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November 8, 2004

U.S. Health Insurance & Medical Coverage

Mental Health

HIV Treatment

HIV Disease Progression

Complications of HIV/HAART

Children & HIV/Hepatitis

Safe Sex & HIV Transmission

Strange but True

• U.S. HEALTH INSURANCE & MEDICAL COVERAGE

Maintaining Health Insurance After an Interstate Move
I live in Boston, but am thinking of moving to Florida to start my own business. Currently, I get health insurance through my employer; when I start my new company, I expect I'll get small business insurance. How can I maintain my insurance in the meantime?

Medicare's Rules on Coverage of HIV Meds
How can I get information about what will happen when I'm eligible for Medicare and need to purchase my HIV meds? I'm 63 and taking tenofovir (Viread) and Trizivir (AZT/3TC/abacavir), which my own private insurance plan covers with a low copay.

• MENTAL HEALTH

When HIV Seems to Loom Over Everything
I've been positive for two years now, and it's been the most devastating thing I have ever been through. I have a supportive group of family and friends, work full-time, maintained my military career, completed a bachelor's and master's degree and will be pursuing a Ph.D. However, amidst all of these accomplishments, I can't seem to put HIV out of my mind. I feel as though I'm living behind a barrier that I just can't break through. What is the magic for removing this HIV overlay that covers every aspect of my life?

What's Causing My Depression: Chemo or Efavirenz?
I've been on 3TC (lamivudine, Epivir), efavirenz (Sustiva, Stocrin) and tenofovir (Viread) for two years, and was treated with chemotherapy earlier this year after being diagnosed with Hodgkin's disease. Now I'm quite depressed. Do you think the chemo might have triggered it, or is it a long-term effect of the efavirenz? How can I get help for my depression without taking any more meds?

• HIV TREATMENT

Could I Have Pre-Treatment Drug Resistance?
I tested positive in March and was placed on treatment shortly afterward. It dramatically reduced my viral load, but it's been 14 weeks now, and I'm still not undetectable. I'm perfectly adherent to my regimen, so I know I'm not developing resistance, but I'm worried that I might have been infected with a resistant strain of HIV. Do you think it'd be out of line if I asked my doctor to give me a resistance test to be sure, or to add another drug to my regimen?

Add a Drug to Trizivir-Only Therapy, Even if It Works?
I've taken Trizivir (AZT/3TC/abacavir) alone for the past four years, with great success: My latest viral load was undetectable and my CD4 count is 1,100. Now my doc wants me to add nevirapine (Viramune); he says Trizivir alone could weaken faster if I don't. But I'm wary of messing with what works. What do you think?

• HIV DISEASE PROGRESSION

How Long Will I Stay Healthy?
What's my prognosis? I'm a 41-year-old man who was diagnosed with HIV in February 2003. I quickly started taking Combivir (AZT/3TC) and nevirapine (Viramune). My viral load is undetectable and my CD4 count is 846. I do weight training four to five times a week, eat right, don't drink and don't smoke.

Am I a Long-Term Nonprogressor?
Since I was diagnosed in January 2002, my CD4 and CD8 counts have both increased, even though I'm not on treatment: My CD4 count is currently 1,494, and my CD8 count is 1,890. What does this mean? Am I a long-term nonprogressor?

What Is "Wild-Type" HIV?
I was recently diagnosed with HIV. I asked my physician which type of HIV I had and he said "wild type," adding that it was not resistant to any medications. Can you tell me more about what "wild type" is, and how it relates to HIV-1 and HIV-2?

• COMPLICATIONS OF HIV/HAART

Reversing Lipodystrophy: How Long Does It Take?
After many years on indinavir (Crixivan), Kaletra (lopinavir/ritonavir) and, most recently, d4T (stavudine, Zerit), my lipodystrophy got so bad, I just couldn't stand it anymore. Finally, my doctor switched my d4T for tenofovir (Viread) nine months ago. How long do I have to wait before I start to see my symptoms (bulging veins, huge upper belly, back fat, etc.) improve?

Hip Problems in Older People With HIV
How common is avascular necrosis (bone collapse) in the hips in HIVers over 50? I was told that my avascular necrosis was caused by AIDS and the steroids I took when I had pneumocystis carinii pneumonia. Now I'm facing two hip replacements in the next three months, and my friends are worried they might be next.

New-Fill (for Facial Wasting) Hits the United States
Is it true that New-Fill, the facial wasting treatment available over in Europe, is available in the United States as well? What do I need to know about it?

• CHILDREN & HIV/HEPATITIS

HIV, HAART and Learning Disabilities
My two adopted children have been on HAART since they were diagnosed; both have good CD4 counts and undetectable viral loads. However, they are both small and have learning difficulties. How much of a role did HIV, or HIV meds, play in these problems?

Risks of Hepatitis C Transmission
I am fostering 2-week-old identical twins born to a mom who has both HIV and hepatitis C. The birth mom did all the right things to (hopefully) prevent the twins from getting HIV, but what are the chances they have hepatitis C?

• SAFE SEX & HIV TRANSMISSION

Monogamy, Anal Sex and HIV Risk
My partner and I have been in a monogamous relationship for the past 10 years, but we frequently have anal sex without a condom. Are we at risk for HIV?

Penis Size: Can Too Big Bust a Condom?
I've read that condom breakage rates double for each centimeter of penis length over the average (5 inches). When will you people admit that, when it comes to condoms, one size doesn't fit all?

Can I Infect My Husband?
My husband and I were shocked when I was diagnosed with HIV earlier this year. He's negative, even though we've been together since 1994 and hadn't used condoms since we first started dating. Since my diagnosis we've been using condoms again, but only sometimes; we also use "Jell," a substance that researchers say can prevent HIV transmission. Are these good methods to use to keep him safe, or is he still at risk?

• STRANGE BUT TRUE: THE TRIALS OF DENIAL

How Could I Possibly Not Have HIV? I Have ARS!
I met a girl at a party in law school, and I had sex with her. I used a condom, but before having sex I licked the exterior of her vagina for about 10-15 seconds. Now I'm positive I'm exhibiting classic symptoms of acute retroviral syndrome (ARS). However, the health services staff at my law school had the nerve to tell me that I was being lame, and that my risk was virtually nonexistent. I'm sorry, but I beg to differ. Give it to me straight, doc: Isn't it true that I MUST have HIV?

I Have HIV -- The Proof Is Perfectly Clear
I'd like to announce that I'm the first guy who's ever contracted HIV through deep kissing, fingering or receiving oral sex -- and I've got a week-by-week summary of my symptoms to prove it.

NOMINATE SOMEONE FOR AN
HIV LEADERSHIP AWARD!

Ask Dr. Pierone About:
STARTING HIV TREATMENT

Dr. Gerald Pierone Jr. is one of three highly skilled, personable HIV specialists staffing our "Ask the Experts" forum on starting HIV treatment. From deciding when to start to choosing your first regimen, Dr. Pierone, who founded and directs a 600-patient HIV clinic in Fort Pierce, Fla., can fill you in on what you need to know.

ART FROM HIV-POSITIVE ARTISTS

Untitled (Self-Portrait), 1993-96;
Nelson Edwin Rodriguez

Visit the November 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.

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