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July 31, 2006
In This Hot Topics:
  • Living With HIV
  • Starting HIV Treatment
  • Questions About Atripla
  • Complications of HIV & HIV Meds
  • HIV News & Views
  • Strange but True

    Do We Have an Unusually Aggressive HIV Strain?
    My partner and I were recently diagnosed with HIV and AIDS. How could this have happened so quickly? The longest we could have been positive is about three years, and our HIV strains aren't resistant to any meds. Yet our CD4 counts are very low (mine is only 25) and I've already developed thrush. Do we have an especially aggressive strain of HIV? Does this mean my life span is destined to be shorter than that of other recently diagnosed people?

    I Don't Want to Rely on Antidepressants
    I was diagnosed with HIV six months ago and haven't started meds. I have a CD4 count of 568 and a viral load of 7,800. I take Zoloft (sertraline) for depression, and I'm concerned that the medication isn't as effective as it used to be. I'm not feeling bad, just not as well as when I first started taking it. The first two or three months on Zoloft I was really happy and active. Now I don't feel as energetic or cheerful, and I'm afraid that I'll start experiencing depression or anxiety attacks again. I don't want to tell my psychiatrist about this, because I'm afraid she might want to increase the dose -– and that could lead to an endless progression of ever-higher doses of Zoloft. What can I do?

    Is There Any Chance of Recovery if Your CD4 Count Drops Near Zero?
    A relative of mine in Ecuador recently died of AIDS. His CD4 count had dropped to 2, and he had a number of illnesses before he passed on, including chickenpox, pneumonia and a brain infection. I know he's gone to a better place, but I wonder: Did he have a chance of survival, or is it impossible to bounce back from such a low CD4 count? Was it the low CD4 count or the illnesses that caused his death?

    My Docs Disagree on When I Should Start Taking Meds
    I was recently diagnosed with HIV. My labs are good, but my doctors disagree about when I should start meds. One doctor says that I should start a regimen right away, while the other tells me to hold off as long as my labs are good. I am really confused -- why is there this discrepancy on when to start meds? The doctor who wants me to start meds immediately says that since today's meds are less toxic than before, earlier treatment is the better option. Is one theory better than the other? Is there any supporting evidence that holding off on treatment is a better option?

    Do I Have to Switch My Meds if My Viral Load Doesn't Quickly Become Undetectable?
    I found out that I was HIV positive in February. My initial labs showed a CD4 count of 179 and a viral load of 55,000. I started treatment almost immediately and have been 99.9% adherent. My first set of lab numbers since starting meds is due in the next week, and my doctor told me that if my viral load isn't undetectable he'll probably want to change my meds. Is this appropriate after only three months on treatment? I really like this regimen -- easy to take, once-a-day pills, no side effects -- and I would hate to have to change it. What do you think?

    When Should I Start Treatment? Can Meds Really Boost My CD4 Count?
    My recent diagnosis left me sleepless and hopeless for a while, but now I've had a turnaround -- I've started modifying my diet and exercise routine, and I'm thinking about my future. My CD4 count is 360, but I suffer from recurring thrush and sinus problems. Is it true that HIV medications can really improve my CD4 count? My doctor has advised me not to start treatment until my CD4 count is between 200 and 250. Is my doctor right?

    Why Did My CD4 Count Drop After Starting Treatment?
    When I started HIV treatment, my CD4 count was 254. Within a few months, my count was up to 541 -- but a few months later it had dropped to 225. My doctor told me not to worry, but I thought HIV treatment was supposed to make my CD4 count go up and stay that way.

    Atripla for Rescue Therapy?
    I'm resistant to almost every HIV medication, and I have trouble taking T-20 (enfuvirtide, Fuzeon) because of the injection site reactions. Can Atripla (efavirenz/tenofovir/FTC) help me?

    Fear of New Meds: Is It Smart to Worry About Unknown Problems?
    I'm very cautious when it comes to switching to new HIV meds: Last year, I avoided making the change from efavirenz (Sustiva, Stocrin) + Combivir (AZT/3TC) to efavirenz + Truvada (tenofovir/FTC) because I wanted to wait and see if researchers would find any new concerns about Truvada's long-term effectiveness and side effects. Now I feel the same way about Atripla. Am I right to worry about Atripla's effectiveness?

