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August 14, 2006

Starting HIV Treatment

HIV Treatment Strategies

You and Your Labs

Complications of HIV HIV Meds

Hepatitis

Relationships

Strange but True

• STARTING HIV TREATMENT

Is It Best to Start Treatment While We're Still in the Acute Phase?
My partner and I both just tested positive. Our CD4 counts are 537 and 524, respectively, and we have very low viral loads. My doctor suggests waiting until I have a low CD4 count before I go on medications. My partner's doctor recommends the "hit hard, hit fast" approach, which means starting treatment now. We may still be in the acute phase, and I worry that, if we don't begin medications now, we'll be missing a key opportunity to protect ourselves. Should we start or wait it out?

Never on Meds, but Already Multidrug Resistant
I tested positive in April, and my first labs showed a CD4 count of 497 and a viral load of 49,000. My doctor says I have resistant HIV and my treatment options are severely limited. Could he be wrong? If he's right, can I still control HIV with medication and a healthy lifestyle?

Should I Join a Clinical Trial if I've Never Taken Meds Before?
I've never taken HIV meds before and my doctor just told me it's time to start my first regimen. My CD4 count is 252 and my viral load is 216,000. My doc suggested that I become part of a clinical drug study that compares two of the most commonly used combinations of HIV meds: one combination includes Epzicom (abacavir/3TC, Kivexa), while the other includes Truvada (tenofovir/FTC). If I enroll in this study, it is my understanding that I will randomly be placed on one of these two regimens. Should I take the chance of a random placement? Or is one of these regimens better to start with?

My Doc Says I Should Start Meds Now, but I'm Not Sure
I am a 42-year-old, HIV-positive man. I was diagnosed less than a year ago. My most recent lab results showed a CD4 count of 348 and a viral load of 12,000. My doctor has advised me to immediately start efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC), but I'm not sure. I'm afraid of the possible side effects, like lipodystrophy, and I don't want to start on meds until it's absolutely necessary. What should I do?

How Should Someone's CD4 Count Respond to Meds?
My partner was diagnosed with HIV two years ago and started taking meds three months ago when his CD4 count dropped to 200. His first tests since then found that his viral load was undetectable and his CD4 had gone up to 275. Is this good CD4 count progress for three months on meds? Will his CD4 count continue to rise?

• HIV TREATMENT STRATEGIES

Is Using Only Kaletra as Maintenance Therapy a Good Idea?
When I first tested positive 11 years ago, I was prescribed meds. Later, my doctor encouraged me to stop them, because my CD4 count had never fallen under 500 and my viral load was undetectable. I have been off therapy for seven years now and my CD4 count is still above 500, although my viral load ranges from 20,000 to 50,000. What do you think about using Kaletra (lopinavir/ritonavir) on its own as a maintenance regimen?

Someone Stole My Meds! Will I Develop Resistance?
My luggage was stolen from my hotel room in Thailand -- HIV meds and all! I managed to get replacement meds late the following evening, but I still missed my morning Combivir (AZT/3TC) tablet and took my evening Combivir and efavirenz (Sustiva, Stocrin) tablets hours later than usual. Four years on this regimen has given me an undetectable viral load and a CD4 count of 650. Will I develop resistance to my medications because of this incident?

Should I Stay on My First Drug Regimen, or Consider Switching?
When I was diagnosed two months ago, I had a CD4 count of 77 and a viral load of 150,000. My doctor started me on fosamprenavir (908, Lexiva, Telzir) + ritonavir (Norvir) + Truvada (tenofovir/FTC). My new lab results show a CD4 count of 295 and a viral load of 1,300. In your opinion, is this a good first regimen? What side effects can I expect? Would I be better off switching to a once-a-day pill like Atripla (efavirenz/tenofovir/FTC)?

Can I Switch to Atripla From Efavirenz + Epzicom + Tenofovir?
I'm currently taking efavirenz (Sustiva, Stocrin) + Epzicom (abacavir/3TC, Kivexa) + tenofovir (Viread). Would a switch to Atripla (efavirenz/tenofovir/FTC) make sense for me? Are there any differences in possible side effects?

• YOU AND YOUR LABS

When Your CD4 Bottoms Out
Does a CD4 count of zero mean that you have no more CD4 cells left in your body?

