Update on Egrifta for the reduction of visceral fat accumulation associated with HIV lpodystrophy

Serono launched Egrifta this month.
Doctors are calling in the number included in the link below to get the paper work started for insurance reimbursement.
It seems that some insurance companies are  already starting to pay for it, but high copays may be required. Serono has a $200 copay assistance per prescription.
The total yearly cost is $23,900.   It is injected once a day under the skin (2 mg).  After 26 weeks, some people lose anywhere from 15 to 25 % (avg 18%). You will regain the fat if you stop using i.
I encouraged Serono to fund studies with exercise and the use of Metformin, two approaches that may enhance fat loss.
They could not tell me if any Medicare Part D program has already paid for drug yet.  There is no copay assistance for Medicare Part D patients due to a federal law that prohibits them.
The patient assistance program provides free drug to people with incomes lower than 6 times the poverty level ( around $68,000 per year for a single person with no dependents). Your doctor has to contact them, per the following link:
I encourage that people on this list try to apply for the patient assistance program. The Fair Pricing Coalition ( a group of activists that I am part of) needs to find out if there are any problems in applying for this program, so please help us audit it and report to this list.
More info in Egrifta.com

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January 25, 2011 Visit the Forums “Hot Topics” Library Change/Update Subscription



LIVING WITH HIV/AIDS
 Unprotected Sex Between Two Poz Partners: How Likely Is Superinfection?
I was diagnosed HIV positive in August 2009. My viral load is undetectable and my CD4 count has gone from 40 to 467 since I started taking Atripla (efavirenz/tenofovir/FTC) more than a year ago. A few days ago I had unprotected sex with a guy and ejaculated inside him. I told him I was HIV positive and he told me he was too. How easily could I have been reinfected (or “superinfected”) with a new strain of HIV from topping him? What should we do?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum

 How Can I Cut Back on Smoking Pot?
I’ve smoked marijuana daily for years. I use it to help my appetite and it literally saved my life in the past when I was very sick and couldn’t eat. I now use it to cope with anxiety, and it helps me sleep. I suppose I’m addicted, but I’m not sure that’s really a problem for me. I am concerned, though, about what it’s doing to my lungs. What do you think? Can you advise me on how to cut back if necessary?

David Fawcett, Ph.D., L.C.S.W., responds in the “Substance Use and HIV” forum
EXERCISE, NUTRITION & HIV/AIDS
 Why Does It Take So Long for Me to Recover From Weight Training?
It takes me almost four days to recover after exercising with weights. My T-cell counts average about 450 and I take Atripla (efavirenz/tenofovir/FTC). What could be the explanation for this? I hope it’s not that I’m old — I’m only 57.

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Which Whey Protein Drink Should I Use?
I’ve been taking Sustiva (efavirenz, Stocrin) and Truvada (tenofovir/FTC) for the past eight months. My viral load has dropped from over a million to undetectable, but my CD4 count is still only 100. I read recently that whey protein could help increase a person’s CD4 count. Is this true? I use Immunocal now, but are there better brands of whey protein I should be looking out for?

Nelson Vergel responds in the “Nutrition and Exercise” forum
MIXED-STATUS COUPLES
 What Do My Partner and I Need to Know to Keep Our Active Sex Life Safer?
I’ve been HIV positive for three years; my current CD4 count is 825 and my viral load is undetectable. My partner is an HIV-negative female, and we’re very active with sex. We engage in oral sex, and during foreplay my penis might enter her vagina without a condom for a bit. We’ve tried, but we’re not able to avoid this kind of foreplay. Should my girlfriend take prophylaxis treatment? If so, when and under what circumstances should she take these treatments?

