Hot Topics: Slowing CD4 Decline; Pill Care on Road Trips; Assessing Your Brain Health; and More

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June 10, 2014 Visit the Forums Read Past Email Newsletters Change/Update Subscription
Can I Slow My CD4 Decline Without Taking Meds? I'm a woman who's been living with HIV for four years, but hasn't started medications. I'm in good health, but my CD4 count is dropping very slowly. Is there anything I can do to delay starting HIV treatment as long as possible? Nelson Vergel responds in the "Nutrition and Exercise" forum  How Does Substance Use Affect Our Lives With HIV? How does the use of recreational drugs -- crystal meth, for instance -- affect our life expectancy as people with HIV? If I'm diagnosed late while doing drugs, how does drug addiction change my chances for long-term survival? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  Is Xanax a Good Way to Reduce Bedtime Anxiety? I sometimes have panic attacks at bedtime, and they often result in my not sleeping for 24 hours or more. My doctor has prescribed Xanax to help, and it's calmed me down a bit, but is this the right solution? David Fawcett, Ph.D., L.C.S.W., responds in the "Mental Health and HIV" forum  What Are the Best Developing Countries to Live in With HIV? As I reach retirement age, I'm considering moving outside the U.S. Where would be the best place to find information about retiring overseas (Mexico, Thailand, Costa Rica) for someone who has HIV? Nelson Vergel responds in the "Aging With HIV" forum  Lynda Arnold: Living With Memory Loss "I don't remember how long I truly have been battling this," TheBody.com blogger Lynda Arnold writes, "but I do know that in the past two years it has risen to a crisis in my mind." More than 30 years into the HIV epidemic, the general public remains remarkably uninformed about the nature of HIV. This misinformation, combined with rampant HIV stigma, has created a landscape in the U.S. and in many other countries where laws regarding HIV transmission are based on HIV myths and stigma rather than cogent scientific fact. TheBody.com's HIV Criminalization Spotlight Series aims to show the faces of those affected by criminalization, report on the progress of anti-criminalization activists nationwide and abroad and dispel the stigma around HIV. Come read our latest additions!  Will My HIV Meds Survive a Road Trip? I'm a 60-year-old man doing well on Complera. I've been planning a two-week motorcycle trip through an area where temperatures can often be over 100 degrees Fahrenheit. Will my Complera be OK? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  Pluses and Minuses of Stribild I had settled on starting Stribild, but I heard other poz folks say they would go with Tivicay plus Truvada over Stribild. Can you help me decide? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  Is Atripla OK for Pregnant Women? My wife and I are planning to have a baby. She is currently on Atripla, has an undetectable viral load and a CD4 count of 520. Should she switch off of the Atripla, or will it be safe for her during pregnancy? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  You and Your Meds: The Dance of a Lifetime As the saying goes: It takes two to tango. With good preparation and coordination, you and your meds will dance together beautifully -- a partnership that will likely keep you healthy for the rest of your (long) life.  Neurocognitive Problems: How Can I Know for Sure? Is it possible that, despite maintaining viral control in the blood, my HIV meds are not adequately penetrating into my brain? How can I tell if the neurological symptoms I've been experiencing lately are a prelude to HIV-associated neurocognitive disorder (HAND)? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  How Do I Get My Butt Back? I'm having an issue with wasting of buttock area and was wondering what are my options are to treat it. I don't want implants because I have heard they can be dangerous due to infection and the recovery is long. Nelson Vergel responds in the "Nutrition and Exercise" forum  Is My Hair Loss Caused By Stress or Meds? I was diagnosed in January 2014. I am now on week 10 of treatment. I noticed about five to six weeks ago that hair has been brittle and falling out, noticeably when I run my hands through my hair. How can I figure out what's causing this and how to fix it? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum Many types of medications can save or improve lives, but they can also have unintended consequences. Side effects of meds (whether for HIV or some other condition) can be mild or life altering, horrible or even pleasurable; some people living with HIV never experience any at all. Whether you've worried about side effects or dealt with them firsthand, it seems like everyone's got a story about them. We want to know about yours. To share your "side effects" story, write it out in 1,000 words or fewer, or film a YouTube video, and email it to mrodriguez@thebody.com. Many readers' stories will be posted on TheBody.com!  Can PEP and Pregnancy Mix? I'm on day 10 of my HIV post-exposure prophylaxis (PEP). My wife has mentioned wanting to try to have a baby in the near future. Can we do this while I'm on PEP -- and if she gets pregnant, are there risks of side effects to the baby from me taking this medication? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  How Can I Get Over My Fear of HIV Testing? I am scared to get the HIV test. I need to talk to a friendly doctor who won't scare me and can reassure me that the symptoms I'm feeling can be fixed. Do you know of any gay-friendly doctors I can turn to? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum  Long-Term HIV Risk Estimate for Mixed-Status Couples Is Not Zero The risk of transmitting HIV within mixed-status couples may be higher than the "zero" number widely reported in a recent major study, even when the positive partner is on treatment and condoms are being used consistently. Worried Your Spam Filter Might Trash Our Mailings? TheBody.com's email 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, add update@news.thebody.com to your address book, talk to the person who manages your email security or check your anti-spam program's instructions for more information. About This Email This email update has been sent to nelsonvergel@yahoo.com. Want to change your subscription? Click here or send us a message at updates@thebody.com. Missed an update? Our archive of past updates will keep you in the loop. If you'd like to unsubscribe, click here. Have any other questions or comments, and don't want to send an email? Feel free to snail-mail us at: TheBody.com's Email Updates Remedy Health Media, LLC 750 3rd Avenue, 6th Floor New York, NY 10017	Gmail Users: We Need Your Help! Many of our emails have been getting caught in Gmail spam. If you have noticed this, please help us by marking our newsletters as "Not Spam." We hate that our subscribers are missing the latest updates because of this. Thank you for helping! -- Warren Tong, Research Editor Advertisement  Nelson Vergel Asks for Your Help to Save HIV+ Venezuelans' Lives  CDC Launches "Start Talking. Stop HIV.": A New National HIV Prevention Campaign for Gay and Bisexual Men  The HIV Economic Empowerment Campaign: A Time for Change, a Time for Action  Tell the White House to Ensure HIV Coverage Under Obamacare

