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

From: “News at The Body” <update@news.thebody.com>
Date: 06 Nov 2012 19:02:19 -0500
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at TheBody.com’s “Ask the Experts” Forums

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November 6, 2012 Visit the Forums “Hot Topics” Library Change/Update Subscription

Living With HIV  Looking Toward the Future: How Long Will It Be?
I was diagnosed with HIV at age 53, shortly after I seroconverted. A year later I started HIV meds with Isentress (raltegravir) and Truvada (tenofovir/FTC) and my viral load has been undetectable since six weeks thereafter; my CD4 count has never been below 550, and I have no other medical conditions. What do you think my prognosis might be? How might HIV affect HIV my future health and well-being? What else do you suggest I keep an eye on?

Nelson Vergel responds in the “Aging With HIV” forum
Mixed-Status Couples  Partner of 12 Years Just Tested Positive: Will I Remain Negative?
My partner of 12 years was recently diagnosed with HIV. I tested HIV negative at six weeks post-exposure. I’ve been informed that I can rely on these test results, but I’ll be testing again at the three-month mark. Is it likely that I’ll end up testing positive at three months? Does it help that we primarily had oral intercourse? How can we reduce my risk of becoming HIV positive going forward?

Shannon R. Southall responds in the “Safe Sex and HIV Prevention” forum
Insurance, Workplace & Legal Concerns  Does My Job Need to Know My HIV Status So I Can Take Off for Doctor Visits?
I recently inquired with my job regarding leaving early for doctor’s visits. I was informed that I’d already exhausted my paid-time-off hours for the year. I’ve only been at this job for eight months; I have to be on the job for at least a year to qualify for more hours. I understand these regulations, but I just found out my HIV status two months ago and have several upcoming doctors’ appointments. They’re requesting that I disclose my ailment before they’ll accommodate me. Is this a breach of my privacy rights? What can I do to get this accommodation?

Jacques Chambers, C.L.U., responds in the “Workplace and Insurance Issues” forum
Body Shape Changes & HIV/AIDS  Dumping an Ancient Regimen: Will My Body Go Back to Normal?
I’ve been living with HIV since 1998. I’ve experienced lipodystrophy in that time, namely a great deal of fat loss in my arms and legs and a small hump on the back of my neck. My CD4 count is 1,360 and my viral load is undetectable, so my doctor is taking me off Crixivan (indinavir), which I’ve been taking since my diagnosis. I hope to start taking one of the new, recently approved one-pill-a-day regimens. Will coming off Crixivan help me regain fat in my arms and legs?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum
living with hiv during natural disasters
Rescued During Hurricane SandyFor those living with HIV, natural disasters such as last week’s “Superstorm” Sandy bring a whole host of difficulties and fears. Here’s some practical advice for those who are living with HIV and experiencing challenges after a disaster.

And while we’re on the subject of Sandy: Check out ways to help out, donate or volunteer in areas ravaged by the storm — including parts of the region where HIV rates are high. And here’s an interesting perspective on “Sandy stigma” and its similarity to HIV stigma.

HIV/AIDS Treatment  Could These Spicy Supplements Interact With My HIV Meds?
I’m HIV positive, taking Epzicom (abacavir/3TC, Kivexa) once a day and Selzentry (maraviroc, Celsentri) twice a day and doing very well on these meds. Is there any issue with taking a turmeric supplement with black pepper extract? I have four herniated discs in my cervical spine, as well as arthritis, and my chiropractor suggested the turmeric and black pepper to help reduce inflammation. Could taking these natural products interact with my HIV meds?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Should I Switch Back and Forth Between Meds to Avoid Toxicity?
I was recently put on Epzicom (abacavir/3TC, Kivexa), Norvir (ritonavir) and Prezista (darunavir) because of kidney issues with Truvada (tenofovir/FTC). Is there any literature on the benefits of switching between various combinations on a consistent basis to mitigate long-term side effects?

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

More Questions About HIV/AIDS Treatment:

Other Health Issues & HIV/AIDS  Why Am I Not Being Treated for My Anal Lesions?
I’m a 48-year-old man and I was given an AIDS diagnosis in June 2011. At the time my CD4 count was 43 and my viral load was 123,000. I now take Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC); now, a bit over a year later, my CD4 count is 251 with an undetectable viral load. However, I was diagnosed with low-grade anal lesions six months ago. My doctor has made the decision not to treat them at this time and will not tell me why not, and I’m very distressed because of this. Why wouldn’t they treat my condition now if there’s a greater chance of it becoming cancer given my compromised immune system?

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

 How Can a Hypochondriac Manage Living With HIV?
I’m a 25-year-old woman; I got my HIV-positive diagnosis at age 14. My CD4 count was only 20 at the time, but I went on meds and got better. I was not constantly worrying and lived a normal life until six months ago when I suddenly became terrified of fungal diseases like thrush. I search the Internet nonstop, losing entire days looking at pictures and symptoms. I look at my mouth literally every hour with mirrors and flashlights and analyze every red or white spot. My doctor tells me fungal infections should not worry me because my labs are so good — my CD4 count is 915. I’m afraid these results aren’t mine and the nurse made a mistake. I can’t live like this anymore. What do you suggest?

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

 Does Losing My Libido Have Anything to Do With HIV?
I am living with HIV; after recent bouts of tuberculosis and herpes, I lost my libido. Could this have anything to do with HIV, or the meds I take for HIV?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
Connect With Others Hurricane Sandy Roll Call: Anyone Out of Meds Since the Storm?
(A recent post from the "Living With HIV" board)

Anyone not able to get their meds due to the hurricane? I am so thankful that I’d just gotten a refill because I live at the Jersey Shore and let me tell you, it’s quite a disaster over here!