How Could My Viral Load Go From 30,000 to 23 Million While on Treatment?
After 15 years of continuously undetectable or low viral loads, my latest lab results show a viral load of 23 million. Could this be an error? I don't know what to do.

• COMPLICATIONS OF HIV & HIV MEDS

Can HIV Cause Vertigo?
I'm a 39-year-old guy who's had HIV for the past three years and has never been on HIV treatment. I'm fit, but my CD4 count dropped below 200 for the first time last month, and for the last two months I've been having bouts of vertigo (dizziness, nausea, vomiting) that have gotten progressively worse. The nurse from my clinic doesn't think that the vertigo is related to HIV, but I'm not so sure. What do you think?

What's Causing Severe Pain in My Leg?
I went to the emergency room recently after experiencing two months of intense pain in my left leg, near my knee. The emergency room doctor said it could be neuropathy from my HIV meds or possibly a sports injury, but two months of steady pain isn't normal for such an injury. X-rays and labs have all come back fine. What's causing this, and what should I do about it?

• HEPATITIS

Infected With Both HIV and Hepatitis C: What's the Treatment?
I was just diagnosed with HIV and hepatitis C. My HIV specialist has put me on Combivir (AZT/3TC) + efavirenz (Sustiva, Stocrin), but I read that AZT can be toxic to the gastrointestinal tract and that newer meds like Truvada (tenofovir/FTC) are less toxic. Considering my coinfection, should I stay with the Combivir? Also, how often should I be monitored for liver damage or abnormal liver function?

How Long Do I Have to Take Hepatitis C Treatment?
I'm HIV positive and also have hepatitis C genotype 2. A regimen of ddI (didanosine, Videx) + efavirenz (Sustiva, Stocrin) + tenofovir (Viread) has helped me achieve an undetectable HIV viral load and a high CD4 count. In March, I began treatment for hepatitis C with Pegasys (peginterferon alfa-2a) + ribavirin. I achieved an undetectable hepatitis C viral load after a 12-week course of treatment. I know that multiple 12-week courses are the norm, but in my case, could just one or two be sufficient?

HIV Versus Hepatitis C
Can you explain the difference between the hepatitis C virus and HIV?

• RELATIONSHIPS

My Boyfriend Is Afraid of Giving Me HIV
My boyfriend is HIV positive and I'm not. In spite of a lack of support from family members, our relationship is still going strong after more than a year. The trouble is that, although we always practice safer sex and I get tested regularly, he spends weeks worrying after every time we're together. I love him so much that I'd be willing to have a more chaste relationship, but I really wish I could allay his fears so we can have a less-stressful love life. Do you have any advice?

Monogamous, HIV-Positive Couple: Is Unprotected Sex Okay?
My partner accidentally infected me nine months ago. Now that we're both positive and monogamous, he wants to continue to have unprotected sex. Is this safe?

• STRANGE BUT TRUE

You Want to Lick What?
Can I get HIV by licking my HIV-positive girlfriend's armpit?

Oral Sex ... From a Cat?
While I was getting dressed, my 12-week-old kitten jumped up and licked the end of my penis. What's my HIV risk?

Now at The Body: Full Coverage of the XVI International AIDS Conference!

The largest HIV conference in the world is underway in Toronto, Canada -- and The Body is on hand providing extensive reports! While at the XVI International AIDS Conference, we'll be conducting podcast interviews with researchers, activists and other attendees; keeping a photo journal throughout the week; and providing expert analyses of important research presentations. We'll also feature live Webcasts of key conference events from kaisernetwork.org! Visit our conference home page for the very latest.

Art From HIV-Positive Artists

Image from the August 2006 Visual AIDS Web Gallery

"Leaf Project (Donald, Nureyev, Logan and Jaun)," 1996-2006; Eric Rhein

Visit the Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The August gallery is entitled "Between Ten"; it showcases the work of seven artists spanning the 10 years since the introduction of combination HIV treatment in 1996. The Web gallery highlights some of the works in a larger exhibit being shown at the XVI International AIDS Conference in Toronto, Canada, this week.

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Might Trash Our Mailings?

The Body's e-mail updates are especially prone to being caught up in spam filters, since our newsletters tend to refer frequently to sex, drugs, the human anatomy and so forth.

To make sure you never miss one of our mailings because anti-spam software labeled it as junk mail, talk to whoever manages your e-mail security about how to put our mailings on a "white list," or check the anti-spam software's instructions for more information.

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