IDSA: HIV Patients Face Early Anal Cancer Risk

By Ed Susman, Contributing Writer, MedPage Today
Published: October 25, 2011
BOSTON — Anal intraepithelial neoplasia seems to develop during in the first year of HIV infection, according to the results of a cross-sectional study.

Among 82 patients in the study group, 32.4% were diagnosed with high-grade anal intraepithelial neoplasia and 35.4% were diagnosed with low-grade disease, said John Lough, a medical student at Rush Memorial College in Chicago, in his presentation at the annual meeting of the Infectious Diseases Society of America. In addition, 3.7% were observed with atypia and 18% of the group had normal pathology.

Action Points  

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Explain that anal intraepithelial neoplasia seems to develop during the first year of HIV infection, according to the results of a cross-sectional study.
  • Note that individuals who had more than one unprotected receptive anal sex partner during the past six months had a 4.53-fold increased risk of developing high-grade anal intraepithelial neoplasia.

“Intervention with early treatment and possibly vaccination may be able to prevent the future development of anal cancer in this high-risk population,” Lough said. He noted that high-grade anal intraepithelial neoplasia is considered a direct precursor of anal cancer.
Lough and colleagues recruited the 82 men (average age 36 years) from the Options Project, an NIH study of individuals with confirmed, primary HIV infection within the previous year. Nearly 70% of the patients in the cohort were white and about 16% were Hispanic.
About 32% of the men admitted to use of drugs, such as amphetamines, while 30% were tobacco smokers at the time of the study. Additionally, 40% of the patients were on highly active antiretroviral therapy. The median CD4-positive cell count was about 550 cells/mm3.
The patients underwent a comprehensive clinical examination, an external visual examination, and biopsies of visible anal lesions with high-resolution anoscopy. The researchers used logistic regression to find risk factors for the development of high-grade anal intraepithelial neoplasia.
The authors found that patients who had been infected with HIV for longer than six months had 5.91-fold risk of developing high-grade anal intraepithelial neoplasia when compared with patients who had been diagnosed for less than six months (P=0.01).
He said that 22% of the patients diagnosed with HIV infection for less than six months tested positive for high-grade anal intraepithelial neoplasia compared with 51.6% of patients who had been infected for more than six months (P<0.01).
Individuals who had more than one unprotected receptive anal sex partner during the past six months had a 4.53-fold increased risk of developing high-grade anal intraepithelial neoplasia (P=0.06).
“High-grade anal intraepithelial neoplasia likely develops in the later part of early HIV infection,” Lough suggested. He said that CD4-positive cells counts were not particularly helpful in determining the lesion grade.
“There is a need to continue to build capacity for screening for anal cancer especially among HIV-infected men who have sex with men,” Lough concluded.
Screening patients for anal intraepithelial neoplasia is controversial, commented IDSA session moderator Joel Gallant, MD, from Johns Hopkins University in Baltimore.
“Many of us assume we should be screening for this because of what we know about cervical cancer which is such a similar disease,” he told MedPage Today. “We extrapolate from cervical cancer that we should be doing this screening.”
But there is currently no evidence that screening can help prevent anal cancer, Gallant said, pointing out that some professional guidelines recommend it while others do not. One problem with anal cancer screening is that high-resolution anoscopy requires special training and equipment that may not be widely available, he added.

Primary source: Infectious Diseases Society of America
Source reference:
Lough J, et al “Prevalence of high-grade anal intraepithelial neoplasia increases further in early HIV infection” IDSA 2011; Abstract 1391.  

Fw: Hot Topics at The Body’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 18 Oct 2011 18:15:38 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

If you have trouble reading this e-mail, you can see the online version at: www.thebody.com/topics.html

October 18, 2011 Visit the Forums “Hot Topics” Library Change/Update Subscription



LIVING WITH HIV/AIDS
 Which Diet and Supplement Regimen Will Help Me Build Muscle?
I weight train four times a week, do cardio and take supplements, and I would like to build more muscle. It seems that consuming more calories or taking products like Muscle Milk aren’t the answer because they may result in more visceral fat, which is already a concern for me given the metabolic changes caused by my HIV meds. Can you suggest an approach to diet and supplement use that would help me increase muscle without adding belly fat?