Robert J. Frascino, M.D., responds in the “Safe Sex and HIV Prevention” forum
BODY SHAPE CHANGES & HIV/AIDS
 Should I Start Exercising Before I Start HIV Meds?
I’m about to start taking HIV meds for the first time since becoming HIV positive back in 2003. My CD4 count is 454 and my viral load is 1,256. I have my first supply of Atripla (efavirenz/tenofovir/FTC) already, but I haven’t started taking it yet because I’m concerned about side effects. I’ve already gained about 10 pounds recently and I don’t want to put on more weight. If I start an exercise routine before starting Atripla, do you think that would help me cut down on body-shape side effects?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Which Facial Fillers Will Give Me the Most “Bang for My Buck”?
I’m seriously considering facial filler treatments, but some of the available ones might not work for very long, and many others are way outside my budget. What are my options, especially if I want to get the most for my money — and not waste funds on treatments that won’t work?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum
Connect With Others My New Partner’s HIV Positive: How Do I Get Him to Give Me Support?
(A recent post from the "My Loved One Has HIV/AIDS" board)

My new partner is HIV positive with a non-detectable viral load, and I’m negative. Condom broke and I came inside him without realizing it had broken. Currently on a 30-day course of Truvada. … I don’t appear to be getting support from my partner about taking the medication as he sees it as unnecessary because he has an undetectable viral load, and in fact hung up on me over it. I’m getting the “you don’t trust me” shit, and “you can’t get it from me.” It’s hard enough loving him and getting through his barriers … without the issue of me now taking medication.

Sorry — just needed to vent as I need support too now. Has anyone else been through this? How can negative folks ask for the support they need from poz partners? — new2serodisco

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HIV/AIDS TREATMENT
 24 Years Without Needing HIV Meds: Should I Start Taking Them Now?
I’m 46 years old, I’ve been HIV positive since 1987 and I’ve never had to take HIV meds. My CD4 count has been between 490 and 520 for the past 10 or so years, and my viral load is 2,200. My doctor of the past three years has been encouraging me to start taking meds. What are some of the pros and cons to starting treatment now?

Robert J. Frascino, M.D., responds in the “Fatigue and Anemia” forum

 Should I Take an Additional HIV Med to Lower My Viral Load?
I’m a 44-year-old man who began treatment with a CD4 count of 199 nearly four years ago. My last labs show that my CD4 count is at an all-time high of 560. My viral load stayed undetectable from my first month on Atripla (efavirenz/tenofovir/FTC) until five months ago. It’s been climbing since then and although the numbers are still low, the consistency suggests it’s not just a blip. Would you advise adding another drug like Isentress (raltegravir) to my regimen to get the viral load below 50? Is there an option I’m not considering?

Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the “Understanding Your Labs” forum

 How Do I Keep From Confusing My Pills?
Why on Earth are Atripla (efavirenz/tenofovir/FTC) and Isentress (raltegravir) pills the same color? I was prescribed both drugs and though they’re different sizes and shapes, the color is exactly the same: peach. After 20 months taking them both, I finally took one when I meant to take the other. I’m a careful person, so I imagine this must happen to others as well. How can I keep from making this mistake again?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
OTHER HEALTH ISSUES & HIV/AIDS
 Tightness in My Chest: Is It Pneumonia or Anxiety?
I was diagnosed with asthma in 1989 and HIV in 2002, and I had pneumonia in 2009. This year I had pain and tightness in my chest; my doctor said it was the initial stages of another bout of pneumonia and put me on antibiotics. She also prescribed Urbanol (clobazam) for anxiety. It has been three days and my antibiotics are almost finished but the tightness is still there. What could be causing this, and what can I do?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum

 What Can I Do About Recurrent Fungal Infections?
I’m not on HIV meds and very prone to fungal infections. Lately I’ve been getting ringworms on my face and thighs. I’m also addicted to sugary foods, which don’t help the situation. What can I do about these infections?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
HIV TRANSMISSION
 Does PEP Have Any Long-Term Side Effects?
I’ve been taking Combivir (AZT/3TC) and Kaletra (lopinavir/ritonavir) as PEP (post-exposure prophylaxis) for three days now. I feel weak and thirsty and have no appetite. Will I feel normal again once I’ve finished taking PEP, or will I feel these effects forever?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum

 Could My Lover Have Gotten HIV From a Used Blade?
My lover is a self-cutter, and he told me he got HIV from sharing a blade with another self-mutilator. Is this possible?

