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April 10, 2006
In This Hot Topics:
  • Issues for People With HIV Drug Resistance
  • Various HIV Treatment Questions
  • Metabolic Complications
  • Other Complications of HIV & HIV Meds
  • Health Insurance & HIV
  • HIV Transmission & Prevention
  • Strange but True
  •  ISSUES FOR PEOPLE WITH HIV DRUG RESISTANCE (NEW FORUM!)

    Are you a treatment-experienced HIVer with questions about your meds? Stop in at The Body's newest "Ask the Experts" forum! Dr. Eric Daar, a top HIV specialist who has been researching and treating people with HIV for the past three decades, is on hand to answer your questions about what to do when your HIV treatment options are limited -- whether because of drug resistance, side effects or other problems. Here's a sampling of the questions that Dr. Daar has answered in his first few days at the forum:


    Multidrug Resistant: Try a Drug in Development, or Fiddle With Existing Meds?
    I'm considering enrollment in a clinical trial for maraviroc (UK-427,857), an HIV drug in development. A drug resistance test was done as part of the enrollment process; it found that I had major resistance to all classes of HIV meds. I'm on a regimen now and I'm feeling relatively healthy, but my viral load has been rising (it's now at 420,000) and my CD4 count has been dropping (it's now at 150). My question is: Should I sign up for this maraviroc trial, or would I just be setting myself up for failure since the other drugs in my regimen don't work well? Would I be better off playing around with already-approved meds while I wait for other new drugs to be developed?


    Is My New Regimen More Effective and More Fat-Friendly Than My Old Regimen?
    I recently switched from Combivir (AZT/3TC) + indinavir (Crixivan) to 3TC (lamivudine, Epivir) + atazanavir (Reyataz) + ritonavir (Norvir) + tenofovir (Viread). Do you think my new regimen is likely to be effective? Will it help me regain any of the fat I've lost in my legs and buttocks?
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     VARIOUS HIV TREATMENT QUESTIONS

    Why Boost With Ritonavir?
    What's the reason that so many protease inhibitors are "boosted" with ritonavir (Norvir)?


    Starting Treatment With a CD4 Count of 243?
    I was just diagnosed with HIV last month. My CD4 count is 243 and my viral load is 5,000. Should I start treatment? Which meds should I take?


    Can I Stop Taking Meds Now That I've Had My Baby?
    I started taking Combivir (AZT/3TC) + nevirapine (Viramune) during my pregnancy. By the time I had the baby, my CD4 count had gone from 430 to 900 and my viral load had dropped from 230 to 90. Now that I've had the baby, can I stop my meds?


    CD4 Count and Viral Load Both Rising on a New Regimen
    My CD4 count is on the rise, but so is my viral load. I've been on treatment for two years and have never missed a dose, but after switching regimens in June 2005, my viral load has climbed from undetectable to 60 and then 400, while my CD4 count has shot up from the mid-300s to 485. What's going on? Could I be developing resistance, even though the regimen seems to be working wonders for my CD4 count? Should I consider another switch?


    Undetectable Viral Load but Stagnant CD4 Count on Efavirenz + Truvada
    I have been on efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC) for four months. After the first month, my viral load went from 100,000 to undetectable, where it remains. My CD4 count, however, won't budge from 292. My doctor mentioned some research that indicates my CD4 count might rise if I switch to a protease inhibitor. Should I wait and see if my CD4 count rises on my current regimen, or should I look into the protease inhibitor option?
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     METABOLIC COMPLICATIONS

    Protease Inhibitors and Metabolic Problems (Lipodystrophy, High Cholesterol, Etc.)
    As a class, are protease inhibitors mostly responsible for lipodystrophy (unusual fat gain/loss in specific parts of the body), high cholesterol/triglycerides and insulin resistance?


