Forum on Fatigue and Anemia

Snorting cocaine and Hep c risk

Sun, 09 Oct 2011 13:45:17 -0400

Q: The other night I did something really stupid and had a line of cocaine at a house party, but used my own straw. The only thing is that I am starting to think that maybe the bread knife I used to cut the straw might have had blood on it (not that I noticed anything). For instance, say if, hypothetically, somebody cut himself or herself beforehand and then (even after washing the knife with standard washing up liquid) the knife still managed to scrape tiny or microscopic traces of blood onto the ...

A: Thanks for writing. I think you are in the grip of anxiety over having used cocaine. As I understand it, you didn't notice anything on the knife but are imagining what your risk might be if there were dried blood on it. Hepatitis C is not spread by sharing utensils or other household items - it is transmitted by direct through-the-skin exposure to blood. You are correct that the virus can live outside the body but that is significantly reduced if the blood is dry. Were there an actual expos...

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Fatigue Versus Sleepiness

Fri, 09 Sep 2011 04:11:28 -0400

Q: Hi Doc,Is there a difference between fatigue and feeling sleepy? After a high risk exposure, I can't stay awake past 9 PM and also feel very sleepy during the day. Is this possible to be HIV related fatigue?

A: Hello.So you're basically wondering about the difference between tiredness and exhaustion. Well, there is an old proverb that states: "Man who runs in front of car gets TIRED while man who runs behind car gets EXHAUSTED." Somehow I doubt Confucius said that.If you've had a high-risk exposure, you need an HIV-antibody test outside the seroconversion window period, whether you're tired, exhausted, sleepy or as peppy as a Starbucks barista!Dr. Bob

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L Carnitine and Atripla

Fri, 09 Sep 2011 04:10:21 -0400

Q: Hello Dr. Frascino,After 8 months on Atripla and started Neuropathy ( numbness,tingling, shooting pain on my toes) about a month ago ( probably because TB meds that stopped about 6 weeks ago), I decided to try L Carnitine powder.I don't have diabetes history at allMy questions;1.Is there any drug interaction between Atripla and L carnitine? ( I take Atripla every night and L carnitine 5 grams every morning before breakfast)2.Should I take alpha lipoic acid as well for neuropathy?3.Is it true tha...

A: Hello, Ivan.1. Nope.2. I have not seen convincing scientific evidence that this is helpful.3. Again, I have not seen any scientific evidence that this would help.4. Unlikely.See link below for additional information on HIV-associated neuropathy. You could also consult a neurologist to confirm the diagnosis and get additional advice on potential treatments. Good luck.Dr. BobUnderstanding and Managing Peripheral...

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Tired of low sex drive and sensation

Fri, 09 Sep 2011 04:04:19 -0400

Q: Hmm I hope this can be fitted under your category. Very healthy long term survivor, all numbers great, great diet, plenty of sleep, emotional state fine...not on any new meds or anything... Yet sex drive and sensation continue to plummet. Doc says my testosterone level is right in the mid range, and she does not want me to start taking it yet. I am in my mid 40's and feel like my drive and sensation is like someone in their 60's. I hear about natural supplements like Tribulus terrestris and...

A: Hi.Decreased libido and/or sexual functioning can result from a variety of causes, including psychological causes (depression, stress, etc.), hormonal causes (low testosterone), physical causes (anatomic or neurological issues), etc. The first thing to check would be your "free testosterone" level. Even though your total testosterone may be in the normal range, if your "free testosterone" is low for age-matched controls, testosterone-replacement therapy would be warranted. If your doctor has not...

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Nothing works to alleviate my fatigue

Fri, 09 Sep 2011 04:03:23 -0400

Q: Hi, Dr. F,I was diagnosed in 1991, began HAART in 97, no OI's. Dx'd with sleep apnea, on CPAP machine 3 years, had throat surgery 2008 removing tonsils, uvula, other stuff in there (horrrrrrible recovery), still sleepy, fatigued, developing restless leg syndrome that awakens me. Have been on an anti-depressant for 3 years, on testosterone patch for low hormone levels. Getting a B12 shot monthly for low levels. I recently went to a seminar on HIV by a well-known professional in the HIV field ...

