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July 17, 2006

Starting HIV Treatment

Questions About Atripla

HIV Drug Resistance

Complications of HIV HIV Treatment

• STARTING HIV TREATMENT

Should Lab Tests Be Done Twice Before Starting Treatment?
Aren't doctors supposed to do CD4 and viral load testing at least twice before starting a person on HIV meds? My doctor decided to start me on meds immediately after getting the results of my first lab tests: My CD4 count was 487 and my viral load was more than 100,000. I followed his advice and started treatment, but would it have been better to wait a month or two, do the CD4 and viral load tests again, and then decide what to do?

Is It Too Late to Stop the Meds I've Started?
I was diagnosed with HIV, hepatitis C and syphilis, all at the same time. My HIV viral load was high when I was diagnosed (611,000), but my CD4 count was 394. I've heard that having untreated syphilis can lower a person's CD4 count and raise a person's viral load. Nonetheless, my doctor immediately started me on HIV treatment -- he didn't even do a second round of blood tests to confirm my CD4 count and viral load. Do you think it was wise for me to start treatment so quickly? Would it be safe for me to stop treatment?

I'm Undetectable on My First Regimen. So Why Isn't My CD4 Count Up?
I started taking HIV meds four months ago. Before meds I had a CD4 count of 249 and a viral load of 16,000. After one month, my CD4 count was 349 and my viral load was 170 -- a strong response! But in the two months since, my CD4 count has dipped down to 267, even though my viral load has been undetectable. My doctor is taking a "wait and see" approach, but I'm worried. Why isn't my CD4 count still going up?

• QUESTIONS ABOUT ATRIPLA (TENOFOVIR/FTC/EFAVIRENZ)

Should I Switch From Efavirenz + Truvada to Atripla?
I'm doing well on efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC). But now that there's a new drug, Atripla, that combines both, is there any reason for me not to switch to it?

How About Switching From Combivir + Efavirenz to Atripla?
For the past three years, I've been doing well on Combivir (AZT/3TC) + efavirenz (Sustiva, Stocrin): my CD4 count is above 500 and my viral load is undetectable. But I'm worried about the possible long-term side effects of the AZT (zidovudine, Retrovir) in my Combivir. I was considering a switch to the new three-in-one pill Atripla (tenofovir/FTC/efavirenz). What do you think?

Is It OK to Switch to Atripla Even if My Current Regimen Works?
For about a year now, I've been doing very well on a regimen of atazanavir (Reyataz) + ritonavir (Norvir) + Truvada (tenofovir/FTC). I've had no side effects, and other than atazanavir's annoying "take with food" requirement, taking meds has not been a hassle. Still, I think I might want to switch to the new three-in-one pill, Atripla (tenofovir/FTC/efavirenz). Am I crazy to consider a switch when my current regimen is just fine?

When's the Best Time to Take My Atripla Dose?
Since doctors recommend that people take efavirenz (Sustiva, Stocrin) at bedtime, does that mean that the new three-in-one pill Atripla (tenofovir/FTC/efavirenz) should also be taken at bedtime?

• HIV DRUG RESISTANCE

Is Resistance Unavoidable?
I've been on efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC) for 16 months without missing a single dose. If I stay 100 percent adherent, can I avoid resistance, or will it inevitably develop at some point?

My First Two Regimens Couldn't Make Me Undetectable. What Next?
I was diagnosed with HIV while it was still in the acute phase, when my viral load was very high -- in the 500,000 to 600,000 range. I decided to join a clinical trial in which people with acute HIV were put on meds. I took efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC), but viral load plateaued at 2,400. Then my docs added Kaletra (lopinavir/ritonavir) and my viral load dropped a bit more, but it's still not undetectable. I haven't missed a single dose since I started meds three months ago, but I'm being told I have "fossils" of resistance to some meds. What does this mean? If I switch meds again, will the new regimen be any more likely to make my viral load undetectable?

• HIV-RELATED HEALTH CONCERNS

Will My Stool Ever Stop Flowing Like a River?
I started taking HIV meds a month ago: atazanavir (Reyataz) + Epzicom (abacavir/3TC) + ritonavir (Norvir) + tenofovir (Viread). Since then, I've had bowel movements at least six times a day! My boyfriend says it'll always be like this. Is he right?

A Question From the Winnie the Pooh in You
Is it safe for people with HIV to eat fresh honey? I know that honey can contain botulism toxin, which is why it's not good for babies. Does the same risk apply to HIVers?

• LIVING WITH HIV

Could I Have Reinfected Myself During Sex With My Pos Boyfriend?
I've been HIV positive for about six years, and for the past six months I've been having unprotected sex with my HIV-positive boyfriend. He always pulls out before ejaculating, but for the past couple of weeks I've been suffering from symptoms similar to those I felt during my original seroconversion illness. I've been tested for everything under the sun, but I have no sexually transmitted diseases and it's not strep. Could I have become reinfected with my boyfriend's strain of HIV? I've been off of HIV treatment for over four years; if I've been reinfected, should I rush to my doctor and get on meds right away? Or should I wait and see what my numbers are at my routine check in August?

