Today’s Supreme Court Decision on Health Care Reform- The fight is not over and it is now up to the states

The fight over healthcare is not over.

Today’s decision means that state lawmakers will have to pass legislation to establish insurance exchange that will allow uninsured people and small businesses to access quality healthcare coverage at affordable prices. If the state Legislature fails to do so, people will have to buy insurance through a federally created exchange. Additionally, the state Legislatures will be forced to make a decision on how to provide healthcare for their uninsured people. If a state turns down the billions of federal dollars it is set to receive through a Medicaid expansion, local hospital districts funded through local property taxes will continue to bear the burden of funding care for indigent people.

Fw: Hot Topics at TheBody.com’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 26 Jun 2012 18:04:25 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at TheBody.com’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

June 26, 2012 Visit the Forums “Hot Topics” Library Change/Update Subscription



Living With HIV  How Long Can I Live Healthily With HIV?
I see people that look healthy and have been HIV positive for 20 years or more. I’m so scared that I’ll live that long, but look and feel sick. Can you tell me how long an HIV-positive person can stay healthy? Also, how long can a person stay on the same HIV med regimen?

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

 What’s the Deal With the Green Coffee Bean?
Have you heard about this green coffee bean craze for losing weight and controlling your sugar spikes and carb cravings? I saw something on Dr. Oz about it being packed with antioxidants and better for you that regular coffee beans. What have you heard? Are there any interactions between these special coffee beans and HIV meds?

Nelson Vergel responds in the “Nutrition and Exercise” forum

More Questions About Living With HIV/AIDS:

Mixed-Status Couples  My Sex Partner’s Positive, but He Pulled Out: Am I at Risk?
I had unprotected sex with a man who has HIV. He didn’t inform me of his HIV status before our sexual encounter, and assures me now that I wasn’t at risk since he pulled out well before he came. Is this true? If I am at risk, what can I do at this point?

Richard Cordova responds in the “Safe Sex and HIV Prevention” forum
Insurance, Workplace & Legal Concerns  Can I Keep the Insurance I Got Before I Was Positive?
I signed up for and received group life insurance coverage through my employer’s plan, as well as a short-term disability plan of my own, several months prior to my HIV-positive diagnosis. I haven’t received any notification of cancellation. Is my coverage still valid since I hadn’t been diagnosed positive when I applied, and therefore nothing fraudulent took place?

Jacques Chambers, C.L.U., responds in the “Workplace and Insurance Issues” forum
criminalizing hiv: what do you think?
HIV criminalization Got thoughts about HIV accusations and prosecutions? We bet you do!

The SERO Project would like to hear from people living with HIV, their partners, friends and family, workers in HIV fields, advocates and allies in response to a survey gathering opinions about HIV criminalization. Take the survey, and let your ideas be heard.

HIV/AIDS Treatment  What Could Replace Reyataz in My Regimen?
I’ve been taking Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC) for a year. Ever since that time I’ve dealt with gut side effects like indigestion and nausea for hours after I take my meds. The side effects are taking a toll on my daily life as I can’t drink or eat anything after taking my meds. I also can’t drink milk anymore. My doctor advised me to switch the Norvir-boosted Reyataz in favor of Edurant (rilpivirine). Is this the best option for me? What about Prezista (darunavir), or something else? What are my next steps toward switching?

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


 Can I Take My Meds Only on Weekends?
My CD4 count is 515 and my viral load is undetectable. I’ll be going to a live-in academy soon and will not be able to take my HIV meds there. I didn’t list Atripla (efavirenz/tenofovir/FTC) when asked which medications I am currently taking, because I’m afraid I’ll face discrimination at the school for being HIV positive. Should I continue taking the pill on my nights off — Friday, Saturday and Sunday? Or should I completely discontinue the medication?