A: Hello.I've seen no convincing evidence that B-12 tests are unreliable or that "ultra high doses of B12" are effective in treating HIV-associated fatigue in a person with normal serum B-12 levels. HIV-associated fatigue is often multifactorial, and you certainly have many potential causes that could be contributing to your ongoing problem:1. Sleep apnea. Has this completely resolved post-surgery?2. Restless legs syndrome. There are mediations available for this condition.3. Anti-depressants. Depr...

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White little spots on my skin

Fri, 09 Sep 2011 04:02:33 -0400

Q: I have been in treatment for hiv for two years now and i suddenly started getting some white little spots on my skin, i live in a tropical area (Yucatan, MX) a doctor said it was caused by the exposure to the sun (im addict to swim)but im still worried cause they are not disappearing at all even when i have stopped swimming under the sun light.

A: Hi.I can't diagnose the cause of your white spots over the Internet. It's possible that it's a common skin fungus: tinea versicolor. I'd suggest you consult a dermatologist. Most likely there is a simple and effective treatment for your spots. Dr. Bob

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Fear to death about HIV infection

Thu, 08 Sep 2011 04:00:05 -0400

Q: Dear DR. Bob,I truly love your smile on your phone, which comforts me in certain way!My greatest thanks to you in advance for your answer to my quesiton as below.My brother, who is in China, in April this year went to a beauty shop to repair the hard skins on his feet because such hard skins are thick and hard, he felt not comfortable to walk. He has been a very clean person in sexual life and even very rare sexual activities because his wife and his son are living in another city. The guy in th...

A: Hello,You truly love my smile on my phone???? What??? How did you get ahold of my phone?Oh well, nevermind; but I must advise you that this forum is dedicated to HIV-positive folks, particularly those who have concerns related to fatigue and/or anemia. Questions related to HIV transmission, prevention, safer sex, HIV testing and risk should be sent to me at the "Safe Sex and HIV Prevention" expert forum. Please resubmit your question there using the same title and add the phrase, "resubmitted fo...

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Im HIV + and would like to know the risk of transmission to my HIV- husband?

Thu, 08 Sep 2011 03:54:46 -0400

Q: I've tested HIV + for three years and Im currently on no meds. My CD4 count is 760 and viral load 320. My husband is HIV negative and refuses to wear protection. What is the risk of transmission and are there methods we can use to minimise transmission of the virus?

A: This forum is dedicated to HIV-positive folks, particularly those who have concerns related to fatigue and/or anemia. Questions related to HIV transmission, prevention, safer sex, HIV testing and risk should be sent to Dr. Bob at his "Safe Sex and HIV Prevention" expert forum. Please resubmit your question there using the same title and add the phrase, "resubmitted form the Fatigue and Anemia Forum." Thank you.

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Following up 2 : Unprotected Intercourse with a POZ women..Strong Symptomes but neg at 12 weeks

Fri, 02 Sep 2011 03:57:03 -0400

Q: Hi Dr bob, I have read some days ago, what I see as the most amazing response from you, ironically it was not about HIV, yes, when you have answered a girl about fasting in Ramadan.http://www.thebody.com/Forums/AIDS/Fatigue/Q216620.htmlI was really, really, really amazed, to the point that I printed your post, and have shown it to some Islam preacher, you know what, they where more amazed than I was, there is 6236 verses in Coran, and the one you state in your response, in the case of that lady,...

A: Hello.Welcome back to the forum. Thanks for your very kind comments regarding the Ramadan fast question.Sorry to hear you and your wife are still having difficulties and that your physicians have been unable to diagnose the cause of your ailments! I agree your next step should be a visit to a tertiary referral center, like McGill, for a more extensive diagnostic evaluation.Your recent T-cell subset test reveals normal helper (CD4) and suppressor (CD8) cells with a normal CD4/CD8 ratio. The sligh...