Nelson Vergel responds in the “Nutrition and Exercise” forum
MIXED-STATUS COUPLES
 Can You Give Me the Pregnancy Info My Conservative Doc Wouldn’t?
I was diagnosed with HIV six years ago while living abroad. I remember the professionalism and kindness of the doctor who gave me hope and sound advice. Upon returning to east Texas, I eventually found and married a wonderful lady who’s HIV negative. We want to have a child together but when I asked my doctor about this she said I should forget about it. It would be expensive, and I couldn’t possibly “do something like that in this conservative part of the country.” This was personally hurtful, but I listened to her. Now I have so much regret. I’m 42 and my wife is 40. Is it too late for us to have a baby? If not, what should we do next?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum
BODY SHAPE CHANGES & HIV/AIDS
 Could My Dental Work Cause My Facial Filler to Get Infected?
I read somewhere that dental work, even just teeth cleaning, may cause infection in an existing Bio-Alcamid (poly-Alkyl-Imide) implant in the cheek. How is this possible and what can be done to prevent it?

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

 I Survived Prostate Cancer: Does This Mean I Shouldn’t Take Egrifta?
I had my prostate removed successfully two years ago. I’ve recently gained a lot of belly fat, but because of my prostate cancer history I’ve been told I can’t be a candidate to take Egrifta (tesamorelin). Why would this be? Do you have any suggestions for dealing with my weight situation?

Nelson Vergel responds in the “Nutrition and Exercise” forum
Visual AIDS: Art from HIV-Positive Artists
Image from the October 2011 Visual AIDS gallery Detail from:
“Self Divided,” 1999;
Brent Nicholson Earle

Visit the October 2011 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "Stereopsis," is curated by Andrew Blackley.

HIV/AIDS TREATMENT & SIDE EFFECTS
 Did My HIV Med Resistance Go Away?
I became HIV positive about six years ago. I’m not on HIV meds yet; my CD4 count is 800, my percentage is 30 and my viral load is stable at 5,000. When I first tested positive, a resistance test showed M41L and T215 mutations. I recently had another test which showed no mutations. My doctor explained that this is common as the virus can mutate to a stronger wild-type virus and compete with the original, weaker version, but he did say the mutations would still be archived. Is all this correct? If so, what are my treatment options?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum

 Could My HIV Meds Be Causing Depression and Fatigue?
I was diagnosed with HIV 18 months ago and have been taking Isentress (raltegravir) and Truvada (tenofovir/FTC) with good results. The problem has been increasingly severe problems with fatigue and depression. I’ve been a steady gym-goer for over 25 years, but lately I seldom have the energy to get through a workout. I also battle serious bouts of depression that last several days. I’ve tried therapists and antidepressants with no real benefit. We’ve looked at hormone levels but so far nothing is abnormal. I know there was one published study of temporary worsening of existing depression with Isentress. Do you know of any further data on this phenomenon?

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

More Questions About HIV/AIDS Treatment & Side Effects:

OTHER HEALTH ISSUES & HIV/AIDS
 Depression Worsening as I Deal With Health Concerns: How Can I Cope?
I’ve stopped taking my HIV meds and antidepressants on my doctor’s recommendation because my liver is damaged. I was diagnosed with HIV in 2003 and have been on the same HIV med regimen since 2004; the liver damage happened all of a sudden. We’ve been looking for answers since June and there are no conclusive ones. I’ve been working in HIV prevention since I was diagnosed; I did this work as my way to “get back at the disease” and recently, because of my liver, I’ve missed a lot of work. I’m in therapy because of all this but can only take Ativan (lorazepam) for anxiety. I’m at a loss as to how to lift my spirits. Do you have any suggestions?

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

 Anal Itching Driving Me to Distraction: How Can I Treat It?
In the last year I’ve had two episodes of anal candidiasis after taking antibiotics. They each lasted two weeks and caused intense itching in my anus. Two months ago I tested HIV positive with a CD4 count of 200 and started on Atripla (efavirenz/tenofovir/FTC) immediately. I had to be on antibiotics again last week and now my anus is again itching unbearably. How can I treat this condition? Is it likely to get better now that I’m on HIV meds?

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

 Heavy Drinking and Redness on Hands: Could It Be Liver Failure?
I’m 40 years old and I was diagnosed with HIV less than a year ago. I have 686 CD4 cells and an undetectable viral load. I had a full organ panel in May, including liver tests, and all the results were normal to good. I have, however, been drinking heavily (six to 10 beers per evening, four to six days a week). My concern is a slight redness in my fingers and palms, which I’ve read could be a symptom of liver failure. Could I have developed cirrhosis in only a few months?