Robert J. Frascino, M.D., responds in the “Safe Sex and HIV Prevention” forum
STRANGE BUT TRUE
 Hippie Smackdown Outside the Natural Food Store: Any Risk of HIV?
I was standing on the street outside Whole Foods when a stranger approached me demanding money and cigarettes. I simply ignored him whereupon he savagely sucker-punched me with his open hand in my lower-left lip. When I arrived home I noticed a slight scabby abrasion to said lower lip. The next day I went to the emergency room, but the doc there said he didn’t recommend PEP (post-exposure prophylaxis) in my case. What do you think?

Robert J. Frascino, M.D., responds in the “Safe Sex and HIV Prevention” forum

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Activist Central
 Fill Out a Survey by Jan. 31: Involvement of Young People Living With HIV in the HIV Response

 2011 Youth Action Institute: C2EA Youth Caucus Seeking Applications Until Feb. 1

 Transgender Health: Submit an Abstract by Jan. 31 for National Summit in April

 Urge Your Elected Officials to Defend the Affordable Care Act

 Let 2011 Be a Year of Action! Ask Family and Friends How They’ll Join the Fight

 Act Now: No Airtime for Killer AIDS Denialist

 Demand That the CDC Reach Out to Transgender Youth

 Call on Peruvian Authorities for Justice in Murder of HIV/AIDS & Gay Activist

What Happens When Testosterone Replacement Fails to Improve Them?

Erectile Function and Fatigue- What Happens When Testosterone Replacement Fails to Improve Them?
By Nelson Vergel
Excerpt from “Testosterone: A Man’s Guide” (available on amazon.com )




