and ritonavir (Norvir). I've had HIV for the last 4 years, but for 2 months now, I've been feeling weak all the time and have no energy. I get sick with flu-like symptoms when I get overly tired. What could be causing it?

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     OTHER HEALTH PROBLEMS

    Low Testosterone Level
    My first lab results since I was diagnosed with HIV showed a testosterone level of 5.8. How low is this? Should I get on some therapy to help raise it?


    Yeast Infections in Men?
    Can men get yeast infections? I am a bit embarrassed by this, but I have a substance that looks kind of cheesy -- like a gummy substance or small white specks gathered together in small clumps. It causes the foreskin to stick together and is difficult to remove even when I shower and attempt to clean it out. When I pee it also feels a bit uncomfortable, bordering on pain. I have been using the antifungals Monistat and Canesten off and on -- when I do, the substance goes away, but when I stop it comes back. I tried going to a doctor, who proceeded to tell me nothing was wrong with me. What do I do?

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     INSURANCE & HIV

    Disability and Health Insurance Concerns
    I've been HIV positive since 2002; at the time of diagnosis I was insured through an employer. Later that same year I was involved in an accident that left me unable to work until recently. In the meantime, my COBRA benefits ran out; now I'm on Medicaid. If I receive a large lump sum in a judgement for my injuries, how will this affect my insurance coverage? Also, if I find work I am able to perform, will I still be eligible to obtain private insurance through my employer regardless of my HIV status?


    Can I Take an Employer's Life Insurance Policy With Me?
    If I've worked for my company for more than 5 years, can I keep the life insurance that I bought into when I was first employed? If so, would it be expensive to do so?
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      HEPATITIS B & C

    Hepatitis B: How Often Should Liver Function Be Tested?
    For people with hepatitis B, how often should liver and hepatitis B virus levels be monitored? Some docs say it should be every 3 months, while others say every month.


    Varying Reactions to Adefovir + 3TC Therapy for Hepatitis B
    When I tested positive for hepatitis B, my hepatitis B viral load was 4 million. I started taking adefovir dipivoxil (Hepsera), and over 6 months my hepatitis B viral load slowly dropped. Then my doctor added 3TC (lamivudine, Epivir) to my treatment every other day, and over the next year my hepatitis B viral load dropped dramatically to about 4,000 -- where it remained. My doc upped my 3TC dose to once-a-day, and since then my liver and kidney levels have been rapidly going up and down. Why is this happening, and what should I do about it?


    Second Course of Hepatitis C Therapy
    My husband, who has HIV and hepatitis C, received peginterferon alfa-2b (PEG-Intron) and ribavirin (Copegus, Rebetol, Virazole) for 48 weeks to treat the hepatitis C. Three months after his treatment stopped, the hepatitis C came back, and his doctor put him on "maintenance therapy" -- peginterferon alfa-2a (Pegasys) without the ribavirin. After 5 months, he convinced his doctor to add the ribavirin. How long should he remain on this regimen the second time around?

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      STRANGE BUT TRUE

    Long-Range Semen and an Unsuspecting Eyeball
    Another guy and I were mutually masturbating -- we had no protection at the time, so we didn't want to do anything else. I thought I was playing it safe by staying 2 to 3 feet away from him, but he misfired and shot semen right into my eye (and a decent amount -- not just a drop). Just a freak accident I guess, but I was really shocked. I tried to wipe away as much as possible, but since I was wearing contacts at the time, I couldn't wash it out for almost an hour. I've read that there might be some HIV risk because there are mucus membranes in the eye. Is post-exposure prophylaxis or HIV testing warranted?
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    Ask Dr. Luzuriaga About
    Women, Pregnancy & HIV

    Dr. Katherine Luzuriaga

    Are you an HIV-positive woman in need of expert advice on gynecological problems, having a baby or other issues? Dr. Katherine Luzuriaga, a prominent AIDS researcher and a winner of several prestigious awards, is one of three experts who are more than happy to answer your questions in The Body's "Ask the Experts" forum on women and HIV. Stop in anytime and ask away!

    Art From HIV-Positive Artists
    Image from the December 2004 Visual AIDS Web Gallery
    Untitled (Smoke Self-Portrait),
    1985; Jimmy DeSana
    Visit the December 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.