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


 Are My New Meds Known for Causing Night Sweats?
I’ve been taking Isentress (raltegravir) and Truvada (tenofovir/FTC) since January with good results; my viral load is undetectable and my CD4 count is 500. I also take generic Lexapro (escitalopram) for depression. However, I have consistent night sweats that have me up and soaking my clothes several times each night, and it’s wearing me out. Is this normal?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
Other Health Issues & HIV/AIDS  Why Am I So Exhausted All the Time?
I’m very active, I eat healthily and get plenty of sleep every night, but I always wake up exhausted. My lab results are extremely good — my viral load is undetectable and my T-cell count is between 700 and 800. My weight is proportionate to my height and I drink very little caffeine. I’ve told my doctor about my fatigue but she finds nothing in my blood work that would indicate anything abnormal. I take Atripla (efavirenz/tenofovir/FTC) but have never had the vivid dreams. I doubt it’s the meds but I’m not sure what else it might be. Any thoughts?

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

 What Are Some Side Effects of Deca Durabolin?
I have cytomegalovirus (CMV) and I’m also on Deca Durabolin (nandrolone decanoate, Deca). CMV has been the source of many problems for me, including muscle loss and swollen glands. I went on Deca to counter the muscle loss, and I’ve noticed that my arms and legs are veinier. I’m also noticing headaches and bulging, pulsating veins in my temples. It’s hard for me to tell which symptoms are side effects of Deca and which are caused by CMV. What are some possible effects of taking Deca?

Nelson Vergel responds in the “Nutrition and Exercise” forum
taking the test: what's your experience?
HIV community membersTo commemorate U.S. National HIV Testing Day on June 27, we asked community members to reflect on their HIV testing experiences. Their stories are funny, heartbreaking, frustrating, empowering, and everything in between.

Read other people’s experiences, and share your own in the comments section of the article!
 


Understanding HIV/AIDS Labs  Should I Be Concerned About My Liver Lab Results?
I feel like I always get conflicting info about my liver labs. I get varying opinions on what’s considered “normal.” My liver enzyme levels are always in the normal range. Sometimes they are on the low end of normal, but most times they are at the higher end of normal. However, I’ve had a few folks and even a doc say that being on the high end of normal means there is some irritation and you really want to be on the low end of normal. Is this true? Does it really matter? How is the decision made as to what’s normal?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
HIV Transmission  Is Protected Sex Really Protected?
Is sex while wearing a latex condom that doesn’t break or fall off throughout anal sex really “protected sex”? I ask because several experts I have read online say the risk is low, not nonexistent, so that has me freaked out a little. I have always heard that condom-protected sex is safe sex and not to worry. I am a top and have never had unprotected sex or had a condom break or fall off, but reading that it is only “low risk,” not “no risk,” has me concerned. Can you give me some insight?

David Wohl, M.D., responds in the “Safe Sex and HIV Prevention” 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
 HIV Accusations and Prosecutions: What Do You Think?

 It’s the Best Kept Secret We Need to Share: There’s a Totally Free and Public International AIDS Conference in Washington, D.C. This Summer

 Join the Black AIDS Institute at the AIDS 2012 International Community Science and Treatment Pre-Conference Workshop

 Train and Triumph With Team to End AIDS!

 Under Attack: Your Health Care Rights

 Activists Launch New Survey to Help Speed HIV Cure Research

 Demand Hershey Reverse Decision on HIV+ Student and Dismiss School Officials

 Count HIV+ Women In! PWN Launches National Campaign on World AIDS Day

Exciting New Data on The Use of JAK Inhibitors to Control HIV

This abstract was recently presented at the  International Workshop on HIV and Hepatitis in Sitges
Abstract 37 by RF Schinazi and colleagues was on the topic of a novel series of inhibitors of HIV replication called Jak inhibitors. These compounds are able to interfere with the Jak-STAT pathway in activated lymphocytes and macrophages in the aftermath of HIV infection. Activation and reactivation of cells was performed using monoclonal antibodies against CD3 and/or CD28 and activation was monitored by flow cytometry. The Jak-STAT pathway is routinely stimulated in HIV-infected cells and can therefore be perceived as a logical target for drug development. Now, in this proof of concept study, it has been shown that two lead compounds termed Tofacitinib and Jakafi demonstrated excellent inhibition of HIV replication at concentrations ranging between 0.02-0.3 µM in cultured human lymphocytes and macrophages as well as against replication of a SHIV in lymphocytes and macrophages obtained from rhesus macaques. Moreover, these compounds were not toxic and the selectivity index for each of these compounds was high. This is the first demonstration that targeted blockage of the Jak-STAT pathway might be an effective way of interfering with HIV replication in both macrophages and lymphocytes. Moreover, the data suggest that these compounds might interfere with the ability of HIV to achieve latency in a variety of target cell types and that they were active against all of a variety of forms of drug-resistant HIV-1 that were tested. In addition, activity was demonstrated in regard to latently infected cells that were re-activated so as to become overt producers of HIV. The field will now await further studies on some of the molecules in this series, at least some of which are already approved by the Food and Drug Administration in regard to other disease indications, such as rheumatoid arthritis and myeleofibrosis.