David Fawcett, Ph.D., L.C.S.W., responds in the “Substance Use and HIV” forum
Connect With Others I Disclosed My HIV Status to a Partner After We Had Unprotected Sex: What Now?
(A recent post from the "Living With HIV" board)

I just told someone who I had unprotected sex with about 24 hours ago that I am positive and she is freaking out. I am very worried about being prosecuted. I live in NYC; I didn’t orgasm; I asked her for a condom and she didn’t provide one; my viral load is undetectable and I was diagnosed six months ago.

I really really hope that she doesn’t press charges, and that she doesn’t get infected. I really screwed up, I know that. That is the first unprotected sex I’ve had since I found out, and I know it was selfish. I just couldn’t bear to tell her after knowing her for only a week, as I was afraid she’d look at me differently.

What can I do in this situation? What should I be prepared for? What could I do differently next time? — dmb147

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UNDERSTANDING HIV/AIDS LABS
 Could a Flu Shot Reduce My CD4 Count?
I’ve been taking HIV meds for a year. In that time, my CD4 count has gone from 70 to 419. My viral load is now at 30. My question is, can a flu shot cause a person’s CD4 count to decrease? If so, how long does this effect last?

Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the “Understanding Your Labs” forum
HIV & HEPATITIS C TRANSMISSION
 Hepatitis C, Sex and My Period: Is My Partner at Greater Risk?
If a woman has hepatitis C and has unprotected sex with her partner while on her period, is the partner at greater risk for getting hepatitis C than at other times of the month?

Barbara McGovern, M.D., responds in the “Hepatitis and HIV Coinfection” forum

 Anxiety After a Rape: Does the Window Period Ever Get Bigger?
I was raped in the fall of last year. In the months since then I’ve been tortured by fear and anxiety over whether I’m now HIV positive. I finally mustered up the courage to get tested a few weeks ago, and the test came back negative. I’m just so worried that the lady administering the test may have lied to me. Has there ever been a case where the “window period” grew wider than six months?

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

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Activist Central
 Sign On: Treatment Prevents Transmission — Obama, Stand Up for Treatment Expansion Worldwide

 Action Alert: Tell Gov. Cuomo to Consider Transgender Medicaid Proposal

 Take Action! PWN Stands With Planned Parenthood

 Tell Your Representative to Join the Congressional AIDS Caucus

 Action Alert: Tell Congress NO on Cuts to Medicaid!

 Community Input for 2012 International AIDS Conference

 You Are Invited! The Inaugural HIV Prevention Justice Leadership Assembly

 Call for Abstracts: 2012 National African-American MSM Leadership Conference on HIV/AIDS and Other Health Disparities in New Orleans

 AIDS Healthcare Foundation Announces March on Washington

CD4 cell manipulation and reinfusion…will they make a difference in long term survival?

Very cool article on Matt’s CD4 cell manipulation and reinfusion

Will this be a solution for people whose CD4 cells have remained low even after years of undectectable viral load? Are these “HIV resistant” CD4 cells functional in the long run? Well, Matt thinks his health has improved and he no longer has sinus infections like he used to before he joined the study.  We may soon need all of you to support this new concept, so be ready!

Fw: News & Views: Speeding Up Cure Research; 10 Q’s Before Starting Meds; Having a Baby; and More

From: “News at The Body” <update@news.thebody.com>
Date: 13 Oct 2011 13:02:29 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: News & Views: Speeding Up Cure Research; 10 Q’s Before Starting Meds; Having a Baby; and More

If you have trouble reading this email, you can see the online version at: www.thebody.com/updates.html

October 13, 2011 Top Stories at TheBody.com News & Views Library Change/Update Subscription


ON THE PERSONAL SIDE Jermaine Wright Jermaine Wright: How My Baby Girl Was Conceived — After My HIV Diagnosis
“We rarely hear about men conceiving while HIV positive,” Jermaine Wright observes in his latest video blog. Yet Wright’s fourth daughter was born in August; she’s the first child he fathered since being diagnosed with HIV. In this entry, Wright walks readers through the nerve-wracking — and less than perfect — steps he took while he and his partner conceived their baby (both mom and daughter stayed negative).

Rae Lewis-Thornton Rae Lewis-Thornton: I Once Prepared to Die Young; Now I Prepare for Menopause
“I remember when I first started speaking I would go to high schools and ask the freshman to stand, and I’d say, ‘By the time you graduate I’ll be dead,'” Rae Lewis-Thornton remembers. “But a funny thing happened on the way to death: I lived!” Now, Rae’s facing another “change of life,” one she never thought she’d live to see: menopause.

