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June 21, 2005
In This Hot Topics:
  • HIV Treatment
  • Understanding Your Labs
  • HIV/HAART-Related Health Issues
  • Privacy & Insurance Issues
  • HIV Transmission & Testing
  • Hepatitis
  • Strange but True
  •  HIV TREATMENT

    Is Generic ddI Available in the United States?
    I just had a prescription for Videx EC filled, and was very surprised to find that my prescription was filled with a generic version of the drug (didanosine). I brought it to the attention of an HIV group that I attend, and everyone is perplexed: We all thought that generic HIV meds were not being dispensed in New York. Do you know of other HIV generics that are being dispensed in New York or other parts of the United States?


    Viagra, Efavirenz and Truvada: Any Interactions?
    I recently began therapy with efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC), and have been responding very well. Could the occasional use of Viagra (generic name: sildenafil) have any interaction with my HIV medications?


    Is My Combo OK for First-Line Treatment?
    I started HIV treatment with ddI (didanosine, Videx) + efavirenz (Sustiva, Stocrin) + tenofovir (Viread), but had to switch the efavirenz to atazanavir (Reyataz) + ritonavir (Norvir) after I developed dizziness and fatigue. Now that I've added atazanavir and boosted it with ritonavir, does the dosing of my other meds need to change? Is there another regimen I should consider? My CD4 count hovers between 70 and 160.


    Second-Guessing a Switch to a Protease Inhibitor
    Since I tested HIV positive, I've been on the same combination of meds, none of which are protease inhibitors. I had no side effects, my CD4 count climbed to around 500 and my viral load was undetectable -- until recently, when it increased to between 100 and 400. Given that fact and my growing ALT levels (I have hepatitis C), my doctor wants to switch the nevirapine (Viramune) in my regimen to nelfinavir (Viracept). His suggestion made me realize just how afraid I am of starting protease inhibitors -- afraid of side effects, both long and short term. What do you think? Should I go ahead with this switch?
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     UNDERSTANDING YOUR LABS

    In Lay Terms: What Viral Load and CD4 Count Numbers Mean
    I'm a supportive friend of someone who recently tested HIV positive. He tells me his viral load over the past two months has gone from 7,800 to 355,000, and that his CD4 count dropped from 290 to 230. But I don't really understand what these numbers represent. Can you help me to understand them in non-clinical terms?


    One Blood Sample, Two Different Viral Loads?
    How can two of the available HIV viral load tests -- PCR and NASBA -- both be legitimate when they each get different results from the same person? The wrong test was used for my last blood draw; it showed a viral load of 29,000. When my healthcare team discovered it had used the wrong test, it ran the other test on the same blood draw -- and got a viral load of only 9,000! Can you help me understand this disparity? It leaves me, the patient, without a point of reference. It also makes me wonder if any of these numbers really mean anything.
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      HIV/HAART-RELATED HEALTH ISSUES

    Kaletra and Caffeine: How Much Is Too Much?
    When I first started taking Kaletra (lopinavir/ritonavir), I was told not to have caffeine. I've had no problem giving up caffeinated coffee, tea and soda, but giving up chocolate is killing me. Is it safe to eat some chocolate when I'm taking Kaletra, and if so, how much?


    Do Nevirapine's Side Effects Happen for Efavirenz, Too?
    Three years ago I took nevirapine (Viramune) for one week, but stopped it after developing a high fever and hepatitis. Since then, I haven't taken any meds, but now I'm about to start treatment again. Is it safe for me to take efavirenz (Sustiva, Stocrin), which is an NNRTI just like nevirapine, or will I have the same side effects?


    Lactic Acidosis, Hepatitis Coinfection and Liver-Related Side Effects
    I have HIV, hepatitis A and hepatitis B, but am otherwise in excellent health. I began HIV treatment a year ago with Combivir (AZT/3TC) + Kaletra (lopinavir/ritonavir) and did very well, but had to stop treatment after I developed lactic acidosis and discomfort in my upper stomach, near my liver. Now, after a two-month break, my doctor has started me on Kaletra + Truvada (tenofovir/FTC), but the stomach discomfort has started up again. What should I do?


    What's Causing My Rash?
    I've been on HAART for almost four years: I started with efavirenz (Sustiva, Stocrin) + Trizivir (AZT/3TC/abacavir), but switched the Trizivir to Epzicom (abacavir/3TC, Kivexa) six weeks ago. Last week, I started taking antihistamine tablets for hay fever, and after a day or two I developed a full-body rash. Do you think the antihistamine is the cause, or could I be having a delayed hypersensitivity reaction to the abacavir in the Epzicom, even though I took abacavir for four years as a part of Trizivir?


    T-20: Seizure Drug Interactions and Managing Injection Site Reactions
    I have two questions about T-20 (enfuvirtide, Fuzeon). First, are there any potential interactions between T-20 and Depakote (generic name: divalproex, which is used to control seizures)? Second, do you have any suggestions for treating persistent injection site reactions, beyond the normal creams and lotions?