The Economist: The business of HIV – Battling the virus- A huge, strange drug market

If the process for developing HIV drugs has been unusual, selling them has been even more so. America is the rich world’s biggest market, with 841,000 patients diagnosed—ten times as many as in Britain. More than 60% of HIV drugs in America are bought with public money. Insurers give HIV special treatment: patients are rarely pressed to buy the cheapest pills, as they might be if they had another disease.

http://www.economist.com/node/21556275

Heart Disease and HIV- What to Do?

Some HIV+ people have emailed me worried about this report:

Heart Attacks Found Early and Frequently in HIV Positive People

Calculate your 5 year estimated cardiovascular risk: D-A-D Cardiovascular Risk Equation for HIV+ People

My suggestions to minimize heart disease (not in any other of importance):
1- Do not smoke
2- Keep your cholesterol and triglycerides within normal ranges (with exercise, diet, HIV medication change, fish oils, even medications)
3- Exercise 4 times a week for an hour
4- Take a baby aspirin every day (81 mg)
5- Take 200 mg of Coenzyme Q-10 and 2000 mg of carnitine per day
6- Get a stress test every two years 
7- Have one to two glasses a day of red wine, no more.
8- Controversial topic: avoid abacavir (Ziagen, Epzicom), D4T, AZT, Crixivan.
9- Control your HIV to under 50 copies all the time
10- Manage stress: meditate, take a hobby, do pleasurable things every day, let go of what you cannot control, etc
11- Avoid street drugs, except moderate pot for pain or appetite.
12- Get your blood pressure under control 
13- Keep your weight down
14- Keep your gums healthy
15- Eat cold water fish (salmon, sardines, etc) at least once a week
16- Have a hand full of nuts once a day
17- Keep your testosterone and thyroid hormones within healthy ranges.
18- Know the symptoms of a heart attack and call 911 immediately if you ever have them. Do not deny them or “sleep them off”.  Do not have a friend take you to the hospital. Call 911 and paramedics will pre-treat you right when they are driving you to the hospital. Read about symptoms: Symptoms of a heart attack

The Stigma Project Social Media Campaigns

I want to congratulate the Stigma Project (http://www.thestigmaproject.org ) for their great campaigns to fight stigma.

I particularly love this last ad called “Clean UB2”

On the internet, HIV negative (or those who do not know their status) often refer to themselves as “clean” or DDF (drug and disease free), two terms that really stigmatize HIV positive people. We are not dirty.  And to use DDF as a term that combines HIV and drug use also pisses me off.

If you are HIV negative and want to have sex only with HIV negatives, that is your prerogative and we should respect that.  But stop using those terms.  Just say  “HIV negative and looking for same”.

We need to correct people when they use terms that stigmatize.  Words are loaded weapons that have been used to discriminate and bully many people who are seen as ” different”.

So, good for the people who operate The Stigma Project.  We need to support your innovative work!

Nelson

Nucleoside and Norvir Free HIV Medication Regimen May Provide an Option for Patients with Kidney Problems

http://www.hivandhepatitis.com/hiv-aids/hiv-aids-topics/hiv-treatment/3629-nrti-sparing-art-with-atazanavir-raltegravir-conflicting-data-for-naive-and-experienced-patients 

 NRTI-sparing antiretroviral regimen of unboosted atazanavir (Reyataz) plus raltegravir (Isentress) suppresses HIV in treatment-naive patients as well as standard 3-drug combinations, but its twice-daily dosing, side effects, and low barrier to resistance limit its appeal. For treatment-experienced people already doing well on atazanavir triple therapy, however, the dual regimen may be an attractive simplification option.
According to the latest U.S. antiretroviral treatment guidelines, preferred first-line regimens consist of a NNRTI, a ritonavir-boosted protease inhibitor, or the integrase inhibitor raltegravir, all combined with 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs and ritonavir can cause multiple drug toxicities, however, prompting researchers to explore alternative regimens.