Injection Every 3 Months to Prevent HIV- Study in San Francisco Enrolling Now

There's a new clinical trial about to get started in SF looking for 25 men or transwomen who are at relatively low risk for HIV to test the safety, tolerability and acceptability of a very long acting (injected once every three months) for Pre-exposure prophylaxis (PrEP). If that sounds like you or someone you know, you can get more info by calling 415-881-7190

HIV-Positive Venezuelans Are Desperately Seeking HIV Medications- Please Help

Even though Venezuela is the third largest oil exporter to the United States and has the largest oil reserves in the world, you would not know that if you visited the country now.

The country's infrastructure is in ruins. State officials have been able to pocket much of the oil revenues and imposed illogical dollar exchange restrictions that are suffocating the economy and its people. The inflation rate is 57% and the crime rate is among one of the worst in the world. Since February 12, students and the general population have been out in the streets protesting the scarcity of goods and high crime rate.

At least 41 people have been killed since February 12 and hundreds have been jailed for protesting against the regime. The Venezuelan Supreme Court, which consists mostly of regimen backers (Chavistas), has recently made it illegal to protest to scare the population. Leopoldo Lopez, the opposition leader educated in Harvard, is in prison due to the regime's claims that he incited protests. All TV and radio stations that criticized the regimen have been shut down. Opposition newspapers have been denied currency to import paper, so they are also unable to provide news. Twitter is the only media venue left for Venezuelans to get news not distorted by the regimen. Most Latin American countries and the United States have turned a deaf ear to the situation. Some speculate that Venezuela's oil is keeping leaders around the world quiet.