Kaleo  Kaleo: HIV in Hawaii (Video)
Kaleo, an eighth-generation native Hawaiian, has been living with HIV since 1989. In this video interview, he shares his views on how Hawaiian culture deals with HIV and homosexuality. It’s one of three new interviews with HIVers featured in our latest collection of videos from The Positive Project.

Ellisya Ellisya: My Early Years — and Why I Am Sharing Them
Every person’s tale is uniquely their own. Blogger and HIV/AIDS activist Ellisya recounts poignant memories from her childhood growing up in Malaysia. This raw story of survival follows her from grade school to young motherhood, before she learned that she and her daughter were HIV positive.
Connect With Others How Should I Mark My One-Year HIV Anniversary?
(A recent post from the "Living With HIV" board)

“The day I found out I am HIV positive is coming up in a few days. It will mark year one. The year has been marked with eventful highs and lows. To be honest, I don’t know how I should feel about it. I know I feel a little anxious. Which is silly in a way that a particular day is any more important than another. … How do you all mark or don’t mark the day? I am thinking about doing something special just for me, to add a positive note to the day instead of marking the bad — or should I just treat it with the same regard I do any other day?”

 — kicker

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HIV TREATMENT & HEALTH ISSUES question marks 10 Questions to Ask Yourself Before You Begin HIV Treatment
An HIV diagnosis comes with its very own set of questions to ask yourself and decisions to make. Among the biggest is: When should you start treatment? It’s a Russian nesting doll of a decision, with many other questions tucked inside. HIV/AIDS advocate Heidi Nass guides us through the most important ones.

Nelson Vergel What Can We Do Now to Speed Up HIV Cure Research? (Video)
“I came to the realization that we needed a video that would wake people up to the challenges ahead of us to get to a cure for HIV that is accessible and practical,” advocate Nelson Vergel writes. So Vergel did just that: He traveled around the country interviewing key players in the HIV community as part of a documentary he’s directing on the cure. Here he shares a preview of his work.

Arlene Martínez You’re Young, You’re Latino, You’ve Got HIV. Where Do You Go for Help?
“Once they learn their diagnosis, one of our biggest problems is getting them to adhere to the medication,” says Arlene Martínez, youth transitional case manager at AltaMed Health Services in East Los Angeles. Martínez discusses the challenges HIV-positive young Latinos face in taking all their meds, and the huge obstacles that can prevent undocumented youths from accessing HIV care services in general.

throat HPV Spurs New Cases of Mouth and Throat Cancer in the U.S.
In the HIV community, we know human papillomavirus (HPV) mainly as the chief culprit behind rising rates of anal cancer in both men and women. But a recent U.S. study finds that HPV’s dangers extend to the other end as well: The virus is now the leading cause of cancers of the throat, mouth and neck, researchers suggest.

More Headlines on HIV Treatment and Health Issues:

Visual AIDS: Art from HIV-Positive Artists
Image from the October 2011 Visual AIDS gallery Detail from:
“Seat-Leg Table,” 1989
Scott Burton

Visit the October 2011 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "Stereopsis," is curated by Andrew Blackley.

NEWS & VIEWS  Inside the Activists’ Summit: Empowering Women to Become Leaders in the HIV/AIDS Movement
As we send this newsletter, an important meeting is taking place in Baton Rouge, La., to address the serious lack of input from, and leadership by, women living with or affected by HIV/AIDS. We sat down with some of the central women behind this key gathering to talk about its significance.

Bronx AIDS Services HIV/AIDS Organization Spotlight: Bronx AIDS Services
This year, Bronx AIDS Services in New York celebrated its 25th anniversary. The Bronx is no stranger to the HIV/AIDS epidemic: At the end of 2009, 22,248 of New York City’s 108,886 HIV-positive people were living in the Bronx. In this article, we interview Jose Davila, the executive director of Bronx AIDS Services, to go in-depth about the work his organization does.

 HIV-Positive Teacher Files Discrimination Lawsuit Against Chicago School System
An HIV-positive elementary school teacher in Chicago filed a discrimination lawsuit against the city’s school district this week. Jumeck Smith claimed that his school’s principal denied him accommodations granted by the CPS because of his HIV status. Smith, who is black, also claimed that the principal treated him less favorably than teachers who were not African American.

More News & Views Headlines:

Join the Conversation Rob (From Canada) on “Remembering Robert Frascino, M.D.

Dr. Bob Frascino“I placed his picture in a frame and hang it where I can see him often and remember, gratefully, how he helped me during the most difficult days of my life. I miss him greatly.”