My comments:

I bet this nucleoside-free regimen could do even better when it comes to side effects if the Reyataz (atanazavir) dose was cut to 150 mg twice a day instead of the 300 mg twice a day. However, this lower dose of atanazavir has not been tested in combination with raltegravir, so patients should not take the risk to experiment with it.
I think twice a day dosing is not a big deal, no matter how bad pharmaceutical companies and clinicians make twice a day dosing to be. Many patients will be happy to take a twice a day combination if they do not have to be exposed to nucleosides.
I really believe this is a great option for patients who do not want to take nucleosides  due to kidney and bone issues, or who have hypersensitivity to abacavir.
Both raltegravir and atanazavir boost each other, but it seems that raltegravir boosts atanazavir so much that 20 percent of patients experience high bilirubin, a common side effect of atanazavir.
Note: Nucleoside-free combos are not recommended with patients coinfected with Hepatitis B and HIV (Tenofovir, a nucleoside analog, is also a treatment for Hepatitis B)

Fw: Hot Topics at TheBody.com’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 19 Jun 2012 17:25:10 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at TheBody.com’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

June 19, 2012 Visit the Forums “Hot Topics” Library Change/Update Subscription



Living With HIV  How Is the “Berlin Patient” Doing?
Dear Nelson Vergel: I’ve read some of your posts about “Berlin Patient” Timothy Brown, the guy who was cured of HIV. I was shocked to find out he’s been struggling here in the United States since moving back here from Germany. How is he doing now? What’s he been up to? How is his health? Is there anything the community can do to help him out?

Nelson Vergel responds in the “Nutrition and Exercise” forum
Mixed-Status Couples  How Can I Support My Partner, and Hold Onto My Own Faith and Hope?
I met my fiancé last year, right before he went into a coma, and that’s how I found out he’s HIV positive. It’s been a challenging year but we’ve made it through. However, we recently found out he needs to start taking HIV meds as soon as possible. I don’t know how we’re going to afford the meds, and my fiancé’s afraid he might lose his job if he can’t handle the side effects. I just ask God to make me stronger in this new challenge. How can I support him on this new path with meds? How can I stop crying all the time and thinking, “Why me?”

Rev. Todd A. Brown responds in the “Spiritual Support and HIV” forum
Insurance, Workplace & Legal Concerns  I Think I Was Fired for Being HIV Positive: What Can I Do?
I was hired by a local firm last July 12. On September 1 the owner’s wife, who is the bookkeeper, gave me a health insurance form to complete, which led me to believe that I’d be with the company long term. On September 3 I was terminated from the company. The reason given by the company owner was that I was not a good match. During my tenure with the company I never received any disciplinary action of any sort. I think owners of the firm saw what I put on my health insurance forms and decided to terminate my employment. Can you help?

Christa Douaihy, Esq., responds in the “Legal Issues and HIV” forum

 Should I Help Others Get Low-Cost Meds From Overseas?
I have friends who go back and forth to India all the time. They provide me with Viraday, a generic form of Atripla (efavirenz/tenofovir/TFC) made in India, which is working perfectly for me. If others want information on this, I would assist. Is that legal? Can I get in trouble for helping others access a source of lower-cost meds?

Jacques Chambers, C.L.U., responds in the “Workplace and Insurance Issues” forum
tips on keeping up with hiv meds
Word on the Street It’s easy for someone to tell you, “Just take all your meds, and you’ll be fine.” But the challenge of taking HIV meds every single day, and the obstacles that life throws in your way, can make adherence a lot tougher in real life than it might seem on paper. Check out some invaluable advice on adhering to meds from HIV experts and people living with HIV.

You can read first-person stories, watch videos and get more information and advice on adherence in TheBody.com’s Resource Center on Keeping Up With Your HIV Meds!

