Shout Out Health

ASK THE DOC: Will Glutathione supplements interfere with HIV treatment?

Q: I have been living with HIV since 2007, and have been on HAART treatment for 2 years now (Stocrin & Combivir). But I am having problems with my platelet count, which has been low since I was diagnosed. This was the reason why I had to start on HAART treatment (I'm feeling better now).

Here's my question: I have friends who have been taking glutathione supplements (for skin as well as for an immune booster), but will taking it interfere with my HAART treatment or affect my platelet count? Thank you for your help.

A: Hopefully your platelet count has improved now that you are on antiretroviral therapy. As for glutathione, it has been touted as having antioxidant properties, but I have never used it nor recommended its use. A recent poll of physician colleagues could find no one who used it.  As with so many homeopathic substances, it is hard to assess them for measurable value but at this time I don't know of any interaction with your ART regimen. Good luck to you! -- Susan Ball, M.D., M.P.H.

ASK THE DOC: What is PrEP, and could an HIV vaccine be a reality soon?

Q: "I've recently heard about some HIV studies being done relating to Pre-Exposure Prophylaxis, but would like to understand better how PrEP works. Also, what are the odds an HIV vaccine could be a reality soon?"

A: These are great and important questions! First of all let me touch a little on the Pre-Exposure Prophylaxis news. As you know, there was a recent large study called iPrEx done among MSM and transgender women. In the study, an anti-HIV medication called Truvada taken every day, along with condoms, treatment for other STDs and monthly HIV testing, helped cut the risk of getting HIV by about 44%. That’s really important and great news for the prevention field but there are still lots of questions that need to be answered.

For example, is it necessary to take the pill every day, or is it enough if it’s taken a few times a week, or right before & right after sex? What about long term side effects of taking Truvada? And how effective is this strategy in women and other populations, as communities of MSM are very diverse. In other words, there is a lot of excitement about these results; at the same time there is still a lot we need to learn about the effectiveness of taking anti-HIV medication for prevention of HIV.

Developing a safe and effective vaccine that prevents HIV infection or lessens the severity of infection in those who become infected is an important goal of the prevention field. But what are the odds that a vaccine could be a reality soon? It will likely be a number of years before we have a safe and highly effective HIV vaccine.

However, over the past year, there have been some exciting advances in the vaccine field which are helping to move the field forward. For example, researchers have been identifying pieces of the virus that are believed to be least likely to "change" and are common across many HIV viruses; or regions that are “weak spots” of the virus that, if blocked, could potentially prevent the virus from attaching itself to, entering and infecting the cell.

The goal is to use this information to make a vaccine and present to the immune system, teaching it to react to it quickly and effectively when and if the virus enters the body. In the human trials, there was exciting news almost two years about the results of a large vaccine trial done in Thailand. The group of participants who got the vaccine had a 31% lower HIV infection rate compared to those who got placebo. Although it still is not clear how the vaccine regimen accomplished it, work is being done to find out what exactly what responsible for this positive result. While the level of efficacy was modest, it demonstrates that an HIV vaccine is possible. This Thai study is also providing important information to build on.

Currently, the largest vaccine trial taking place in the United States is called HVTN 505; in fact, at present it is the only vaccine efficacy study going on in the world. It is being conducted in New York City and in 17 other cities around the U.S. HVTN 505 is hoping to add to this growing knowledge and get us closer towards a goal of finding a safe and effective HIV vaccine. If you want to find out more about this study go to TopsAndBottomsWanted.com or nycvaccine.org. -- Magda Sobieszczyk, MD, MPH

ASK THE DOC: Where can I get an anonymous HIV test?

Q: I haven't had an HIV test in a few years, and I want to get one anonymously. I live in a middle sized city with one public clinic, and I don't want to use my regular doctor. What are my options, and how quickly can I get the results?

 A:  If you want to get tested anonymously, your local department of health can usually provide that service. Home tests can be done using the HIV self test kit which should be sold in retail pharmacies or at 1-800-448-8378 or 1-800-HIV-TEST or online at HomeAccess.com.

Based on the recent Bartlett book on Medical Management of HIV, these results are confidential and referral and counseling are offered. You might also make an appointment with an Infectious Diseases doctor to get tested, although your regular MD should be the one offering you testing on a regular basis. Good for you for taking the initiative to get tested. Good luck. -- Susan Ball, MD

ASK THE DOC: Shedding Light on a Confusing Situation...

 

Q: I have a confusing situation. I have been on Atripla for three years, and when I started my CD4 was 140 with a 150,000 viral load. A year later I was undetectable with my CD4 at 475. However, six months ago my viral load went up to 200 and my CD4 went to 526. My doctor told me not to worry because my CD4 had gone up. Three month ago I went for my next blood test and my viral load went up to 273 but my CD4 also went up to 589. My doctor told me again not to worry because my immune system is still going up. Should I worry about this?