More articles on testosterone here: http://testosteronewisdom.blogspot.com/
Most men find that their sexual desire increases after they start testosterone replacement. Sexual dreams and nighttime/morning erections may be more easily achievable, but in some cases testosterone alone does not make erections strong or lasting enough for successful intercourse.
For these men the use of prescription phosphodiesterase type 5 inhibitor (PD-5) medications likeViagra, Cialis, and Levitra—may be needed in combination with testosterone replacement.  However, some men do not respond well to these oral agents or have side effects such as headaches, nasal congestion, flushing, gut problems, and, in the case of Cialis, back pain. Cialis may last longer than the others (36 hours compared to 4 hours for Viagra or Levitra), but so may its side effects. Some men take Claritin and ibuprofen with these drugs to pre-treat nasal congestion and headaches, respectively. Cialis is also approved for daily use at 5 or 10 mg/day dose (regular dose is 20 mg/day). They are available by prescription but I have heard that some men are ordering them without a prescription from overseas websites to save money (overseas sources can be ten times cheaper than products in the United States).  This book does not endorse the use of these drugs without a prescription, but it is my duty to mention facts about what is happening out in the real world.
Note: If erectile dysfunction is not improved while on testosterone, ask your doctor about adjusting your dose of testosterone. Ensure that your total testosterone level is between 500 and 1000ng/dL.  Also, have your doctor check your blood levels of estradiol; if too much testosterone is  converted into this female hormone as it may cause sexual dysfunction (.can be treated with low dose Arimidex).  Low levels of thyroid hormone, infections, lack of sleep, alcohol, smoking, medications and depression also can cause erectile dysfunction in the presence of normal testosterone levels. Last but not least, lack of attraction for our sexual partner can get in the way of achieving a strong erection.
Other options for men who need an extra erectile boost while using testosterone replacement:
Yohimbine—Available over-the-counter or by prescription (Yocon); increases sex organ sensitivity. It can raise blood pressure and cause insomnia and anxiety, so talk to your doctor. A small study showed that men who used yohimbine with the amino acid arginine had better erections (read section on supplements in this book)
Muse (alprostadil)this is a prescription pellet that inserts into the penis to produce an erection. Not very popular.
Trimix or Quadmix—Available by prescription from compounding pharmacies. These are mixtures of prostaglandins and papaverine that increase blood flow and retention into the penis. Prostaglandins are mediators and have a variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue. Prostaglandins are not hormones and they are not produced at one discrete site, but rather in many places throughout the human body.
Trimix is a mixture of two prostaglandins (phentolamine and   alprostadil) plus papaverine (a vasodilator medication) that increase blood flow to the penis and cause strong and lasting erections, with or without sexual stimulation. These compounds appear to act together to increase arterial inflow, dilate smooth muscles, and restrict venous outflow promoting erectile rigidity with greater success and in smaller doses than if these compounds were used as single therapies.
An example of a dosage combination for tri-mix is 10 micrograms of alprostadil, 500 micrograms of phentolamine and 15 mg of papaverine. Dosing of tri-mix preparations has not been standardized.
Trimix is injected directly into the side of the penis through a fine-gauge “insulin-style” needle in very small amounts (0.1-0.33 cc) that increase blood flow to the penis.  It results in strong and lasting erections. The main potential side effect are hematomas (bruising), fibrosis if used too frequently and on the same injection site, pain, and   dangerously long-lasting erections (priaprism).  Priaprism may sound great but this can literally kill your penis by causing gangrene of the tissue after stagnant blood coagulates inside it.  I know men who had to go to an emergency rooms 8 hours after having used too much Trimix and have the blood drained from their penis.  To ensure perfect injection technique and dosing, it is imperative to be trained on how to dose this with the help of an urologist.
Compounding pharmacies sell two types of Trimix formulations: Freeze dried (powder to be mixed later with water) or pre-mixed vials.  Some men find the freeze dried form not to be as effective.
It is extremely important to remember never to use Viagra, Cialis, or Levitra before or at the same time as you use Trimix. This is a dangerous combination that can increase the risk of priaprism.  Be particularly careful with Cialis since it can stay in your blood stream for a longer time.  I know someone who had priaprism since he had forgotten he had taken Cialis two days before using Trimix.
Most men who use Trimix love it, even if they have had to learn the hard way about priaprism during one instance.  Most of these men did not respond well or had too many side effects to oral agents like Viagra or Cialis.
For instructions on how to inject Trimix, read:
For instructions for physicians on how to treat priaprism in the unfortunate case that it happens:emedicine.medscape.com/article/777603-diagnosis
A 10 cc bottle of Trimix can cost from $70 to $100 in compounding pharmacies.  If 0.15 ccs are needed per erection, this bottle can be good for 67 erections.  In comparison with Cialis and Viagra ($16 a pill), this option seems economical.
Caverject— This is an injectable form of alprostadil. Injections of alprostadil have been reported to cause pain, bleeding, hematomas and scar tissue leading to Peyronie’s Disease (excessive curvature of the penis) in some patients. Caverjet is available by prescription and it is not a compounded product, so some doctors who are not comfortable prescribing compounded products feel more at ease prescribing it. However, it is not as effective as Trimix, it requiresa large injection volume, and it comes preloaded in syringes with thick needles.  It is also 10 times more expensive than Trimix but several insurance companies pay for it (Trimix is rarely covered by insurance). This injection into the penis that produces an erection that can last 1 to 2 hours. It has a larger injection volume than Trimix and is a lot more expensive, unless your insurance pays for it. Follow instructions from your urologist since overdosing can also cause priaprism.