    Avoiding Resistance: Can Twice-Daily Be Better Than Once-Daily?
    I'm considering a switch from efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC) to Atripla (efavirenz/tenofovir/FTC), but the idea makes me nervous. Right now, I take my Truvada in the morning and my efavirenz at night, so I feel like I get good "coverage." If I take Atripla, I'll only be taking one pill once a day. Could that put me at a greater risk for resistance if I ever miss a dose?

    Lipo Is a Serious Problem, but My Doc Doesn't Seem to Care
    I am 39 years old and have been positive since 1996. Although my viral load is undetectable and my CD4 count is over 500, I suffer from a distended belly due to lipohypertrophy. I also have lumps in my chest, back and arms, and my breasts are enlarged. The medical staff I work with minimizes my concerns and seems to think I have an agenda to stop my meds or get free plastic surgery -– which is crazy! I realize the importance of taking medications, and I don't want to stop, but I really need to do something about the side effects. Lipodystrophy is causing me pain, discomfort and embarrassment. How can I get my doctor to take my concerns seriously and work with me on a solution?

    Truvada and Kidney Function
    Is it a risk to take Truvada (tenofovir/FTC) when I have only one kidney? I've heard it can put a strain on kidney function.

    I Can't Stand Fuzeon-Related Injection Site Reactions
    I've been on T-20 (enfuvirtide, Fuzeon) for over a year, and I get horrible injection site reactions: Wherever I inject, the site becomes inflamed, swells to the size of a coaster and hurts like hell within 12 hours. My skin is like leather. How can I alleviate some of this discomfort and pain? Will my skin be damaged for life? I feel as though I'm at the end of my rope with this regimen. I know it's beneficial, but at what cost?

    Will Kaposi's Sarcoma Lesions Fade After Starting HIV Treatment?
    Over the past month, I've developed Kaposi's sarcoma lesions on much of my body. Will these lesions go away after I start taking HIV meds?

    Dr. Bob Responds to Question About AIDS Denialism
    Dr. Bob, there's a molecular cell biologist named Peter Duesberg who says HIV doesn't cause AIDS. What do you say?

    Can I Make My HIV Test Negative -- Just Until My Wedding?
    I just tested positive, but I have no symptoms and a CD4 count of 790. Is there anything I can do to make my HIV test come up negative, at least for a little while, so I can get pregnant and my partner doesn't have to find out about my status before we get married?

    Masturbation: A CD4 Cell Killer?
    If you masturbate a lot -- like five times a day -- does it weaken your immune system?

    Lipoatrophy Center
    Personal Stories From HIV-Positive People With Lipoatrophy

    Jim Shea
    When the U.S. Food and Drug Administration approved Sculptra (poly-L-lactic acid, New-Fill), Jim Shea thought he could finally fix the HIV-related fat loss in his face. But his insurance company refused coverage due to what it said was the procedure's "cosmetic" nature. Well-versed in insurance procedures, Jim knew that this wouldn't be the end of things: "You don't have to take no for an answer," he said.

    It was an uphill battle, but Jim eventually won: His insurance company agreed to pay for his Sculptra treatments. He says he looks and feels "200 percent better," which helps him focus on his volunteer work: Assisting others with their own insurance appeals.

    The Body's interview with Jim Shea (available as a transcript and a podcast) is part of The Body's newly launched Lipoatrophy Resource Center, the Web's most comprehensive resource for the latest news and information about this difficult side effect. Visit the center for news, research updates, overviews, reviews of facial fillers, tips on how to get insurance coverage for lipoatrophy surgery and compelling accounts of what it's like to live with lipoatrophy.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the July 2006 Visual AIDS Web Gallery
    "Vestment," 1993; Valerie Caris
    Visit the Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The July 2006 gallery is entitled "Vital Signs"; it's curated by Catharina Manchanda, curator at the Mildred Lane Kemper Art Museum at Washington University in St. Louis.