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Dr. prescribed drug holiday

Wed, 31 Aug 2011 03:58:49 -0400

Q: I have been having issues with high liver enzymes, mostly my ggt that kept rising. The docs (I have seen a liver specialist) have done so many tests and even a liver biopsy. They are now having me take a drug holiday for two weeks and checking my liver function and ggt at that time. I have looked into other drugs, which my doc has suggested that maybe we will start with Kaletra and Isentress, but they all run the risk of liver damage, which is the problems right now. It makes me hesatant to take...

A: Hello, Brenda.It sounds like you have a complex problem and your physicians haven't yet been able to sort out what's going on. As long as your liver specialist is working closely and cooperatively with your HIV specialist, a short break off treatment to ascertain if the antiretrovirals are causing or aggravating your liver problems is reasonable. If a switch in antiretrovirals is warranted, it's worth noting that some are much easier on the liver than others. Your next regimen should be chosen b...

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Help for the HIV- partner - Thanks!

Sun, 28 Aug 2011 20:13:46 -0400

Q: First, thebody.com and your answers are the first place I've found any help/advice/solace on being the HIV- partner in what I've learned is called a "serodiscordant couple". Since I learned the other day that my partner of 8 years tested HIV+ and I tested HIV-, I've been trawling the internet for information to help him and me figure our way through the possible coming mess of problems, latest information, doctors, tests, medications when I realized that everything is geared toward helping the ...

A: Hi.No one will lash out or stone you here, I promise. When HIV finds its way into a relationship it definitely affects both individuals, even if only one is positively charged. I absolutely agree we don't spend enough time discussing issues from a "negative" perspective. These concerns are many, including not only fear of becoming infected, but also issues related to fears of the positive partner getting ill or dying, survivor guilt, how to interact with friends and family, how friends and famil...

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Fatigue and anemia caused by zoftloft

Sat, 27 Aug 2011 15:30:43 -0400

Q: Can fatique and anemia be caused by taking Zoftloft?

A: Hi.Fatigue yes, but anemia, no.Dr. Bob

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How safe is Truvada for long term?

Sat, 27 Aug 2011 15:30:16 -0400

Q: Hello Dr.Bob,Just diagnosed + on January this year with TB co infected ( CD4 was 55 at that time)and on Atripla until now ( TB meds stopped by my team docs 2 weeks ago).Have insomnia since on Atripla and 1 month ago started to have neuropathy symptom on my toes (Numbness) and don't have history of diabetes.Also noticed few weeks ago have 'hollow cheeks'( Facial wasting?)Due to those symptoms as I mentioned above,I'm considering to switch from Atripla to Truvada/Isentress OR Intelence/Isentress.M...

A: Hello.First a few comments about your symptoms, as apparently you are considering a switch in antiretrovirals because of these. "Insomnia." Atripla is associated with sleep disturbance, particularly "vivid dreams." Atripla side effects generally calm down within six to eight weeks. If, after an evaluation by your doctor, your insomnia is felt to be related to Atripla, and you've been on it since January without improvement, a switch in therapy could be considered."Neuropathy." Distal sensory neu...

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Repeat Test

Sat, 27 Aug 2011 15:29:08 -0400

Q: I was diagnosed in February 2010. CD count 440 viral load 45000I must do a repeat teast but im scared. Ive been sexually inactive since then.

A: Hi.Scared? Scared of what? You are HIV positive and have known about your diagnosis since February 2010. Certainly a period of adjustment to your new reality as a virally enhanced person is to be expected. The best way not to be frightened by your HIV disease is to learn as much as you can about HIV and your treatment options. Take control of your situation and work closely with your HIV specialist to be and stay healthy. Control your HIV; don't let HIV control you!This Web site is an excellent ...

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Had gay protected anal sex and unprotected oral.

Sat, 27 Aug 2011 03:16:39 -0400

Q: Hi Dr. Francisco. Hi Dr. Francisco. I was at San Francisco 6 days ago and went to the Castro District. I met this man and we drank for a while. Then we headed back to his place. We had oral sex, he gave me oral sex for a while but I only gave it for 5 seconds or so because I felt unconfortable about it. He didn't ejaculate in my mouth nor do I think there was any pre-cum involved. Then we proceeded to have protected anal sex. Afterwards he finishhed me off with annilingus but i did not give him ...