My Pharmacist Told My Daughter I Have HIV
I'm an HIV-positive father and grandfather. I used to fill my HIV med prescriptions at a pharmacy where my daughter's former in-laws work. It seems as though the former in-laws disclosed my HIV status to my daughter by showing her the computer records of prescriptions I had filled at their pharmacy. Now my daughter refuses to let my wife or me see our grandchildren! Is there anything I can do legally to rectify this?

• HIV IN THE WORKPLACE

What if I Take Too Many Days Off From Work?
My company has a time-off policy that says if we use more than our allotted paid time off (including sick time), we'll be subject to disciplinary action -- which can include being fired! I don't use my sick time excessively, but since I found out I was HIV positive, I have tended to stay home when I am sick to facilitate a faster recovery and avoid other bugs. Would I be protected under the Americans with Disabilities Act if I were to take a few extra sick days without pay? What do I do to make sure I am protected?

If I Help the Disabled, Must I Disclose My Status?
I work for an Indiana organization that provides services to people with developmental disabilities. Am I legally bound to disclose my HIV status because I provide direct care (including help with bathing, going to the bathroom and taking meds) for my clients?

• HIV & MEDICAL COVERAGE

How Can Low-Income Women Get Access to HIV Meds After Pregnancy?
My 21-year-old daughter is pregnant and HIV positive. Currently, she is on Right from the Start Medicaid (a Georgia-based program that pays for medical care and medications for low-income pregnant women), which will cover her meds until 60 days after she gives birth. Her insurance coverage has already said it will not pay for meds after her baby is born. My daughter has mental limitations, credit problems and no permanent home. Her husband is in Iraq, and her housing supplement has been revoked. She isn't able to get on disability benefits and does not have the money to pay for her own needs. What should we do?

• HIV TRANSMISSION

My New Boyfriend Says He's Too Big for Condoms
I met my new boyfriend on the Internet. Turns out his penis measurements were in "real" rather than Internet inches! That's never happened to me before. This guy could make King Kong blush with envy. He wants to have sex, but says condoms don't fit because he's such a big boy. What do you recommend?

No, I Swear: You Can Be Too Big for Condoms!
Yes, condoms can expand to something like 20 times their original size, but one thing people forget is that the bigger the schlong, the tighter the condom gets -- and, as a result, the more difficult it is to maintain an erection. I've also been scared many times, because condoms seem to break almost every time I use them!

Advice for People With King-Kong Dongs
I'm a health educator in Washington, D.C., who's given safe-sex advice to guys with large penises. One creative solution that some of my clients were very satisfied with is using a "female" condom. Even men can use them, although it can be a little trickier. (Read the full post for some great practical advice.)

Women, ADHD and HIV Risk
I want to comment on an earlier post in this forum (click here to read it). I came to this site in a situation similar to the earlier writer: I'm an HIV-negative woman with ADHD (Attention Deficit and Hyperactivity Disorder) wondering whether to pursue a relationship with an HIV-positive man, worrying particularly about prevention and risk. In your response, you didn't mention the fact that people with ADHD tend to act impulsively. For some women that translates into a tendency not to use protection during sex. I don't want to comment on what decision women in this situation should make; however, I think it's important that we understand the risk factors of both HIV and ADHD. The correlation between ADHD and risky sexual behavior is not spoken about often enough, and being aware of psychological and medical tendencies can be very helpful in proper prevention.

• STRANGE BUT TRUE

Adventures in Shaving
I'm 12 years old, and the other day I decided to stick my shaver (for shaving underarms) in my vagina. Then I stuck it in my butt. Then I stuck it back in my vagina. Could I get HIV from this?

A Closer Look at the Most
Popular Fixes for Lipoatrophy

What are the pros and cons of using poly-L-lactic acid (Sculptra, New-Fill) to fill in the hollowed cheeks or shrunken rear-end that are the hallmarks of HIV-related lipoatrophy? How about other treatments, like Bio-Alcamid, PMMA or collagen injections? Consult The Body's handy overview on fillers, which includes a chart of some of the most popular treatment methods!

This rundown of filler materials 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, tips on how to get insurance coverage for lipoatrophy surgery and compelling accounts of what it's like to live with lipoatrophy.

Art From HIV-Positive Artists

"Listening to Myself: Open," 2002;
Richard Sawdon Smith

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.

Tuesday in New York: AAHIVM Discusses Resistance Survey

In Manhattan on Tuesday, July 18, the American Academy of HIV Medicine (AAHIVM) will announce findings from a national survey of HIV-positive adults and HIV doctors on the topic of HIV drug resistance. A panel of prominent AIDS experts, including Dr. Howard Grossman and Dr. Martin Markowitz, will speak at the event, and will be available to answer questions from people who attend.

Want to attend? Call Lauren Graham of the GCI Group at 212.537.8037, or e-mail her at lgraham@.... The event will take place at Housing Works Bookstore Cafe from 11 a.m. to 1 p.m., and a light lunch will be served.

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