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April 18, 2005
In This Hot Topics:
  • Issues for Treatment-Experienced HIVers
  • Starting HIV Treatment
  • Living (and Dating) With HIV
  • HIV & Health Insurance
  • HIV/HAART-Related Health Problems
  • Mother-to-Child HIV Transmission
  • Strange but True
  •   ISSUES FOR TREATMENT-EXPERIENCED HIVERS

    Can Old Resistance Hurt a New Regimen?
    Can pre-existing NRTI resistance reduce the efficacy of a regimen containing Truvada (tenofovir/FTC)? I took NRTIs from 1991 to 1999 (much of that time was before HAART existed), but then took a treatment break until this year. I've been taking efavirenz (Sustiva, Stocrin) and Truvada for 75 days now, and though my viral load almost immediately dropped by more than 99%, my two-month checkup showed a slight rise. A resistance test back in 1998 found 3TC (lamivudine, Epivir) resistance. Could that be why my treatment response hasn't been even stronger?


    Choosing Between Two Protease Inhibitors in Development
    I'm resistant to most HIV meds. My doctor has recommended I switch to a regimen containing T-20 (enfuvirtide, Fuzeon) and one of two protease inhibitors in development: tipranavir or TMC-114. I could start tipranavir now, or I could wait and join a TMC-114 trial this summer. My CD4 count is 60 and my viral load is over 100,000. Should I go with the tipranavir, or wait for the TMC-114?


    Should I Keep Waiting for a New Drug Class?
    I was diagnosed with HIV in 1993, and since then have developed resistance to many different HIV meds; although I've gotten great medical care, if my doctors and I knew then what we know now, we never would have switched meds so often. Lately my health and numbers have been declining (CD4 count 60, viral load 180,000), and my doctor is anxious to start me on T-20 (enfuvirtide, Fuzeon) and tipranavir. But a specialist at a nearby university is recommending I wait a while longer, and then enroll in a clinical trial that will include a new class of drug -- an integrase inhibitor -- along with T-20 and tipranavir. Would it be worth it to wait?


    Was It the Wrong Time for T-20?
    My husband was diagnosed with AIDS and multiple opportunistic infections in October 2002, but got better thanks to a wonderful doctor and 98% adherence to his HAART regimens. He's been through a couple of regimens, though -- the first one was stopped due to side effects, and his viral load began creeping up while on the second. When his viral load reached 614 a couple of months ago, his physician added T-20 (enfuvirtide, Fuzeon). But lately, my husband has also become depressed and angry, and stopped adhering well to his new regimen. What should we do? Was adding the T-20 a good idea?

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      STARTING HIV TREATMENT

    First-Line Therapy Choices
    I'm likely going to have to start treatment soon, and was hoping to get your opinion on the "perfect" combination of meds. What's your take on Epzicom (abacavir/3TC, Kivexa) vs. Truvada (tenofovir/FTC)? Non-nucleoside reverse transcriptase inhibitors (NNRTIs) vs. protease inhibitors?

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      LIVING (AND DATING) WITH HIV

    Disclosing to an HIV-Negative Partner in a Threesome
    My partner of 19 years (who's negative) and I (positive) want to bring a third man into our relationship. Everything seems to be going well, but now we have to figure out how to tell him I have HIV. Can you suggest a way of breaking this news to our new partner?


    Health Priorities for HIVers
    What do you feel are the three most important health priorities for a person living with HIV?

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     HIV & HEALTH INSURANCE

    Health Insurance Enrollment and "Pre-Existing Health Conditions"
    Do employers ask questions about pre-existing health conditions on health insurance enrollment forms for new hires? I'm an HIVer living in Washington State and am about to start a new job; I haven't filled out healthcare insurance forms with a new employer since 1994.