The government controls access to foreign currency but hasn't made enough dollars available to cover imports of medicines. Venezuela imports about 90% of its pharmaceutical drugs.

Venezuela imports 29 HIV antiretrovirals and produces none. It also imports most of its food. Due to currency exchange restrictions, red tape and price controls, medication and food imports have halted in the past quarter. Many importers have run up big debts with providers abroad due to red tape and delays acquiring dollars through the highly corrupted state currency agency.

The shortage of medicines is part of broader economic turmoil that forces Venezuelans to routinely form hours-long lines outside shops to buy staples such as toilet paper, cooking oil, flour and milk.

"Companies that import and make medicines and medical items say they now owe their suppliers some $1.2 billion," said Freddy Ceballos, president of Pharmaceutical Federation of Venezuela in an interview for USA Today.

The wretched condition of Venezuela under its socialist leadership is now worsening the ability of hospitals to treat people, especially patients with HIV.

The latest shortage in antiretrovirals exposed the debilitation of the country's socialized medical system, which is touted as free and comprehensive by the government but often is neither. Former president Hugo Chavez often cited the country's health system as one of his revolution's greatest accomplishments. But it has been a total failure.

"I go to the state hospital once or twice a week to see if my pills have arrived,'' says schoolteacher Jose Ramos, 38, who stays alive with antiretroviral medicines that have always been free here under a government program. "They always tell me to come back later."

Ramos isn't alone. Nearly 50,000 Venezuelans are taking antiretrovirals to keep HIV from turning into full-blown AIDS. "Thousands of HIV patients are now without their medicines," said Feliciano Reyna, a leading HIV activist in Venezuela and founder of Acción Solidaria, a non-profit organization in Caracas.

With HIV/AIDS, the shortages have been made up in antiretroviral donations from outside the country.

"It's not easy to find donations abroad now,'' says Feliciano Reyna. Reyna returned last year after a trip abroad with 120 bottles of antiretrovirals. A similar trip this month netted nothing. "Our situation is really critical."

The government repeatedly denies any problems and blames the opposition and the "Empire" (the United States).

The danger of this medication shortage for HIV positive people is that any interruption in their drug regimen not only can allow the virus to acquire resistance to the medications but would also mean death to thousands if the problem is not resolved. No one knows if in fact it will be eventually be resolved by the regimen.

Please help by donating your unused medications to: http://aidforaids.org/recycling-drive/.

Aid for Aids is a cost effective organization with a reach far greater than its size, with a massive impact that today reaches people in over 40 developing countries. AFA was founded in 1996 by a simple, yet powerful idea: a lot of very expensive HIV medication is thrown away; why not collect it and get it to people who need it but can't get it? Since their founding in 1996, they have redistributed over $110 million of life-saving medication to more than 18,000 people worldwide.

AIDS SURVIVORS SUMMIT SAN FRANCISCO CONVENED ON JUNE 5, 2014 NATIONAL HIV/AIDS LONG-TERM SURVIVORS AWARENESS DAY

San Francisco, CA — June 5, 2014 is the first-ever National HIV/AIDS Long-Term Survivors Awareness Day (NHALTSAD). On that day, Let’s Kick ASS—AIDS Survivor Syndrome convenes the AIDS Survivors Summit/San Francisco 2014at theSan Francisco LGBT Center on June 5, 2014 from 1:00-9:00 PM. Let’s Kick ASS is bringing together survivors, both HIV-positive and negative, with key Bay Area AIDS organizations in an effort to begin addressing the unique challenges facing those longest affected by the HIV epidemic.