Does anyone else have experience getting prepared before a storm or other event? — riverprincess

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Understanding HIV/AIDS Labs  Should I Worry About a One-Time Viral Load Spike?
I’ve been HIV positive and taking Atripla (efavirenz/tenofovir/FTC) since September 2009. Last week my lab test results showed a CD4 count of 454, up from 382 six months ago; however, my viral load was 28 copies, which is also up from less than 20 copies six months ago. Should I be concerned about this rise in my viral load? I do have a cold now; could I have picked it up last week, before I went to the lab, and it affected the lab test results?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum
HIV/STD Testing & Transmission  Herpes Help: What Are My Chances of Infection?
I recently received oral sex from a girl with herpes. She wasn’t having an outbreak at the time, and she only performed the act on me for a short time. What are my chances of getting herpes through unprotected oral sex?

Richard Cordova responds in the “Safe Sex and HIV Prevention” forum

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HIV, Active HCV, Low Income Tied to Shorter Telomeres, a Cellular Aging Marker

From Natap.org

HIV, Active HCV, Low Income Tied to Shorter Telomeres, a Cellular Aging Marker
3rd International Workshop on HIV and Aging, November 5-6, 2012, Baltimore

Mark Mascolini

HIV infection, active HCV infection, and income below $15,000 a year independently predicted shorter telomere length in a study of 229 HIV-positive people and 166 HIV-negative people in a Vancouver cohort [1]. HIV infection had a slightly greater negative impact on telomere length than 10 years of age.

Telomeres cap the ends of chromosomes and shield them from damage. Shrinking with each cell division, telomeres shorten with age. Thus telomere length offers a marker of cellular aging. Telomeres may shorten more rapidly than normal when exposed to the oxidative stress resulting from HIV-induced inflammation, chronic immune activation, or treatment with antiretrovirals. And antiretroviral therapy itself may inhibit telomere activity.

To assess the impact of HIV and non-HIV variables on leukocyte telomere length, researchers conducted this prospective study of adults between 19 and 75 years old enrolled in the Vancouver’s CARMA cohort between 2008 and 2011. Heterosexual sex and injection drug use are the prime routes of HIV acquisition in this socioeconomically disadvantaged study group.

The study included 229 HIV-positive people and 166 HIV-negative people, most of them women (79% and 71%). The HIV-positive and negative people were similar in age (median 40 and 38). The HIV group had a significantly higher proportion of blacks than the HIV-negative group (17% versus 1%, P < 0.01). Proportions of participants with an annual income below $15,000 were 45% in the HIV group and 54% in the HIV-negative group, a nonsignificant difference (P = 0.51).

Maternal age at the cohort member’s birth was slightly but significantly lower in the HIV group than in the HIV-negative group (24 versus 26, P = 0.02), but paternal age at birth did not differ significantly by HIV status. The researchers had maternal and paternal age data for only half of the study group, so these variables were not included in the final multivariate model.

HIV-positive people had a median HIV infection duration of 9 years and a median lifetime antiretroviral duration of 4 years. Median nadir and current CD4 counts were 190 and 450, and 60% of HIV-positive people had an undetectable viral load at the study visit.

Univariate statistical analysis identified several factors associated with shorter telomere length: HIV infection (P = 0.031), HCV infection (P < 0.0001), income below $15,000 (P = 0.0002), having an older father or mother at birth (P = 0.0006 and P = 0.029), being black versus white (P = 0.031), being South Asian versus white (P = 0.018), older age (P < 0.0001), pack-years smoking (P = 0.017), and illicit drug use (P < 0.0001). Smoking, illicit drug use, and low income were associated with shorter telomere length only in HIV-negative people.

In the final multivariate analysis including HIV-positive and negative people, four variables were independently associated with shorter telomere length:

— Every 10 years of age, beta -0.24, < 0.0001
— HIV infection, beta -0.28, P = 0.004
— Active HCV infection, beta -0.24, P = 0.004
— Annual income below versus above $15,000, beta -0.32, P = 0.001

Cleared HCV infection did not predict shorter telomere length. Among the 229 people with HIV infection, shorter telomere length was not linked to current CD4 count, CD4 nadir, time since HIV diagnosis, antiretroviral duration, or number of treatment interruptions. Nor did those factors predict telomere length in 126 HIV-positive people with an undetectable viral load.

The Vancouver team concluded that–besides older age–HIV infection, active HCV infection, and low income predict shorter telomere length and “may therefore affect telomere maintenance and cellular aging.” Because the beta value for HIV exceeded that for 10 years of age (-0.28 versus -0.24), they suggested that HIV infection has a greater impact on telomere shortening than a decade of age. The researchers speculated that low income may be a surrogate for lifestyle and environmental factors that directly affect telomere length.

The investigators proposed that the link between active HCV infection and shorter telomeres may mean ongoing HCV-induced immune activation or inflammation could affect leukocyte telomere length. They suggested that future research should weigh the impact of anti-HCV therapy on telomere length.

A workshop attendee observed that the study measured telomeres in all leukocytes–the collection of white cells in which granulocytes predominate. Lymphocytes (which include T cells) make up about 30% of leukocytes.

1. Zanet D, Thorne A, Sattha B, et al. Active hepatitis C virus (HCV) infection, HIV+ status and low income are associated with shorter leukocyte telomere length in a cohort of HIV+ and HIV- adults. 3rd International Workshop on HIV and Aging. November 5-6, 2012, Baltimore. Abstract: O_07.