Read through more beautiful posts from hundreds of your fellow readers who have paid their respects to Dr. Bob, one of the HIV/AIDS community’s most tireless educators and advocates, who passed away on Sept. 17.

HIV/STD TRANSMISSION & EDUCATION California Gov. Jerry Brown California’s Governor Signs Two Bills That Promote Needle Exchange and Harm Reduction
While most states do not support needle exchange programs to reduce HIV and hepatitis infections, Gov. Jerry Brown is moving California in the other direction: He recently signed two bills making clean syringes more accessible, an approach that has been frequently linked to reductions in HIV risk among drug users.

More HIV/STD Transmission & Education Headlines:


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Activist Central
 Sign On: Treatment Prevents Transmission — Obama, Stand Up for Treatment Expansion Worldwide

 Action Alert: Tell Gov. Cuomo to Consider Transgender Medicaid Proposal

 Take Action! PWN Stands With Planned Parenthood

 Tell Your Representative to Join the Congressional AIDS Caucus

 Action Alert: Tell Congress NO on Cuts to Medicaid!

 Community Input for 2012 International AIDS Conference

 You Are Invited! The Inaugural HIV Prevention Justice Leadership Assembly

 Call for Abstracts: 2012 National African-American MSM Leadership Conference on HIV/AIDS and Other Health Disparities in New Orleans

 AIDS Healthcare Foundation Announces March on Washington

Are there any options for HIV+ patients who cannot get Egrifta to treat their belly fat?

From : http://www.thebody.com/Forums/AIDS/Nutrition/Q217585.html?ic=700101

Anything Available for Those of us who cannot get Egrita?
Oct 4, 2011
Nelson, my insurance company refuses to pay for Egrifta after my doctor wrote a letter. I have a lot of visceral fat (18 pound increase in weight since I started HIV treatment). Is there any other option for me? I have a good job but cannot afford the $2000 per month cost of Egrifta.
Response from Mr. Vergel

I am sorry that you have had such trouble trying to access Egrifta(Tesamorelin)which is indicated for the reduction of excess abdominal fat in HIV-infected patients with lipodystrophy. Egrifta is a growth hormone releasing hormone that makes your own pituitary gland release physiologic levels of growth hormone. Prior studies using growth hormone (Serostim) showed that visceral fat was effectively decreased by growth hormone, but GH caused side effects that made the FDA reject Serono’s application for lipodystrophy for Serostim. So Serono bought the rights of Tesamorelin from a Canadian company (Theracnologies) after it was shown that their growth hormone releasing hormone did not have the same concerning side effects (hypergylcemia, joint aches, edema, and others) that Serostim had. Egrifta got approved by the FDA but the FDA also required the company to engage in post approval studies to prove that the hormone did not increase incidence of cancer, since there is some fear that growth hormone products can do so.
I know that Serono is making progress trying to get the product included in different formularies around the country, but there are still insurance companies and Medicare Part D programs that are not paying for it. And sometimes it is difficult for physicians to spend the extra time required to write letters of necessity to try to fight insurance companies. Some Medicare Part D patients who are lucky enough to get the product paid for cannot afford the high copays of over $100 per month, so there are still challenges in access even for those with third party coverage (there is copay assistance for non Medicare patients, though). Hopefully that will get better with time. For those patients with no insurance, Serono has set up a very good compassionate access program to cover the cost of the hormone for those with incomes under $60,000 a year. More on Egrifta.com
I remind people that this hormone requires daily injections under the skin. The average visceral fat loss in the studies was around 17%, but when Theratecnologies (the manufacturer) separated responders versus non responders they found out that 30 % of all patients did not respond at all to the injections (their fat did not decrease). But the rest who responded, the fat reductions were as high as 27%. The manufacturer did not control for those who exercised or went on a special diet, however. So, we do not know if patients who responded best were also using other modalities that may have improved that response. As it stands, Serono and Theratecnologies have no idea how to predict who will respond to the daily injections. Also, do not forget that the fat lost will come back if you stop the product, although no one has done a study to see what happens to those patients who made permanent and durable life style modifications through the use of Egrifta. Those patients may retain some of the benefits even after drug cessation, but that is just my opinion.
There is a generic option of a growth hormone releasing hormone that acts in the same way as Egrifta but it is a peptide with a shorter molecule chain. It can only be obtained by prescription from a compounding pharmacy. It is called Sermorelin Acetate. Like Egrifta, it stimulates the pituitary gland to naturally produce increased amounts of human growth hormone. The increased volume of human growth hormone produced by the pituitary gland causes an increase in the production of Insulin-Like Growth Factor-1 (IGF-1) by the liver. Increased IGF-1 has been associated with increased lean body mass and decrease fat but as I said before, some skeptics fear that it may also increase growth of malignancies (this is unproven).
Sermorelin can cost anywhere from $300-$500 a month depending on the dose used. And insurance companies will not pay for it, so you will have to pay out of your own pocket. Most doctors do not know about this option, however.
Like with any option to improve body composition, you should make sure that your thyroid and testosterone hormone levels are OK since that will ensure that your response will not be impaired by deficiencies of both hormones. Resistance/cardiovascular exercise and high fiber-low sugar-high protein diet are also two life style habits that will probably enhance response, although we really do not have controlled data on this combination that intuitively makes sense.
You can find a compounding pharmacy close to you at :
Compounding pharmacies
Depending on the state that you live in, most compounding pharmacies deliver by mail to your home. The price differential among pharmacies is big, so call around.
I and a lot of my pozhealth group members have been usingapsmeds for a few years for cheaper testosterone, nandrolone, HCG and other products like Sermorelin.
Please let me know if you have any more questions. This is an emerging area that has been of great interest in the community, but one that has lost a lot of funding even as we grow older with HIV and need more data on therapies that can help us live healthier and stronger.
Nelson Vergel