With over half the People Living With HIV already over age 50 in the Bay Area we realize that providers are attempting to figure out how to best serve this cohort. There is growing evidence of an AIDS survivor syndrome (ASS). It manifests in depression, anxiety, anger, isolation, posttraumatic stress, and lack of future orientation during this second wave of the epidemic. Some give up hope and end their lives rather than life with the losses and survivor guilt. Other related concerns are Aging with HIV, and retirement after disability among others.

The daylong gathering is designed to empower participants through talk show-style discussions and presentations with an emphasis on optimizing survivors’ lives and envisioning the future they never imagined. We want to help survivors live the best lives they can now while we begin making plans for the next. We want the recall the resilience, strength and bravery the community exhibited.

Visit: LetsKickASS.org. Twitter: @AIDSsurvivors

On Facebook: https://www.facebook.com/NationalHIVAIDSLongTermSurvivorsAwarenessDay

Bill sponsored by HIV-Positive Legislator Advances Tuesday to Help People with HIV-related Lipodystrophy

The bill was sponsored by Carl Sciortino, one of the nation’s few openly gay and openly HIV-positive legislators. The 35-year-old has since stepped down from the legislature to serve as executive director of the well-respected AIDS Action Committee.

The story of the young, handsome Sciortino is remarkable in and of itself. The child of a self-proclaimed Tea Party conservative, he told his dad in an endearing campaign ad in a bid for Congress that he is a “Massachusetts liberal.”

While most insurance companies pay for procedures to reconstruct a breast when a woman loses one to cancer, or at least a prosthesis, people with lipodystrophy and lipoatrophy must wear their deformity like a badge unless they have the resources to correct the problem. It’s a throwback to the days when people with HIV were thin and gaunt, essentially with bodies that screamed out “I have AIDS.”

Source: http://www.imstilljosh.com/breaking-news-hiv-positive-legislator-advances-bill-disfigured/

For more information about treatments for lipoatrophy and visceral fat accumulation in HIV, visit:

www.facialwasting.org

Lipodystrophy survey

Lipodystrophy presentation

Statin Therapy Does Not Improve Cardiovascular Risk for Patients With HIV and Low HDL

The main lipid abnormality of people living with HIV is low high density lipoprotein (HDL).  There are 5 subfractions of HDL: 2a, 2b, 3a, 3b, and 3c, from largest (and most effective in cholesterol removal) to smallest (and least effective).

Neither pravastatin nor rosuvastatin changes the distribution of high-density lipoprotein (HDL) subfractions in patients who are HIV-seropositive with severe dyslipidaemia undergoing treatment with a combined antiretroviral therapy (cART) and protease inhibitor, according to substudy results presented at the 82nd European Atherosclerosis Society (EAS) Congress.

In their substudy, Dr. Bittar and colleagues set out to determine the distribution of the HDL subfractions in 90% of these patients, both at baseline and following statin treatment.

Thirty-six patients (median age, 49 years; 81% male) were part of the pravastatin group (40 mg/day) and 38 patients (median age, 46 years; 76% male) were part of the rosuvastatin group (10 mg/day), all with 45 days of treatment.

At baseline, the HDL subclass distribution in the pravastatin and rosuvastatin groups was similar, with percentage distributions for HDLs 2a/b/3a/b/c of 27.1%/12.8%/31.7%/20.7%/7.3% and 26.6%/13.8%/31.3%/21.0%/7.1%, respectively.

After the 45 days of statin treatment, these values were unchanged, at 27.5%/12.4%/32.7%/19.9%/7.2% and 27.1%/14.6%/31.7%/19.1%/6.6%, respectively.