Body Shape Changes & HIV/AIDS  Could Liposuction Work in Combating Belly Fat Gain?
I’ve been HIV positive for five years. I take Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC) and my CD4 count has always been over 600. However, I’ve recently developed a round belly. I’ve exercised and watched my food intake to control it, but it’s still there. I was thinking of getting liposuction but I wonder, if I get this done, if the problem will come back. Do you know if liposuction would work, or is this a losing battle?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
HIV/AIDS Treatment  Tried Meth Once: Will It Ruin My Chance to Do Well on HIV Meds?
I take Isentress (raltegravir) and Truvada (tenofovir/FTC). I’ve used meth once since being on HIV meds and will never use again! I’ve been on meds for a year and a half, my viral load has been undetectable since three weeks after starting meds, and my last CD4 count was 964. What can I expect from my next lab results in three months? Could meth have seriously affected my body’s ability to control the virus?

Nelson Vergel responds in the “Aging With HIV” forum


 Which Meds Are Best for Primary Infection?
I was very recently infected with HIV, so I’m still experiencing primary sickness. What treatments would you recommend to someone in this early stage of HIV infection?

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

More Questions About HIV/AIDS Treatment:

Other Health Issues & HIV/AIDS  Are Shock Treatments My Best Option for Treating Severe Depression?
I was wondering if you or anyone you know has tried electroconvulsive therapy (ECT) for their depression. I have clinical depression and OCD (obsessive compulsive disorder). I’ve tried every antidepressant and had to be pulled off due to side effects or for it just not working. I spend every minute just trying to hang on so I don’t commit suicide. My family and friends do not understand; it does not help for people to tell you to just take your meds because they don’t want to listen to you. What can I do?

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

 Is Different Dosing Normal for People With HIV and Kidney Problems?
I have a friend that has kidney problems; for that reason his doctor changed his Epzicom (abacavir/3TC, Kivexa) dose to Epivir (lamivudine, 3TC) and Ziagen (abacavir) in an oral solution once a day. Is it appropriate to change from the standard doses of HIV meds for people with kidney dysfunction?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
Connect With Others Seroconverted and Scared: Will My CD4 Count Jump Back Up?
(A recent post from the "I Just Tested Positive" board)

I just tested positive on the 10th of June. I am yet to be advised of my viral load, but my CD4 count is 334 and 29%. … I am petrified. I am getting tested again next Saturday. I was very sick with seroconversion and I am trying to comfort myself with the fact that my CD4 count will jump back up again now that I am over my illness. Can anyone offer me words of encouragement? — Richardph1234

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

To do this, you’ll need to register with TheBody.com’s bulletin boards if you’re a new user. Registration is quick and anonymous (all you need is an e-mail address) — click here to get started!

Understanding HIV/AIDS Labs  Is There a Reason I’m Doing So Well?
I was given an HIV-positive diagnosis in 2004. They told me I’d be dead in five years. Now I still have an undetectable viral load and my CD4 count is around 750, and I’ve never taken HIV meds. Is that normal? What do you think is going on?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum
HIV & Hepatitis Transmission  Can I Transmit Inactive Hepatitis B?
Since there’s no virus to be found in my blood, can i infect other people? How many years will it take for me to become HbsAg negative, if that can happen?

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

 Can My Daughter Safely Play With an HIV-Positive Kid?
My daughter is in grade school and I recently found out that a friend of hers is HIV positive. The girls do many things together including sleepovers, summer camp, swimming and sports. I’ve discussed with my daughter that if she is bleeding or her friend is bleeding, they shouldn’t be in contact with each other’s blood. Still, though, I don’t want anything to endanger her. Am I worrying needlessly? Is there anything else I need to be concerned with? Should I discuss anything else with my daughter to ensure she is safe?

Richard Cordova responds in the “Safe Sex and HIV Prevention” 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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 It’s the Best Kept Secret We Need to Share: There’s a Totally Free and Public International AIDS Conference in Washington, D.C. This Summer

 Join the Black AIDS Institute at the AIDS 2012 International Community Science and Treatment Pre-Conference Workshop

 Train and Triumph With Team to End AIDS!

 Under Attack: Your Health Care Rights

 Activists Launch New Survey to Help Speed HIV Cure Research

 Demand Hershey Reverse Decision on HIV+ Student and Dismiss School Officials

 Count HIV+ Women In! PWN Launches National Campaign on World AIDS Day