Fw: Hot Topics at The Body’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 12 Oct 2011 16:28:14 -0400
To: <nelsonvergel@yahoo.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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LIVING WITH HIV/AIDS
 How Should HIV-Positive Individuals Come to Terms With Mortality?
I’m in shock and saddened at the loss of Dr. Bob, who was only 59. I looked up to long-term survivors like him. I’ve known at least five other positive individuals who died in the last couple years when they were just 50-60 years old. The causes ranged from heart attacks to liver failure. I just don’t know how to process the uplifting claims that we will live a normal lifespan versus the people I’ve seen die way too young. I’m thankful that HIV meds give us more healthy years, but HIV may eventually win out. How are we supposed to cope with this?

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

 Is Juicing the Healthiest Way to Consume Fruit?
I am 28 years old, was diagnosed with HIV nine months ago, but not on any HIV meds yet. Recently, I bought a juicer, but I’m not sure what fruits and veggies my body will need more of. I am eager to get started. Is going on a juice fast a good idea?

Nelson Vergel responds in the “Nutrition and Exercise” forum
MIXED-STATUS COUPLES
 How Can I Get My Wife Pregnant Safely?
I am HIV positive and my wife is negative. We want to have a baby now. How can we minimize the risk of infecting my wife and baby? And are there programs in the New York area that can help us?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum
BODY SHAPE CHANGES & HIV/AIDS
 All About Egrifta: Where’d It Come From, and How Can I Pay for It?
My insurance company refuses to pay for Egrifta (tesamorelin), even after my doctor wrote a letter. I have a lot of visceral fat (18-pound increase in weight since I started HIV treatment). What advice do you have on obtaining Egrifta and improving body composition in general?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Can I Use Sculptra to Prevent Facial Wasting?
Does Sculptra (poly-L-lactic acid, New-Fill) prevent facial lipoatrophy or is it only a treatment for when facial wasting has already begun? How do I know when or if to start treatment?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum
Visual AIDS: Art from HIV-Positive Artists
Image from the October 2011 Visual AIDS gallery Detail from:
“Nervous System,” 1997
Eric Rhein

Visit the October 2011 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "Stereopsis," is curated by Andrew Blackley.

HIV/AIDS TREATMENT
 Could Atripla Be Affecting My Sex Life?
Does Atripla (efavirenz/tenofovir/FTC) impede sexual function? Are sexual side effects common for others on this regimen?

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

 Which Tests Does Someone Need Before Starting Treatment?
I am 40 years old and was diagnosed in 2003. According to my most recent labs, taken back in November 2008, my CD4 count was 345 and my viral load was around 1,700. Now I’m thinking about starting treatment. Besides the regular CD4 and viral load tests, what other assessments should I consider before starting meds?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
OTHER HEALTH ISSUES & HIV/AIDS
 Have My Depression and Anxiety Meds Stopped Working?
I’m 58 years old and have been HIV positive since January of 2010. My HIV meds are Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC). I was diagnosed with generalized anxiety disorder (GAD) and clinical depression in 1986. I started with Prozac (fluoxetine) and have been on numerous medications since then. Some helped for months or years before they lost their effectiveness, and others didn’t help at all. I’ve been on my current GAD regimen for more than five years. This year has been horrible for my anxiety and depression. Is it time for a medication switch? What are the options out there for treating GAD?