A: This forum is dedicated to HIV-positive folks, particularly those who have concerns related to fatigue and/or anemia. Questions related to HIV transmission, prevention, safer sex, HIV testing and risk should be sent to Dr. Bob at his "Safe Sex and HIV Prevention" expert forum. Please resubmit your question there using the same title and add the phrase, "resubmitted form the Fatigue and Anemia Forum." Thank you.

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Missing a DOSE

Sat, 20 Aug 2011 18:46:08 -0400

Q: My mum missed one dose (night dose) of ART tablet. And she took the next dose in morning 8 o clock . will the drug become resistance as she missed it for over night. iam very much worried. please reply me.

A: Hi.Missing a single dose will not affect the efficacy of your mom's ART. Certainly we all try for 100% adherence to our antiretroviral regimen, but occasionally mistakes happen. We are all only human.Don't worry. Your mum will not be harmed by a single missed evening dose of her medication, okay?Dr. Bob

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Vaccinations to boost viral suppression

Sat, 20 Aug 2011 18:45:37 -0400

Q: Hello,I have been HIV+ for less than 18 mos and started treatment after approx 12 mos. My doctor wants me to participate in a vaccine study that includes a STI. My last VL before starting therapy was around 2500 and my CD4 count was around 400. MY VL is now below 50 and my CD4 about 500. Is it safe for me to participate in a study which includes a STI of 12 weeks? (I am on Atripla and am concerned about drug resistance and after reading your responses to STI's heart, liver, and kidney disease)

A: Hi.It's fine for your physician to discuss currently enrolling clinical trials, but he should not be actively encouraging you to participate, particularly if there is significant risk involved. An STI for 12 weeks may well result in an increase in your HIV plasma viral load and drop in your CD4 count. This may be offset if the "vaccination" or treatment being evaluated in the clinical trial is effective. However, there is certainly no guarantee any experimental treatment will work or help. I wou...

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TST/Silveroxide (TETRASILVER TETROXIDE, 2010) (COLLODIAL SILVER, 2011)

Sat, 20 Aug 2011 18:44:52 -0400

Q: Hi,Doc Bob i did a little background checking on Marantech Holdings LLC. They did the laboratory testing on tetrasil/musil claiming a cure for hiv/aids and they are not in business any more. But the man that that was CEO of marantech, took tetrasil /TST made a skin cream and is marketing it under the name Aidance Skincare.

A: Hi.So the company that did the testing on tetrasil/musil and claimed it cured HIV/AIDS is no longer in business? Wow, what a surprise, eh?So the charlatan CEO is now marketing his brand of snake oil as a skin cream? Hmm. One wonders what he's claiming it cures this time. Perhaps "the heartbreak of psoriasis"? Thanks for the 411.Dr. BobUse of Silver Colloidal as form of Treatment (TETRASILVER TETROXIDE, 2010) (COLLODIAL SILVER, 201...

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Fatigue

Sat, 20 Aug 2011 18:38:23 -0400

Q: My Testerone levels are fine. I still feel teribly tired each day. I have no libedo. A knowledgeable friend of mine said Androgel or Testim are use to ingrease enery in HIV+ men. They are use without regard to the testesterone levels. Is this true? can Androgel be perscribed for HIV fatigue?

A: Hi.Nope! Testosterone replacement therapy should only be used to treat hypogonadism (low free serum testosterone levels).Talk to your HIV specialist about your fatigue and decreased libido. He'll perform the appropriate evaluation and hopefully get your energy batteries recharged very soon. I'd also recommend you read through the information in the archives of this forum related to the causes and treatment of HIV-associated fatigue.Good luck.Dr. Bob

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Ayurvedic medicines with HIV antibody interaction before testing

Sat, 20 Aug 2011 18:37:26 -0400

Q: Hi Doc,It is already known and published that there is no criteria/ restriction( foods , medicines , full or emptystomach) for HIV testing and the only criteria is to get it tested . But nowadays people consume lot ofayurvedic or herbal products and medicines ( like green tea, herbal tea and many more) . Do u think that these products can in any way hamper the process of antibody formation ? Specially do you think that such things should not be consumed for 10-12 hours before testing? Or else ...

