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December 10, 2007

Living With HIV

Myths Morality

Starting Treatment

Complications of HIV HIV Meds

Taking an HIV Treatment Holiday

HIV/Hepatitis Coinfection

Strange but True

• LIVING WITH HIV

Does Taking HIV Meds Reduce the Risk of Superinfection?
I'd like to know whether taking HIV meds can eliminate an HIVer's risk of becoming infected with a second strain of HIV (called "superinfection"). If it is possible to become superinfected while taking meds, are some drugs better than others at reducing this risk?

How Will My Labs Change Over Time Without Treatment?
I was diagnosed with HIV this past summer. My CD4 count is 356 and my viral load is 7,000, so I haven't started treatment yet. If I continue to stay off meds, how will my CD4 count and viral load change? Will they get progressively worse from now on, or could they potentially remain steady for years -- or even improve?

I'm Going Out for the Night; Should I Take My Meds Before or After?
I take Combivir (AZT/3TC) every twelve hours and Sustiva (efavirenz, Stocrin) every night. When I go out for a night on the town, is it better to take Sustiva before I leave for the night or after I get home? Also, could drinking or using other recreational drugs make my HIV meds less effective?

• MYTHS MORALITY

Should HIV Care Be Reserved for Those Who "Deserve" It?
Dear Dr. Bob: In my opinion, most people who have HIV inflicted the virus on themselves despite fully knowing the risks, and thus don't deserve to get medical care or compassion. Do you agree?

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Why Is This "HIV Cure" Being Kept Secret?
I read on the Internet about an HIV cure invented by a physicist named Dr. Robert Beck. He says he uses blood electrification, ionic/colloid silver and freshly ozonated water to help flush out toxins. It's even been patented! Why doesn't anyone talk about this treatment?

• STARTING TREATMENT

Starting Treatment With Isentress -- But Only Temporarily
I am getting ready to start HIV meds for the first time; my doctor is prescribing the new medication Isentress (raltegravir, MK-0518) along with Epzicom (abacavir/3TC, Kivexa) and Reyataz (atazanavir). My viral load is high -- over 750,000 -- and my doctor wants to use the Isentress temporarily to make my viral load drop quickly. After that, he'll remove it from my regimen. Is this a good plan?

Learning the Basics About HIV Treatment
After a year of unexplained illnesses, I tested positive for HIV with a CD4 count of just 92. Three weeks later, thanks to HIV meds, my CD4 was up to 382. I've been on treatment for a couple months now and I'm doing well, but I need some basic questions answered: Do I need to have my viral load tested? Will I have to take HIV meds for the rest of my life? What happens if I miss doses of my medication?

If My Viral Load Is Over 100,000, Do I Have to Take HIV Meds?
I've heard that people with HIV should start treatment when their viral load goes above 100,000. My first set of blood work showed my viral load is 118,000. Does that mean I need to start HIV meds immediately?

I'm Still Dealing With Addiction and Depression; Can I Delay HIV Treatment?
I was diagnosed with HIV five years ago. In October my CD4 count was 450 and my viral load was 58,000. My doctor is pushing me to start HIV meds now, but I'm reluctant. I struggle with addiction and depression, and I worry that I won't be able to take my meds consistently, which would put me at risk of developing drug resistance. Can I afford to wait before starting treatment?

• COMPLICATIONS OF HIV HIV MEDS

Does My Fat Gain Warrant Switching HIV Meds?
Since I started my HIV treatment regimen of Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC), I've developed extra fat on my body. My doctor thinks the Reyataz may be causing it, and is recommending I switch my regimen to Atripla (efavirenz/tenofovir/FTC). What do you think?

What Can I Do About Fuzeon Injection-Site Reactions?
Six months ago I stopped taking Fuzeon (enfuvirtide, T-20) because my injection-site reactions were really horrible. Last week my doctors told me I needed to go back on Fuzeon. I did, but my injection site reactions are even worse now! What can I do?

Will Atripla's Side Effects Last?
I started using Atripla (efavirenz/tenofovir/FTC) recently; now I feel drowsy all the time and have mood swings. I also seem to have lost my sense of taste. Are these problems permanent? How should I deal with them?

HPV Vaccination for People Who Already Have HPV?
If I already have human papillomavirus (HPV), can the HPV vaccine Gardasil do me any good?

• TAKING AN HIV TREATMENT HOLIDAY

Planning a Five-Year Break From HIV Meds
I was diagnosed two years ago with acute HIV infection and began treatment immediately. I've been off HIV meds for nine months now, with a viral load of 1,900 and a CD4 count of 650. I'd like to wait another five years or so before I start meds again. Do you think that's feasible? Will there be new drugs for me to take that don't have a lot of side effects?

How Long Can I Wait Before Restarting Meds?
I stopped taking my HIV meds after reaching an undetectable viral load. How long can I be off meds before I begin to develop symptoms?

• HIV/HEPATITIS COINFECTION

Wine With My Hepatitis
I'm coinfected with HIV and hepatitis C. I had a liver biopsy two years ago that showed minimal inflammation. I drink about two bottles of wine every week. Could this drinking accelerate the liver damage caused by my hepatitis coinfection?

CD4 Count Dropping During Hepatitis C Treatment
I have HIV and hepatitis C. In February 2008 I'll complete my hep C treatment. While I'm happy that my hep C viral load is currently undetectable, I'm worried because my CD4 count is dropping: In the past six months, it has gone from 350 to 240. Is this something to worry about? Does it mean that I need to start HIV meds now, or can I wait until my hepatitis C treatment is complete?

Should I Start Hepatitis C Treatment?
I've been living with HIV for more than 10 years, and I also have hepatitis C. My liver function tests have been consistently normal over the last two years. I also have an undetectable HIV viral load and a normal CD4 count. My doctor doesn't seem to be in a hurry to start me on hep C treatment or make any changes to my current HIV drug regimen. Is this OK?

• STRANGE BUT TRUE

Does Two Plus Two Equal Safe?
OK, so I've heard that using two condoms during anal sex might actually be risky, since it can cause friction between the two condoms. That's why, when I have anal sex with a man and am on top (don't worry, my wife knows all about it), I use four condoms. Still, do you think I might be putting myself at risk?

From the "Ask the Experts" Forums

Dear Dr. Bob: A few years ago I was suffering from severe anemia because of my HIV treatment regimen. It got so bad that I needed a blood transfusion almost every week. My doctor told me I should just deal with it, but I wrote in to your forums, and you encouraged me to ask questions and not settle for substandard treatment. So I found a better doctor and changed regimens; I now feel better physically and emotionally than I have in several years! Thank you so much!

Click here to read the full post, as well as Dr. Bob's response.

Art From HIV-Positive Artists

Image from the December 2007 Visual AIDS Web Gallery

"Drag Queen Spaceship (detail)," 2005; Curtis Carman

Visit the December 2007 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month's gallery, entitled "You're My New Orleans," is curated by Derek Jackson.

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