Penile restriction rings—These rubber or leather restricting bands (commonly known as “cock rings”) can be very effective at maintaining erections after the penis fills up with blood. Be careful not to use it too tight. Neoprene and leather rings are the most common.  They can be found online.
Other options are penile vacuum devices and penile implants. Due to the scope of this book, these two options will not be reviewed. Plenty of information can be found by Googling those terms.
I highly recommend this paper since I think it is the best I have read with a review of all studies done using different treatments for erectile dysfunction:http://www.ahrq.gov/downloads/pub/evidence/pdf/erectiledys/erecdys.pdf
Medications that could cause decreased sex drive or erectile dysfunction:
Medications can cause erectile dysfunction in some men. A great review of all studies of drugs that affect sexual function in men was provided by Dr Walter K.H. Krause in his book “Drugs Compromising Male Sexual Health”. He was able to identify evidence from different studies (many uncontrolled and small) about the common classes of prescription medications that can cause erectile dysfunction. It is not known if testosterone replacement can counteract the effects of these medication classes. Among the medications are:
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors
  • Blood pressure medications (antihypertensives): Alpha andregenergic antagonists, beta-blockers, diuretics, guanethidine, methyldopa
  • Narcotics and opiates
  • Barbiturates and benzodiazepines
  • Hormone related products:  Anabolic steroids, antiandrogens used in prostate cancer, estrogens, medroxyprogesterone, 5-alpha-reductase inhibitors
  • Anti-acids: Histamine 2 receptor antagonists, proton pump inhibitors
  • Cholesterol –lowering agents:  Bile acid sequestrants, fenofibrates, statins
Fatigue
If no improvements in fatigue are observed after 6 weeks of testosterone replacement, factors beyond hypogonadism may be present.
Thyroid and adrenal function should be checked to ensure that those two glands are working properly Sleep apnea can also be a factor involved in the failure to improve stamina.  Depression may still need to be addressed with the proper medications and counseling.
Thyroid Function:
The thyroid is a butterfly-shaped endocrine gland located in the lower front of the neck. It produces thyroxine or T4, which is converted to tririodothyronine, or T3.  T4 production is controlled by thyroid stimulating hormone or TSH, a hormone produced by the pituitary.  Hypothyroidism, or low thyroid hormone, can cause sexual dysfunction as well as depression, fatigue, dry skin and hair, weight gain and increased sensitivity to the cold.  Blood tests to measure TSH, T4 and T3 are readily available and widely used.
The American Thyroid Association (thyroid.org) has great comprehensive information on how to determine if you have hypothyrodism that could be causing your fatigue.
Adrenal Function:
The adrenal glands, located in the abdomen above the kidneys, regulate stress in the human body. When the body encounters an emergency situation, the adrenal glands release hormones, such as adrenaline, that enable the body to respond accordingly. You may have encountered this reaction, called the “fight or flight” response, if you have encountered danger, fear or shock. Adrenal fatigue is the controversial idea that the adrenal glands can become worn out, creating illness, if continually over stimulated. Proponents of the “adrenal fatigue” theory hold that the adrenal glands may be over worked in some individuals and therefore become “fatigued” and unable to produce sufficient hormones.    When your adrenal glands become exhausted, your natural cortisol levels drop significantly. Cortisol is your naturally occurring stress hormone. In addition to low sex drive and infertility, symptoms of adrenal fatigue may include chronic fatigue, low blood pressure and low blood sugar, dizziness, headaches, anxiety or panic attacks, depression,and other equally debilitating reactions.
Some doctors may prescribe low doses of corticoid steroids if your morning levels of cortisol (measure by blood, saliva or urine tests) are low.  But be careful with corticoid steroids since they can increase fat mass and decrease bone density if given in doses that exceed what the healthy adrenals would produce.
DHEA:
The adrenal glands also produce dihydroepiandrosterone (DHEA), the most abundant hormone found in the blood stream. The body uses DHEA as the starting material for producing the sex hormones testosterone and estrogen in men.  Studies have shown that it only increases testosterone in women. The production of DHEA diminishes in most people after age 40. In people aged 70 years, DHEA levels will be approximately 30 percent lower than what they were at age 25. Low blood levels of DHEA have been associated with many degenerative conditions.
Some controversial and non-conclusive studies have shown that people with immune deficiencies and fatigue may benefit from supplementation with this hormone. It is still available over-the-counter in the United States.  This may change soon due to a new bill passed by Congress that classifies it as a performance-enhancing steroid (no studies have shown that it has such effect).
One study showed that women with the correct levels of DHEA can convert it into testosterone as their body needs while men do not benefit to the same degree. You need a blood test to know if you have low DHEA-S since most of the DHEA converts into this sulfated form. Common doses for women are 5to 30 mg a day, while men tend to benefit from 25-100 mg per day (to bring low levels of DHEA-S to normal)
All the hormones mentioned can be tested with blood tests or by using the easy-do-it-at-home mail order saliva hormone tests that are permissible without a prescription. Mail-order saliva tests for testosterone, DHEA-S, estradiol, and cortisol are offered by Great Smokies Laboratory at 1-800-522-4762.
NOTE: Do not use DHEA supplements unless your blood levels of DHEA-S are low.  If low, start at a low dose and get your DHEA-S tested again after a month.  Men who use DHEA supplements may have problems with higher estrogen levels since this hormone can also metabolize into estradiol. This could result in gynecomastia and water retention.  If you start taking DHEA, have your blood levels checked to make sure they are not above normal. There are many claims about DHEA being an anti-aging and an anti-cancer cure, but none of these claims has been substantiated with strong data.
Sleep Apnea:
Sleep apnea is a sleep disorder in which the patient briefly stops breathing or breathes shallowly many times during sleep and therefore does not get enough restful sleep; oxygen levels drop in the blood, starving the brain of oxygen.  In addition to causing daytime fatigue, it can increase blood pressure and cardiovascular risks. Testosterone-replacement therapy has been associated with exacerbation of sleep apnea or with the development of sleep apnea, generally in men who use higher doses of testosterone or who have other identifiable risk factors for sleep apnea (high body weight, thick necks, snoring, alcohol consumption, and others). Upper-airway narrowing does not seem to be caused by testosterone replacement therapy, suggesting that testosterone replacement contributes to sleep-disordered breathing by central mechanisms rather than by means of anatomical changes in the airway.
If your spouse or partner complains that you snore loudly at night and you  suffer from fatigue,  tell your doctor.  The only real way to find out if you have sleep apnea is to have your doctor refer you to a sleep lab for a sleep study.  If you are diagnosed with sleep apnea, a Continuous Pressure Airway Pressure (CPAP) machine can be prescribed to help you open up your airways with a small air pump while you sleep.  Some people love it while some hate wearing a mask  while being hooked up to a machine at night.  I have seen men regain their quality of life after starting CPAP.  It is paid by insurance, Medicare and most HMOs.
Stimulants:
Some physicians prescribe drugs like Nuvigil, Ritalin or Adderall when everything else fails.
Armodafinil (brand name Nuvigil) is used to treat excessive sleepiness caused by narcolepsy (a condition of excessive daytime sleepiness) or shift work sleep disorder (sleepiness during scheduled waking hours and difficulty falling asleep or staying asleep during scheduled sleeping hours in people who work at night or on rotating shifts). Armodafinil is also used along with breathing devices or other treatments to prevent excessive sleepiness caused by obstructive sleep apnea/hypopnea syndrome. Armodafinil is in a class of medications called wakefulness-promoting agents. It works by changing the amounts of certain natural substances in the area of the brain that controls sleep and wakefulness. Some insurance companies do not want to pay for it.  It is not an amphetamine and it does not require a special prescription since it not a class III DEA regulated drug.  Many doctors have samples so that you can try it before you commit to using it.  You can get a free 14 day supply with a doctor’s prescription by filling out the information in this web site:http://www.nuvigil.com/pat/wakefulness_resources/voucher_form.php?gclid=CJKHs5L8xqYCFcXD7QodKnubFw
Ritalin and Adderall (both come in cheaper generics) are also being prescribed to people with severe fatigue that does not respond to usual means.
Methylphenidate (brand name Ritalin) is used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD) in adults and children. Methylphenidate (Ritalin, Ritalin SR, Methylin, Methylin ER) is also used to treat narcolepsy.  Methylphenidate is in a class of medications called central nervous system (CNS) stimulants. It works by changing the amounts of certain natural substances in the brain
Adderall is a brand-name psychostimulant medication composed of racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide and dextroamphetamine sulfate, which is thought to work by increasing the amount of dopamine and norepinephrine in the brain. Adderall is widely reported to increase alertness, libido, concentration and overall cognitiveperformance while decreasing user fatigue. It is available in two formulations: IR (Instant Release) and XR (eXtended Release). The immediate release formulation is indicated for use in Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, while the XR formulation is approved for use only with ADHD. In the United States, Adderall is a Schedule II drug under the Controlled Substance Act due to having significant abuse and addiction potential. It requires a triplicate prescription in many states.
If you and your doctor decide that stimulants are a reasonable option, you will need to review the many potential drug interactions, physical health and mental health complications that can occur.
Over-the-Counter Supplement: SAMe
SAMe (SAM-e, S-adenosyl-methionine, or S-adenosyl-L-methionine) is a naturally occurring compound that is found in every cell in the body  It is produced within the body from the essential sulfur-containing amino acid methionine. Protein-rich foods are sources of this amino acid.
SAMe is generally considered safe when taken in appropriate doses.  People with bipolar (manic/depressive) disorder should be aware that it could trigger a manic phase. People taking standard antidepressants, including MAO inhibitors, SSRIs, and tricyclics should not take SAMe except on a physician’s advice. It is fairly well tolerated but be it can cause jitteriness or gut problems in some. Taking SAMe with meals can reduce these adverse effects.
I am convinced this supplement works for depression and fatigue. I have taken 400 mg twice a day for a few months and can definitely feel a difference.  I actually get reminded when I do not take it by my having decreased energy. An added bonus is that it can also decrease liver enzymes.
SAMe is not cheap. There are many different manufacturers but I use the Jarrow Formulas brand, as I trust their quality control.  It comes in foil-protected 200 mg-capsules since it tends to lose its effectiveness when exposed to air.
Here is a summary of studies that show that it works as well as commonly prescribed antidepressants, and also some data on liver function and arthritis pain:
I am also including a study done at ACRIA that also found benefits in treating depression in those living with HIV:
Talk to your doctor before taking this supplement.  Do not stop taking your antidepressants to switch to SAMe since it has not been fully studied in large controlled studies.
PERSONAL COMMENTS:  Because of terrible bouts with fatigue in the past, I was referred to a sleep lab and diagnosed with mild sleep apnea. I tried CPAP with different masks (they are smaller ones with “nose pillows” and many other designs, so don’t give up early without trying different styles). I could not get used to it. I have had my thyroid and adrenal functions checked without finding any problems.  I have tried Nuvigil, Adderall, and SAMe with good results for my fatigue.  Unfortunately I get anxious if I use them for long periods, so I only use them as needed.  What has made the most difference, besides keeping my testosterone in the upper side of the normal range, is going to bed around the same time at night and waking up also at the same time.  Traveling and other factors can interfere with maintaining a normal sleep cycle, but the fact is I need to listen to my body’s needs.  I can usually be tired enough to get better sleep by the time bedtime arrives if I avoid caffeine after 3 pm and don’t exercise too late at night.
Testosterone: A Man's Guide by Nelson Vergel