A: Hi.Ayurvedic "medicines," even taken in large quantities, will not affect HIV test results (nor are they helpful in treating any illness). See link below.Dr. BobAyurveda (AYURVEDA, 2011)Feb 8, 2011

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HIV RISK from receiving oral sex

Mon, 15 Aug 2011 18:53:43 -0400

Q: My boyfriend and I just recently broke up. Hurt by the situation I needed some type of comfort. 4 days ago towards midnight. I met up with a guy and he preformed oral sex on me for about 2 hours. There was A LOT of saliva and he deep throat a few times. I didn't ejaculate in his mouth, towards the end I jacked off to ***. The guy and I did kiss a little bit but it was mostly closed mouth kissing and a few times our tongues touched. BEFORE AND AFTER this happened, I questioned the guy about his h...

A: This forum is dedicated to HIV-positive folks, particularly those who have concerns related to fatigue and/or anemia. Questions related to HIV transmission, prevention, safer sex, HIV testing and risk should be sent to Dr. Bob at his "Safe Sex and HIV Prevention" expert forum. Please resubmit your question there using the same title and add the phrase, "resubmitted form the Fatigue and Anemia Forum." Thank you.

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question from Canada (COFFEE AND HIV, 2011)

Sat, 13 Aug 2011 15:13:30 -0400

Q: Dear Dr. Bob, I have a question that regards hiv transmistion within an environmental setting. There is an resturant(In Canada where I live) where someone who is hiv posative was placing his ejaculate into hot coffee. no joke. is it even posible to transmit the the virus this way??Second question. An hiv dna test after one mounth. how reliable is it?

A: Hi.Why do so many folks think their Starbucks has been spiked with HIV-tainted baby batter??? Sorry, I just don't buy this story. But if it were true, the HIV-acquisition risk would be nonexistent. HIV wouldn't survive in the hot cup of java. As for HIV DNA tests, they are not recommended for routine HIV screening. Consequently there are no reliable statistics regarding accuracy at one month. Dr. BobHIV from a drink!?? (COFFEE and...

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Taken my arv's 1 1/2 hours late

Sat, 13 Aug 2011 15:00:10 -0400

Q: My husband took his arvs 1 1/2 hours later than he should have done. Will this be a problem he is very worried,Kind regards

A: Hi.Most antiretrovirals currently in use have a long half-life. Consequently taking them 1.5 hours late (or early) is not at all a problem.Dr. Bob

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Do i have anemia and why am I not treated?

Sat, 13 Aug 2011 14:59:27 -0400

Q: I'm HIV positive and under medication for 9 years.I do my regularly blood tests every 6 months, my CD4 are always around 500 or a little bit more and my viral load undetectable for a few years now.Besides what i mentioned above i also have low count of red blood cells (3,28 when normal limits are 3,8-5,1) increased red blood cells volume (116,5 when normal limits are 81-100)and increased red blood cells average hemoglobin (38,4 when normal is 27-34).Am I anemic? My doctor didn't mention anything...

A: Hello.The changes in your red blood cell count and red cell parameters are consistent with AZT use. AZT is one of the components of Combivir (AZT + 3TC). You are not significantly anemic and treatment is not necessary for the laboratory abnormalities noted in your question. I am, however, glad you got your triglycerides down with omega-3 and diet!You can read much more about the causes and treatment of HIV-related anemia in the archives of the Fatigue and Anemia forum.Be well. Dr. Bob

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Seroconversion

Thu, 11 Aug 2011 17:39:52 -0400

Q: Is it possible to have a seroconversion exactly one month after infection? given that the common discription indicates that once the virus enters the body it can take up to six months to detect

A: Hello.Yes, seroconversion at one month is not only possible; it's quite common. The vast majority of HIVers will have detectable levels of anti-HIV antibodies in their blood (and therefore test HIV positive) within four to six weeks from the date of exposure.The three-month or six-month window period recommendation was established to catch those HIVers whose immune systems may be slow in producing the anti-HIV antibodies that the HIV-screening tests assay for. You can read much more about HIV-di...

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