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June 7, 2005
In This Hot Topics:
  • HIV Treatment
  • Making Sense of CD4 Counts
  • Health Insurance
  • Living With HIV
  • HIV-Related Health Issues
  • Mixed-Status Couples
  • HIV Transmission
  • Strange but True

    CD4 Count 575, VL 48,000: The Right Time to Start Meds?
    I've just been diagnosed with HIV; my CD4 count is 575 and my viral load (VL) is 48,000. My doc is recommending aggressive treatment with Truvada (tenofovir/FTC) and efavirenz (Sustiva, Stocrin), but I'm scared of the side effects I've read about that efavirenz can cause. Should I consider holding off on meds?

    From Once a Day to Once Every Two Days?
    Are any studies being done to test whether some HAART regimens can be taken every other day? A friend of mine recently started taking his atazanavir (Reyataz) + Truvada (tenofovir/FTC) regimen every other day after discussing it with his doctor.

    Taking Two HAART Regimens Together
    My doctor switched me from Combivir (AZT/3TC) + nelfinavir (Viracept) to a new regimen of atazanavir (Reyataz) + ritonavir (Norvir) + Truvada (tenofovir/FTC). Since I still have plenty of the Combivir and nelfinavir pills left over, I've continued taking them as well so I can use them up. Is this dangerous?

    Interaction Risks Involving Boosted Protease Inhibitors
    I'm taking atazanavir (Reyataz) + ritonavir (Norvir) + Truvada (tenofovir/FTC), which is a boosted protease inhibitor-based regimen. I'm doing well, but I'm concerned about possible interactions between my HIV meds and other medications or supplements. For instance, I recently took a generic, over-the-counter version of Sudafed, and went through the roof -- I didn't sleep for three days! Given this reaction, I'm concerned about some other things I'm considering taking: Propecia (generic name: finasteride) for hair loss, as well as some antacids, common vitamins and supplements. What do you think?

    Impact of Spleen Removal on CD4 Count
    I'm a 50-year-old who was diagnosed with HIV 16 months ago. Although I've been told I may be a long-term nonprogressor, my CD4 count dropped from 1,700 to 1,100 within a year, leading me to suspect my immune system may not be as strong as previously thought. I'm particularly worried because I had my spleen removed after a road accident some 40 years ago, and I've read that asplenic patients such as myself can have misleadingly high CD4 counts. My doctors, however, seem to be unaware of this literature, and have scheduled my next appointment for three months from now. I'm concerned that within this time I may lose the advantage of an early diagnosis and strong immune system. Do you think I have cause for concern? Should I consider asking to be put on HAART?

    Why Won't My CD4 Count Top 500?
    When I tested HIV positive last September, my viral load was over 100,000 and my CD4 count was 305 (31%). I started HIV treatment right away, had no side effects, and within three months my viral load was undetectable and my CD4 count was up to 500 (41%). I'm thrilled, but my doctor said that my CD4 count will probably not go much higher. If, as he notes, little damage has been done to my immune system, why won't my CD4 count go any higher?


    Can a Person Use COBRA After Quitting a Job?
    I'm an unhappy employee living with HIV in Georgia. I'd like to pursue other work opportunities, but I get health insurance through my employer's group plan. In my line of work, the majority of available jobs are contracting positions that do not provide health insurance. If I resign from my present job, will I still be eligible for COBRA? Are there any insurance providers that would insure my pre-existing condition?

    Switching Jobs and Health Plans: Coverage and Privacy Concerns
    I'm planning to start a new job (and to switch health insurance plans) in Massachusetts, but because I'm on HIV treatment, I have several concerns about health coverage. First, my new job starts three days after my old job ends, but I don't know when my new health insurance will begin. If it doesn't begin immediately, do I need to sign up, or am I eligible for COBRA? Second, my new employer will require a physical. Could this include an HIV test -- and if so, could I be refused coverage? Third, my new employer may allow insurance for domestic partners, but my partner is HIV positive as well. Will he be tested for HIV as well?



    Anti-Malaria Meds and HAART
    I have plans to travel to Africa, and was advised to take anti-malaria medications. I take Combivir (AZT/3TC) and efavirenz (Sustiva, Stocrin); are there any problems that you're aware of with taking these meds along with a preventive malaria medication?

    Children, Summer Camp, HIV and Privacy
    When we adopted our daughter shortly after her birth, we knew she was HIV positive. She is now 13 and has had absolutely no health problems. She has been on HAART since 1996 with a consistently undetectable viral load. Her CD4 count has always been within the normal range for HIV-negative children but has naturally decreased since her infancy: It is now 925 (42%). She is on Truvada (tenofovir/FTC) and efavirenz (Sustiva, Stocrin). She desperately wants to go to a six-week summer camp with her girlfriends, but we are in a quandary: The camp requires that all medication be dispensed through the camp nurse. Obviously, none of her friends know about the HIV. We live in a very small suburban community and public knowledge of her condition would be devastating (we commute into the city for her HIV/pediatric care). As I see it, we can either 1) stop therapy for six weeks and disclose nothing to anyone, or 2) disclose to the camp and pray that there are no leaks and that the camp nurse doesn't freak out. Both options worry me greatly. What are your thoughts?