There is another problem that I think could relate or impact my results above. Last month I started taking Serostim (5mg). I have been also taking Testosterone Cypionate (200 mg/each 2 weeks) for the past two years. I do not have wasting, but I asked my doctor to give me something to gain weight as I have been skinny all my life, with a big stomach and no muscles.

I started the serostim and after my 12th injection, I noticed I was getting inflammation all over my body, pain on my hands and some flu symptoms. It was a weekend so I stopped the serostim since I could not reach my doctor.

On Monday, the inflammation was almost gone and I went to my doctor. I was told by my doctor to inject it only three times a week instead of daily but to take a Benadryl one hour before the the serostim shot. I have been doing it that way for the past 2 weeks and I still had flu like symptom (stuffy nose and some semi-dry cough) until yesterday.

My concern is that I read on the Internet that Serostim can make your viral load go up exponentially and I am so scared now because my viral load appears to be going up. I also read that Serostim can make the immune system become real strong as well. But I am still somehow afraid of getting my viral load out of control. Should I worry about the side effects that I am getting with Serostim? (I am getting somehow muscular and I would hate to have to stop it)

Should I worry at all about my viral load? Is there any potential problem about using the Atripla, testosterone, Cypionate and Serostim?

 

 

A: We have lots of patients on Atripa and testosterone but not that many on Serostim as well so my experience with it is not that extensive. I have not heard of Serostim's effect on the T-cells or the viral load although given how big Serostim is on the black market, I'm sure there is a ton of stuff on the internet about it. I would suggest you not believe every you read.  Hopefully your doctor can give you the answer.  The fact that he's willing to continue the drug and try to treat through your allergic side effects indicates that he thinks you are getting some benefit from the drug and feels it's worthwhile to continue.

On the other hand, if "all my life" you've been skinny without muscles, your body is going to go right back to that once you stop the Serostim, which is not a drug that I'd advocate being on indefinitely. Changing your body around through drugs is not the same as doing it through diet and exercise.

As far as your viral load bumping up, it is always a concern that you have some developing resistance to the Atripla. That your viral load remains so low would speak to you just having a "viral blip" and it's not particularly concerning; a rise from 200 to 273 is completely insignificant when you consider that the viral load can go up into the tens of millions. Make sure you don't miss any doses. You could potentially add an additional antiretroviral medication to intensify your regimen but I'm not sure I'd advocate for that at this point, especially since your T-cells are great.

Good luck! -- Susan Ball, MD

ASK THE DOC: HIV med - Double Dose or No Dose?

Q: Help! I am taking the one a day HIV med but I couldn't remember if I took it last night, so in  a panic I took one late this morning, just to be sure, but should I have waited? Is there a potential problem if I happened to double the dose? I figured it would be better than maybe missing one, but did I do the right thing?

A: No worries. One extra dose will not hurt you and it is better not to miss an entire day. To avoid similar confusion and anxiety in the future, try to organize your pill taking in a way that this doesn't happen again. For example, put the medication by your toothbrush and take it after you brush your teeth. Or put it in that area first thing in the morning, and take the pill that night. Or you can try some other variation on that theme, whatever works best for you. Good luck! -- Susan Ball, MD

ASK THE DOC: My sex life is a disaster!

 Q: I'm HIV positive and on the one-a-day medication and doing and feeling well. That said, my sex life is a disaster! I want to have safer sex but other positive men I've met simply are not interested in safe sex. I've met some very nice negative guys, but just wonder what the risk is for them having safe sex with me. Does the fact that my viral load is 'undetectable' lower the risk for my partner? I'm too young to be celibate, please help.

A: It's frustrating to hear that you are having such a hard time getting partners to practice safer sex. As a clinician and care provider for people with HIV I can't tell you how sad it is to see a young man come in who is newly infected with HIV. This is PREVENTABLE. And as you know, despite the ads making everyone look fit and fabulous, being HIV positive is a drag. So you deserve lots of praise and support for your efforts to keep your partners safe. 

What is also so crucial these days is the huge pile of random STDs that are growing every day. People are coming in with herpes and syphilis and gonorrhea and warts and all kinds of stuff. Most are treatable, sure, but most also increase the likelihood of HIV transmission. Don't give up on being safe with your partners. Get adventurous and wild and use flavors and lube and whatever else it might take but be of the mindset that sex can still be very awesome with a condom. You may be in a minority but you can have a clean conscience. Keep up the strong work! -- Susan Ball, MD