    Switching Jobs and Insurance Plans
    I'm HIV positive, and am planning to leave my job with a large corporation to join a small start-up. Both my old and new company offer health insurance coverage, but there will be a two-week gap between when I leave my old job and start my new one. I'm not sure how the health-insurance transition works. What should I do?


    COBRA Expiration, Medicare and New Health Coverage
    I am currently on disability insurance, and am covered by my previous employer's policy through COBRA. This policy will end in August of 2005. As of January 2005, I received my Medicare card. I would like to return to work later this year. Assuming that I'm unable to do so until after my COBRA runs out, will my Medicare be considered creditable insurance coverage in the interim period before I get insurance through a new employer?
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     HIV/HAART-RELATED HEALTH PROBLEMS

    Spare the NRTIs, Spoil the Wasting?
    I'm doing quite well on a regimen with two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), but although my lipid levels are fine, I'm concerned about eventually losing peripheral fat and developing facial wasting. I know that some studies are examining the idea of regimens that avoid NRTIs entirely. What are your thoughts on these regimens in terms of managing side effects?


    Taking Oxandrin to Treat Weight Loss
    I'm a 40-year-old man with syphilis who was diagnosed with HIV last September. I'm doing well on my regimen, but after losing 10 pounds during my syphilis outbreak, I now weigh 125 pounds (I'm 5'8" tall). I've always been slim, but my doctor feels that 125 pounds is simply not healthy, and has suggested I start taking Oxandrin twice a day. What do you think? I'm also taking a HAART regimen of efavirenz (Sustiva, Stocrin) and Truvada (tenofovir/FTC), and am taking Lipitor for high cholesterol.


    Boosting Natural Testosterone Production
    I'm 41, living with HIV for more than 15 years, and am on HIV meds. My health has always been great, I'm in good shape and my testosterone levels are normal, but I just don't have the energy or sex drive I had only five years ago. Is there something I can take to boost my own natural production of testosterone?


    Declining Blood Counts and Bone Marrow Concerns
    My blood counts, hemoglobin and platelets have been declining steadily for a while now, and my doctor is urging me to see a hematologist. I think he feels that my bone marrow is pooped out, that I could have some infection in my bone marrow or that I might be experiencing drug toxicity. I feel frustrated and anxious; I've been on meds since 1993, but my CD4 count is 65, my viral load is 180,000, and I've had a few other health problems over the past few months. Do you think a visit to this blood specialist is worthwhile?


    Hepatitis B and C Infection Rates in HIVers
    How many HIV-positive people are coinfected with hepatitis B or hepatitis C?
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      MOTHER-TO-CHILD HIV TRANSMISSION

    Breastfeeding Risk for Undetectable Moms
    Can a mother transmit HIV to her baby through breastfeeding, even if the mother has an undetectable viral load?

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      STRANGE BUT TRUE

    When There's a Prostitute on Your Face
    If a naked prostitute sat on my face, and I had broken pimples at the time, is there a chance she could have transmitted HIV to me?


    The Filipino Zipper Accident
    In December, I took a trip to the Philippines, and foolishly enough, I got some of my foreskin caught in my jeans zipper. It hurt, but there wasn't any blood. Even more foolishly, I went out and paid for a girl for the night, shortly after the zipper accident. All sex was protected with a condom. However, within the last week I've been having strange symptoms. What was my HIV risk?
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    Art From HIV-Positive Artists
    Image from the April 2005 Visual AIDS Web Gallery
    "A Wicked Man and Bold,"
    2002; Memphis
    Visit the April 2005 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists!

    Your Unused HIV Meds
    Can Save Lives!

    AID FOR AIDS

    AID FOR AIDS is a New York-based nonprofit organization that collects unused, HIV-related medications and redistributes them to people living with AIDS in Africa, the Caribbean and Latin America.

    Have HIV-related medications (including antiretrovirals and meds used to prevent or treat opportunistic infections) you'd like to donate? AID FOR AIDS will pay the price of postage if you're unable to afford the cost. Click here to learn more.