Source: http://dgnews.docguide.com/statin-therapy-does-not-improve-cardiovascular-risk-patients-hiv-and-dyslipidaemia

For natural ways to improve HDL: 

    

1. Get aerobic exercise. Moderate to vigorous aerobic exercise can boost HDL by 5% to 10%. Aim for five 30-minute sessions per week.
2. Lose weight if you need to. If you’re overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost, although any amount of weight loss will help.
3. If you smoke, quit. HDL levels rise by as much as 15% to 20% after you quit.
4. Eat a healthy diet. Avoid trans fats, which increase bad cholesterol and decrease good cholesterol. Avoid highly refined carbohydrates, such as white-flour products.
5. Consider medications. Niacin, available over the counter, is the most effective HDL-raising medication available. Niacin can be strong medicine — work with your clinician if you want to try it.    NAC  is also a good supplement to consider.
6. Avoid higher doses of testosterone

New CDC Guidelines: People at Risk for HIV Should Consider Truvada PrEP

Healthcare providers should advise people at "substantial risk" for HIV infection about pre-exposure prophylaxis (PrEP) using tenofovir/emtricitabine, or Truvada, according to new guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC). This includes HIV negative people in an ongoing sexual relationship with HIV positive partners, gay or bisexual men who have had sex without condoms during the past 6 months, heterosexual men and women who have sex without condoms with at-risk partners, and injection drug users.

The U.S. Food and Drug Administration (FDA) approved Truvada for PrEP in July 2012. Only Truvada taken every daily has been approved for HIV prevention. Taking it sporadically before sex or as a "morning after pill" has not been proven effective. HIV testing is important before starting PrEP, as a person who already has HIV and takes Truvada without other antiretrovirals could develop drug-resistant virus.

http://www.hivandhepatitis.com/hiv-prevention/hiv-prep/4689-new-cdc-guidelines-people-at-risk-for-hiv-should-consider-pre-exposure-prophylaxis-prep

PMMA-microspheres for the treatment of HIV-associated buttock lipodystrophy.

Soft tissue augmentation with PMMA-microspheres for the treatment of HIV-associated buttock lipodystrophy.

Authors

Serra MS, et al. 

Journal

Int J STD AIDS. 2014 May 22. pii: 0956462414536878. [Epub ahead of print]

Affiliation

Abstract

BACKGROUND: Progression of lipodystrophy syndrome is a big challenge in HIV treatment. Nowadays, fat loss at the lower part of buttocks has become another problem as patients started to complain that it is painful to be seated for a long time and/or on hard surfaces. We developed a method for buttock lipoatrophy treatment with PMMA-microspheres, as silicone prostheses and autologous fat transplant were not completely efficient.

METHODS: The treatment consisted of net-crossed injections, in the subcutaneous layer, of a 30% PMMA-microspheres solution on the atrophic areas of the buttock.

RESULTS: One hundred and fifty-four patients were included. The amount of PMMA-microspheres used to treat buttock lipoatrophy depended on the degree of atrophy and size of the area to be treated. Patients were satisfied with this treatment and referred to be more comfortable to be seated for longer period of time.

CONCLUSION: We demonstrated that soft tissue augmentation with PMMA-microspheres is safe and efficient for the treatment of buttock lipoatrophy associated with HIV lipodystrophy.

For more information on PMMA use for buttock lipoatrophy visit: http://facialwasting.org/buttock_wasting.htm

The untold side of the movie "Dallas Buyers Club"

The movie Dallas Buyers Club brings attention to a little-recognized part of the AIDS activist movement: the desperate struggle to provide anything that might treat the disease when no treatment was available.

AL-721, Compound Q, Peptide T—buyers clubs formed around the country to bring in potential treatments, whether pharmaceutical or botanical, for both the virus and its effects. Many of these treatments, if not most, were not approved by the Food and Drug Administration (FDA) or not approved for the use for which they were taken.
Vitamins and other nutritional supplements were also sold, in many instances (if not most) at deeply discounted prices.

As shown by the smuggling in the movie, there were illegal risks taken, all in the name of saving lives. Also as shown in the movie, people with AIDS risked their lives on unproven therapies, all in the hope of surviving a disease at a time when it was killing people in large numbers.

“We wanted to live, but we were also desperate,” said longtime AIDS activist and writer Matt Sharp.

More here