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

 Will I Ever Be Able to Take Hepatitis C Treatment Without Interferon?
Several years ago I was treated for hepatitis C but was unable to tolerate the interferon portion of the treatment. Will there ever be a treatment regimen for hep C that doesn’t include interferon?

Barbara McGovern, M.D., responds in the “Hepatitis and HIV Coinfection” forum
Connect With Others Don’t You Get Angry When You Can’t Get a Date?
(A recent post from the "Living With HIV" board)

I’m a 25-year-old man. I’m very upset because I’m looking for a nice woman who I can date. I have tried mixed-status relationships but it’s hard. I want to date a woman with HIV. I know there are tons of us on this same boat, so why am I the only one who’s angry? I have joined a few so-called HIV dating sites but they took money I didn’t have and no one replied to me. Where are the resources for us to meet other HIV-positive people to date? Is there anyone out there for me? — Normalguy

Click here to join this discussion, or to start your own!

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UNDERSTANDING HIV/AIDS LABS
 What’s the Difference Between “Undetectable” and “No Target Detected”?
Is there a difference between the terms “no target detected” and “undetectable” in regards to viral load testing? If so, can you please explain?

Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the “Understanding Your Labs” forum
HIV & HEPATITIS C TRANSMISSION
 Can I Get Hepatitis C From Dried Blood on a Cocaine Straw?
The other night I snorted a line of cocaine at a house party. I used my own straw, but what if the bread knife I used to cut the straw with had dried blood on it and I just didn’t notice? I have read that hepatitis C can live outside the body, so could there have been some risk of infection? How would I be able to tell?

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

 How Many Drops Does It Take to Transmit HIV?
If there is a small drop of blood on household items and we touch the items with an open wound, what is the risk of HIV? Does HIV survive long outside the body and has anyone ever been infected this way?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum

Worried Your Spam Filter 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.

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 Take Action! PWN Stands With Planned Parenthood

 Tell Your Representative to Join the Congressional AIDS Caucus

 Action Alert: Tell Congress NO on Cuts to Medicaid!

 Community Input for 2012 International AIDS Conference

 You Are Invited! The Inaugural HIV Prevention Justice Leadership Assembly

 Call for Abstracts: 2012 National African-American MSM Leadership Conference on HIV/AIDS and Other Health Disparities in New Orleans

 AIDS Healthcare Foundation Announces March on Washington

 HIV+ Gay and Bi Men! Sign-On Letter Supporting an Informed Debate About PrEP Based on Facts, Not Misinformation

Fw: Hot Topics at The Body’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 04 Oct 2011 18:04:22 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

If you have trouble reading this e-mail, you can see the online version at: www.thebody.com/topics.html

October 4, 2011 Visit the Forums “Hot Topics” Library Change/Update Subscription



LIVING WITH HIV/AIDS
 What Could Be Causing My Low Sex Drive?
I’m 60 years old and I’ve been HIV positive for 10 years. My CD4 count is in the 200s and my viral load is undetectable. My partner of 13 years and I have always been extremely sexual, in addition to our great relationship, but lately my libido has been close to zero. Even self-stimulation isn’t successful. Is it because of my low testosterone levels? What are some other causes, and what can I do about them?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Young, Depressed and Newly Diagnosed: How Can I Cope?
I’m 17 years old, and in June I was diagnosed with HIV. I live with my father (my mother passed away in 2008) and he doesn’t quite understand what I’m going through. When I try to tell him something about how I’m feeling or about HIV, he gets really angry and yells. I’ve been really stressed out because of that reason and others, including school and getting ready for college. Is there any way to deal with stress and depression without taking antidepressants?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum
BODY SHAPE CHANGES & HIV/AIDS
 What Can Be Done About Facial Nodules Caused by Sculptra?
I had Sculptra (poly-L-lactic acid, New-Fill) injections four years ago, and some nodules formed. After a few years they went down. Now that I’ve had intense pulsed light (IPL) therapy done on my face, the nodules have returned. Are there treatments available for minimizing or removing these nodules?

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

 Is Egrifta Worth a Shot a Day?
I’ve had increased belly fat for over a year and a half. I’ve read about the new drug Egrifta (tesamorelin) for visceral fat reduction in HIVers. Is it worth injecting myself with it every day? What are the odds that it will actually work?