    HIV Meds + the Sun = Sick?
    I've been taking Combivir (AZT/3TC) + efavirenz (Sustiva, Stocrin) for nine months; my viral load has been undetectable and my CD4 count near 300. My problem is the sun. Let me explain: I feel pretty well in the morning, but as soon as the sun shines brightly, I get a sick feeling. All afternoon and into the early evening I feel almost like I have the flu; I feel fatigued, achy and feverish, though my body temperature is normal. Then, a couple of hours after the sun goes down, I feel better again. Is there a known reaction between the sun and Combivir or efavirenz that would make me feel sick every day?


    Seizures at the Dentist
    I recently went to a dentist, and as soon as he gave me lidocaine (a local anesthetic, used to numb the area where it's injected), I had severe convulsions. Could this have had anything to do with the HIV meds I'm taking?

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      PRIVACY & INSURANCE ISSUES

    Do I Have to Disclose My HIV Status and Meds in a Medical Questionnaire?
    Although I've been working here for two years, my employer has just given me a medical questionnaire to fill out. It not only asks me to name the medications I'm taking, but it also asks if I am positive for HIV and hepatitis! I'm thinking that this is against the law and no one's business. If I am correct, how should I handle this?


    Switching From COBRA to Individual Health Coverage
    I'm HIV positive and am seeking to resign from my current job in order to open my own business in New York City this fall. After I resign, I'll have COBRA for 18 months. What are my options for individual health coverage? My biggest concern is prescription drug coverage, but I'm also worried about issues related to pre-existing conditions. I believe most policies will not cover pre-existing conditions for six months after enrollment, so should I enroll in a new plan at least six months before my COBRA coverage ends?

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      HIV TRANSMISSION & TESTING

    What Happened to the New York City "HIV Superstrain"?
    Whatever happened to the New York City man who was infected with the "new" strain of HIV -- the one that progressed to AIDS quickly and is resistant to all available meds? The story hit the news for a few days, but I never heard anything else about it. Do you have any insight?


    Confidential HIV Testing: Avoiding Medical Records
    I remember reading somewhere that if you're in the United States and you get tested for HIV through your general practitioner (or internal medicine doctor), then -- regardless of the test result -- you can be refused mortgages, loans and so forth in the future. This is because the test goes on your medical record, and can be viewed by parties providing such financial services. Is this correct, or have I been completely misinformed? How can I get an HIV test without it going on my medical record?

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      HEPATITIS

    If I Stop My Hep C Treatment, Will the Virus Come Back?
    I have hepatitis C genotype 2a, for which I began treatment nine weeks ago. My blood tests for the past month have shown a viral load of zero, but I am having severe problems with acid reflux, fatigue and depression. I don't want to stop treatment, but if I have to, what is the chance that my hepatitis C virus will return? Should I consider stopping only part of my treatment -- i.e., drop the ribavirin, but keep the interferon?


    Can a Man Carrying Hepatitis B Transmit It to His Unborn Child?
    I was diagnosed as a hepatitis B carrier in 1998; according to my doctor, there's no cure for this, but that I'd be fine as long as I avoided drinking liquor. My partner and I are planning to get married next year and have kids. My partner doesn't have hepatitis B, but if she gets pregnant, will our baby be infected with the virus?

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      STRANGE BUT TRUE

    The Tale of the Treacherous Tampon
    I know it is highly unlikely that I can get HIV from this, but I just have to ask to be sure because I have never had this happen to me. In the process of removing my tampon in a public restroom, the tampon swung up and hit the rim of the toilet, then swung back and hit me square in the opening of my bottom. Should I be worried? I didn't notice anything on the toilet and, of course, it was my blood on the tampon.


    Procrit Can't Solve This Kind of Problem
    I'm feeling really tired and run-down lately. Will Procrit (generic name: epoetin alfa) improve my energy level? I'm not HIV positive and have no idea if I'm anemic, but I sure feel low. You see, I broke up with my girlfriend after she caught me in bed with a guy. It really wasn't going to work out with her anyway. As if things couldn't get any worse, I was laid off from my job and had to move back in with my mother. My ex-girlfriend called my mom and told her about my sexual adventures; my mother, who is Baptist, didn't take the news well. She refuses to let gay books or movies in the house. She's even screening my calls. Thank god she doesn't understand computers or the Internet! So what do you think: Should I give Procrit a try?
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    Meet the Winners of TheBody.com's 2005 HIV Leadership Awards!
    Michael Bauguess, winner of a TheBody.com 2005 HIV Leadership Award
    Meet Michael Bauguess, PA-C, one of 10 outstanding HIV physician assistants and nurse practitioners who have won a 2005 HIV Leadership Award from TheBody.com. Michael was instrumental in building an HIV practice in Oroville, Calif., a rural area in north-central California that, until his arrival, had no comprehensive healthcare services for HIV-positive people.

    Want to meet all 73 winners of TheBody.com's 2005 HIV Leadership Awards? Click here!
    Art From HIV-Positive Artists
    Image from the June 2005 Visual AIDS Web Gallery
    "Marching for Their Children," 1996;
    Brent Nicholson Earle
    Honor LGBT Pride Month by visiting the June 2005 Visual AIDS Web Gallery, 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.