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From: “News at The Body” <update@news.thebody.com>
Date: 19 Jan 2011 14:43:20 -0500
To: <powertx@aol.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

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January 19, 2011 Visit the Forums “Hot Topics” Library Change/Update Subscription



LIVING WITH HIV/AIDS
 What Are Some First Steps to Getting in Shape?
After years without exercise I’ve decided to change my life. I even started running and bought a barbell. Do you have any tips for those just starting to exercise?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 How Do I Become an Activist for HIV Treatment Funding?
There seemed to be some glimmers of hope with HIV treatment access in the U.S., and now cuts in funding could lay waste to these advances. Is there any activism happening in the ADAP (AIDS Drug Assistance Programs) arena?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 How Can I Deal With HIV/AIDS Stigma?
I’ve noticed a lot of stigma attached to being HIV positive. It’s almost like I’m a leper in other people’s eyes. I’m pissed off at people in general and have no compassion for others anymore. I’ve tried numerous times to go back to school and become active in the community by volunteering but it seems that all doors close on me. What can I do?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum
BODY SHAPE CHANGES & HIV/AIDS
 Should I Take Avandia to Regain Lost Face and Body Fat?
I switched from Zerit (stavudine, d4T) to Viread (tenofovir) a year and a half ago, and since then my lipoatrophy has stopped progressing. I want to take Avandia (rosiglitazone) to regain lost facial and body fat. Do you think this drug will be helpful?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum

 Do You Know of Any Steroids or Hormones to Help Me Maintain My Weight?
I’ve been taking some type of steroid for the past 16 years. I was able to maintain my weight until six months ago when I started losing slowly. I’m 6 feet 1 inch tall and I currently weigh 159 pounds; I normally weigh between 168 and 172. I currently take Oxandrin (oxandrolone). What should I be taking along with it?

Nelson Vergel responds in the “Nutrition and Exercise” forum
HIV/AIDS TREATMENT
 Stopped Treatment When I Moved: How Do I Get Back on Track?
I stopped taking my HIV meds for almost seven months because of a move and other disruptions in my life. Will I need to switch med regimens now? Who can I talk to about this? How can I find an HIV specialist in my new state?

Robert J. Frascino, M.D., responds in the “Fatigue and Anemia” forum

 Can I Change My Dosing Time to Fit My Schedule One Day Out of the Week?
I always take Sustiva (efavirenz, Stocrin) at 10:30 p.m. and Truvada (tenofovir/FTC) at 7:30 a.m. before I go to university at 8 a.m. This semester I have class at 7 a.m. one day a week; the other days are the same as always. Would taking my medication at 6:30 a.m. on just that one day cause any problems? How flexible can I be with the hours I take my meds every day?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
Connect With Others Any Ideas for a Support Group for Recently Diagnosed HIVers?
(A recent post from the "Living With HIV" board)

I’m a social work intern at an HIV clinic and I’m looking to start a support group for people that are newly diagnosed. Can anyone share some activities or topics they’ve found helpful in support groups they’ve been to so I can incorporate similar elements into my own? — angew

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OTHER HEALTH ISSUES & HIV/AIDS
 Could My Recent Cognitive Issues Be HIV Related?
In the past year I’ve experienced short-term memory loss, I can’t remember names or faces, I don’t seem to have any energy and I often lose my words. I’m also on depression medications, which I know make me tired, but the other cognitive issues are scaring me. Could they be HIV related? Is there anything I can do?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Can Recreational Drug Use Affect a Person’s Immune System?
I have a friend who’s HIV positive and addicted to cocaine. His CD4 count is down to 250 and he has been taking medication for a month and a half. Is it true that cocaine can bring your CD4 count down even farther, even while taking medication?

David Fawcett, Ph.D., L.C.S.W., responds in the “Substance Use and HIV” forum

More Questions About Other Health Issues & HIV/AIDS:

HIV TRANSMISSION & TESTING
 Syphilis and HIV: Which Is More Easily Transmitted Through Anal Sex?
I understand that coinfection is always an issue, but all other factors being equal in terms of mode of transmission and risk factors, in receptive anal sex, which is easier to transmit: syphilis or HIV?

Robert J. Frascino, M.D., responds in the “Safe Sex and HIV Prevention” forum

 Can Melatonin Supplements Affect HIV Test Results?
There was a paper a while ago that talked about a negative correlation between HIV viral load and melatonin. I’m worried about a recent possible exposure, and wondering if using melatonin supplements could render a person’s viral load undetectable to the point where HIV would not show up on even a very sensitive test. Is this likely to happen?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum
STRANGE BUT TRUE
 Can “the Vapors” Transmit HIV?
What if you’re talking to an HIV-positive person with your face quite close to theirs, and the person has a bloody nose? Is there any risk of HIV being transmitted through the vapor from the person’s nose?

Robert J. Frascino, M.D., responds in the “Safe Sex and HIV Prevention” forum

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