    High CD4 Count and Fat Loss: Could I Take a Treatment Holiday?
    Do you think it's a good idea for me to stop taking my HIV meds? I've been HIV positive since 1992, but my CD4 count has never been below 510. I started treatment about six years ago; since then, my CD4 count has more than doubled, and my viral load has been undetectable. However, I've lost a lot of fat from my arms and legs over the past two years. Could stopping treatment help me gain some of my fat back?


    What Types of Fat Loss May Be Caused by Testosterone?
    I know that testosterone is often used to treat HIV-related wasting. However, it's also true that fat loss can itself be caused by testosterone. How is this possible? How does the fat loss caused by testosterone differ from fat loss that is caused by wasting, or the fat loss in the arms, legs or face caused by d4T (stavudine, Zerit)?

    [Editor's note: This post is the latest in an ongoing discussion in our "Choosing Your Meds" forum about testosterone and fat loss. The Body highlighted this discussion in the last issue of "Hot Topics"; click here to read previous posts on the subject.]


    Advice for an HIV Treatment Veteran With Fat Gain
    When I was diagnosed with HIV in 1995, I was extremely sick: My CD4 count was less than 50, I had several opportunistic infections and, although I'm small (I'm a five-foot-tall woman), I weighed only 86 pounds. Since starting combination treatment in late 1996, I've had an incredible turnaround: My CD4 count is now at 1,300, my viral load is undetectable and I've gained 51 pounds. The problem is, not all the weight is good weight: I've gained a lot of fat in my breasts, arms, legs, face, chin and belly. My doctor thinks there's no problem -- he calls all this extra fat a much-needed "buffer" -- but I don't look good, and as a result I don't feel good. I've been on several different regimens in the past 10 years, but the fat won't go away. Should I just stop treatment entirely? What else can I do?
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     OTHER COMPLICATIONS OF HIV & HIV MEDS

    Diarrhea After Switching From Old to New Kaletra
    I recently switched from Kaletra (lopinavir/ritonavir) capsules to the new Kaletra tablets. I had no problem on the capsules, but since I switched to the tablets, I've had diarrhea almost constantly. What can I do? Is there any way to get the old Kaletra back?


    How Do I Deal With Unexplained Chronic Diarrhea?
    I've had chronic diarrhea for four months now. It continued even while I stopped taking my Truvada (tenofovir/FTC) + efavirenz (Sustiva, Stocrin) regimen for six days. What could be the cause, and what can I do about it?


    Shoulder Replacement Surgery and HIV: Anything to Keep in Mind?
    I'm considering a complete shoulder replacement due to advanced osteoarthritis. I've been HIV positive for three and a half years, am taking HIV meds, have an undetectable viral load and have a CD4 count of 700. Is there anything I need to tell my surgeon about my HIV status or my current meds?


    Treating Avascular Necrosis: Any Way to Avoid a Hip Replacement?
    I'm 47 years old, and I've already had my right hip replaced due to avascular necrosis. My doctors say it's inevitable that the left hip will need to be replaced as well. I don't understand why my doctors aren't exploring some early-stage treatments to help avoid a second hip replacement. Is there anything I can do to avoid another hip replacement?


    "Bushwhacked" in Australia: How Do I Combat Fatigue?
    I am a university student in Australia and was recently diagnosed with HIV. My CD4 count is 267 and my viral load is 150,000. My doctor started me on efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC) and I haven't missed a dose yet, but I'm pretty bushwhacked! (Or "fatigued," whichever you prefer!) Iron tablets sorted out my anemia, so I reckon the fatigue has a lot to do with being a full-time chemistry student and a busy athlete! I'm having trouble keeping up with all my activities now that I'm poz. How can I manage my fatigue and my schedule? Would it be easier if I disclosed my status to professors and coaches?
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     HEALTH INSURANCE & HIV

    Note From a Reader: Check Your Drug Coverage Options Carefully!
    When I was diagnosed with HIV, my partner discovered that as his domestic partner, I could be added to his company's excellent health coverage plan. Then a nurse from the health plan called to tell me about a mail-order prescription benefit. I now pay just a $45 copay for a 90-day supply of each of my meds -- that works out to about $51 per month, instead of the $367 copay per month I had been paying at the local pharmacy. Those who are lucky enough to be covered by insurance should check their coverage carefully to be sure they are getting the best deal possible for prescriptions!