    False-Positive Drug Tests From HIV-Related Meds?
    A recent drug test came back positive for cocaine and marijuana, but I have not done either of these drugs in about 10 years. Could any of my prescriptions have caused false-positive test results? I am on: 3TC (lamivudine, Epivir), Kaletra (lopinavir/ritonavir), tenofovir (Viread), a multivitamin and several meds to prevent or treat opportunistic infections. Also, I have had several CAT scans, as well as radiation treatment for Kaposi's sarcoma. Would any of this affect a drug screening?



    Dr. Bob's Personal Experience With Sculptra
    Dear Dr. Bob: I postponed a scheduled procedure last week to inject poly-L-lactic acid (Sculptra, New-Fill) into my cheeks to treat facial wasting. I did this because I will be my cosmetic surgeon's first Sculptra patient and am hesitant about being his "first," even though he assured me that he would not overfill. You are the only person I know of who has had this procedure done; are you 100% happy with your results, and would you recommend it?

    Is Some AIDS-Related Dementia Irreversible?
    When I started HAART in November 1998 my CD4 count was 46 and my viral load was 466,000. I also had dementia, which had advanced to the stage where I was experiencing significant cognitive and motor-function impairment, including stumbling, dropping things and slurring of speech. On the plus side, since 1999, my viral load has been undetectable and my CD4 count has risen to 475. However, I continue to experience cognitive problems: poor memory, inability to concentrate, irritability, anxiety, depression, etc. I know there are many causes for these symptoms, but could the dementia have caused damage to my brain and nervous system that HAART cannot reverse?

    Treatment of Recurring Staph Infections
    I've had recurring staphylococcal infections -- four in the past year, each of them resistant to methicillin. Each time I have taken large quantities of Bactrim DS (generic name: sulfamethoxazole and trimethoprim) after a culture indicated susceptibility to the drug. Each abscess was also lanced and drained, and I've taken several other steps to treat these infections and prevent new ones. I'm currently completing treatment for the latest infection: I initially did 10 days of Bactrim DS once a day, then upped it to six a day for another eight days. To "eradicate" the infection, my doctor has prescribed an even more intensive course of treatment. Are we taking the right strategy to wipe out these recurring staph infections?

    Why Am I Getting Pancreatitis?
    I've had two incidents of pancreatitis in the past two years, and was wondering if you knew why it might be happening. I've been HIV positive for 20 years and am in relatively good health, with a CD4 count near 1,000 and an undetectable viral load. I've been on two different HAART regimens and several other medications. My triglycerides have been high for some time but not "over the top," and my cholesterol levels are within norms. I watch my diet very closely, get a moderate amount of exercise and weight training, and never miss a med dose. Why do I keep getting pancreatitis?



    Undetectable, HIV-Positive Woman Wants to Have Unprotected Sex With Hubbie
    I am an HIV-positive lady married to a loving and kind HIV-negative man. My last CD4 count as of April 2005 was 1,080 and my viral load was undetectable. Do you think with my viral load it is OK to have sex without a condom?

    Finding Out Your Partner Has HIV -- Without Him Telling You
    I just heard from someone that my partner is HIV positive! I was shocked! Before we ever hooked up I asked "the question" and he said he was fine! I am pretty sure he was lying back then because I just did some investigating, and found bottles of HIV medications. My partner and his friends never talk about his status (obviously); it seems to be a non-issue in his life. We have never had unprotected sex. I feel upset that he hasn't told me, but am not sure how to bring it up. I don't want him to feel bad. I'm having a really hard time with this; I feel a lot of guilt for not being HIV positive myself. How can I broach the subject without upsetting him?



    Needlestick Injuries and Post-Exposure Prophylaxis
    I had an accidental needle stick to a vein, but decided to stop post-exposure prophylaxis treatment due to side effects, and because I’m not sure how at risk I really am. For instance, I don't know if the needle had previously been in contact with an HIV-positive person. I'm a housekeeper and was stuck through a trash bag. What are my risks of getting HIV from this needle stick? Do you think I made the right decision about stopping the HIV treatment? If I have already been infected, would it really help?

    Men, Strap-Ons and HIV Risk
    I'm a guy with a thing for girls using strap-ons and butt plugs on me. Recently, I went to a sex worker who used a strap-on (with a condom), but I started to panic after I realized how many other guys she may have used it on. Do you think I'm at risk for HIV?


    A Different Way to Use Mouthwash
    I masturbated with a Scope bottle, and afterwards, I discovered some blood in my vagina. What should I do?
    Meet the Winners of's 2005 HIV Leadership Awards!
    Dr. Kristen Ries, winner of a 2005 HIV Leadership Award
    Meet Dr. Kristen Ries, one of 10 outstanding HIV physicians who have won a 2005 HIV Leadership Award from Dr. Ries' name is synonymous with HIV care in Utah: She directly or indirectly cares for nine out of every 10 HIV-positive patients in the state, be they in Salt Lake City (population 182,000) or Spring Lake (population 469). She has been treating HIV-positive people throughout the state since the earliest years of the epidemic.

    Want to meet all 73 winners of's 2005 HIV Leadership Awards? Click here!
    Art From HIV-Positive Artists
    Image from the June 2005 Visual AIDS Web Gallery
    Untitled (Keith Haring),
    c. 1985-1988; Juan Rivera
    Visit the new June 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 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.