Nelson Vergel responds in the “Nutrition and Exercise” forum
Visual AIDS: Art from HIV-Positive Artists
Image from the October 2011 Visual AIDS gallery Detail from:
“HIV/AIDS Obituary Chair,” 1994
Kurt Reynolds

Visit the October 2011 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "Stereopsis," is curated by Andrew Blackley.

HIV/AIDS & HEPATITIS C TREATMENT
 Should I Switch to the New One-a-Day Pill Complera?
I’ve been taking Kaletra (lopinavir/ritonavir) and Truvada (tenofovir/FTC) since I was diagnosed two years ago. My viral load is undetectable and my CD4 count is in the 600 range. I’ve had bad gut side effects with this combination, as well as lipodystrophy and high cholesterol and triglyceride levels. I know my HIV meds have been working for me, but I’d love to only take one pill per day. Might I have the same benefits with fewer side effects if I switched to Complera (rilpivirine/tenofovir/FTC)?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum

 What’s the Latest on a Functional Cure for HIV?
I’ve been seeing a lot of news articles recently about Sangamo BioSciences’ study into a possible functional cure for HIV. What exactly are they looking at?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum

 Newly Diagnosed With Hepatitis C: When Should I Start Treatment?
I’ve been HIV positive for 15 years and I take Atripla (efavirenz/tenofovir/FTC); my CD4 count is 500. I was exposed to hepatitis C (HCV) around mid-July. I went to my doctor for tests in August. I didn’t have HCV antibodies but my doctor found that I did indeed have the virus in my blood. My doctor suggested I start HCV treatment, but I want to hold off for as long as possible as I have a high-pressure job that involves lots of travel. How long can I wait before starting treatment?

Barbara McGovern, M.D., responds in the “Hepatitis and HIV Coinfection” forum

More Questions About HIV/AIDS & Hepatitis C Treatment:

OTHER HEALTH ISSUES & HIV/AIDS
 Androgel and Arimidex: Will This Unusual Protocol Work Against Hypogonadism?
I have secondary hypogonadism (low testosterone), and my endocrinologist put me on Arimidex (anastrozole) and Androgel. What do you think of this combination? Will it affect my ability to have children someday?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Should I Find an HIV-Positive Mental Health Provider?
Do you think it’s important that a mental health provider be HIV positive in order to understand his or her HIV-positive clients? Is there any way to find counselors in the HIV community that are open about their HIV-positive status?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum
Connect With Others My Boyfriend’s Visiting and My Viral Load’s High: How Can We Be Sexual and Keep Safe?
(A recent post from the "Gay Men" board)

This is my first post on these bulletin boards. I was recently infected which means that my viral load is astronomically high. In between being infected and being diagnosed I fell for an HIV-negative guy and he is coming to town this weekend.

I am not feeling very sexual at all but are there safer ways that I can still show him that I am still tremendously sexually attracted to him? My fear is that I will get too into my thoughts and not be as adventurous as I know that we both enjoy. Does anyone have any advice or tips? — Steelers07

Click here to join this discussion, or to start your own!

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UNDERSTANDING HIV/AIDS LABS
 Will My CD4 Count Ever Reach 500?
Ever since I was diagnosed with HIV in 1995 my CD4 count has hovered around the 200 mark. The lowest it’s ever been is 40; then I started HIV meds in 2005. Recently I was astonished to find it had peaked at 350, the highest it’s ever been in 15 years. I see on this site that people should start treatment if their CD4 count is 500 or below, but mine seems to be naturally low. I have never had a day’s illness in all these years. Should I be worried that I have only ever attained 350 CD4 cells at once?

Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the “Understanding Your Labs” forum
HIV TRANSMISSION
 Can an HIV-Positive Person Be Reinfected?
Can someone who has been diagnosed HIV positive be reinfected by another person also living with HIV? Is it possible for someone to know if their strain is the same one their partner has?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum

Worried Your Spam Filter 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.

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Activist Central
 Take Action! PWN Stands With Planned Parenthood

 Tell Your Representative to Join the Congressional AIDS Caucus

 Action Alert: Tell Congress NO on Cuts to Medicaid!

 Community Input for 2012 International AIDS Conference

 You Are Invited! The Inaugural HIV Prevention Justice Leadership Assembly

 Call for Abstracts: 2012 National African-American MSM Leadership Conference on HIV/AIDS and Other Health Disparities in New Orleans

 AIDS Healthcare Foundation Announces March on Washington

 HIV+ Gay and Bi Men! Sign-On Letter Supporting an Informed Debate About PrEP Based on Facts, Not Misinformation