    What's the Best Way for a Self-Employed Person With AIDS to Get Health Coverage?
    Are there specific health insurance companies that are more likely than others to insure a person with AIDS? My husband has AIDS, is self-employed and is on Medicaid. Is it possible for him to buy health insurance?


    My Health Insurance Company Is Merging and Eliminating My Coverage!
    I just received a letter from my health insurance company telling me that, due to a merger with another company, my current health plan is being terminated. I'm allowed to apply for individual coverage with the other company, but if I do so, could my HIV be considered a "pre-existing condition" under the new plan, making me unable to get coverage for my HIV-related medical needs?
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     HIV TRANSMISSION & PREVENTION

    Truvada and HIV Prevention: Worth the Hype, or a Money-Making Conspiracy?
    At first, I was all for this new group of studies being done to see if taking Truvada (tenofovir/FTC) can help prevent HIV-negative people from getting the virus during unprotected sex. But the more I think about it, the more I worry. Could this just end up being another way for a drug company to make huge profits while people who can't afford the drug are left at higher risk of getting HIV?


    HIV Infection and the Law: Can an HIVer Be Arrested for Having Unsafe Sex?
    What does U.S. law say about HIV-positive people who knowingly infect others? I am negative, but I've been involved in sexual relationships with a few HIV-positive people over the years. If an HIV-positive person who knows he or she is HIV positive has unprotected sex with someone like me, can they be prosecuted?


    How Do I Explain to My Daughter-in-Law That I Can't Infect Her Baby?
    My daughter-in-law just gave birth to a healthy baby girl. When I visited with them, I noticed that my daughter-in-law seemed nervous whenever I held the baby. When I talked to my son about it, he explained that she was afraid I might transmit HIV to her child. What should I say or do to help her understand that she's horribly misinformed?


    Condom Slippage and Post-Exposure Prophylaxis
    I'm a 23-year-old, HIV-negative man living in England. Last night I had sex with a guy I met once before, and at some point the condom fell off. I later found out he was HIV positive. Should I seek out post-exposure prophylaxis?
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      STRANGE BUT TRUE

    HIV Risk and "Sounding" (a.k.a. "Cock-Stuffing")
    During one of our more intense play sessions, my partner and I each inserted a glass "sound" (a thin rod) into our penis -- he went first, then we wiped it off and I used it. He's HIV positive; I'm not. Did I put myself at risk for HIV?
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    Profiles in Courage
    Inspiring Stories From HIV-Positive African Americans

    Precious Jackson
    The downsides of living with HIV are all too clear, but some HIVers look back on their diagnosis as a blessing in disguise. Precious Jackson is one of those people. For years after she got HIV from her boyfriend during unprotected sex, Precious was angry, upset and ashamed. When she finally sought out the support she needed, her life changed.

    "For some people I've talked to, HIV changes their lifestyle, how they used to live -- now they feel healthier and are not abusing themselves anymore. That's what happened to me," Precious explains in this exclusive interview with The Body. Her recovery has allowed her to move beyond simply coping with day-to-day life: Precious has found (and married) the love of her life, and as an AIDS advocate, she now helps other people adjust to living with HIV, and fights for better medical care and cultural sensitivity for HIV-positive African Americans, especially women.


    The Body is honored to present this one-on-one interview with Precious, along with 12 other profiles in courage, in our African-American HIV/AIDS Resource Center. Stop in and browse through interviews, personal perspectives, podcasts, resource listings and more!

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the April 2006 Visual AIDS Web Gallery
    Untitled, 1987; John Larabee
    Visit the April 2006 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The April 2006 Web Gallery is entitled "Diving Into the Archive"; it's curated by painter David Spiher, a gallery reviewer for Gay City News.