Forum on Choosing Your Meds

Dose timing

Wed, 17 Jan 2018 21:59:19 -0400

Q: Im taking Lamivudine 150 mg twice daily in combination with Zidovudine and Efavirenz.Ive noticed an acquaintance takes Lamivudine 300 mg once daily. Ive forgot to take my dose in the morning. Is it recommended to take the two pills of 150 mg in a 3 hour period?

A: Hello and thanks for posting.You're taking a dated regimen for the treatment of HIV- most treatment guidelines have moved on to first-line regimens that no longer contain zidovudine (AZT).Having said that, most people can and do take lamivudine once daily. The usually recommended dose is 300 mg, once daily, without regard to food. Since zidovudine is a twice-daily medication, it's also perfectly ok to take your lamivudine in divided doses, twice daily, in combination with the zidovudine- this ...

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lamivudine

Tue, 16 Jan 2018 17:25:18 -0400

Q: is lamivudne and nevirapin a HIV drug therapy

A: Hello and thanks for posting.While both lamivudine (Epivir, 3TC) and nevirapine (Viramune, NVP) are HIV medications, nearly all HIV treatment regimens contain three drugs, so lamivudine+nevirapine would not comprise a complete treatment. (Two different drugs, rilpivirine and dolutegravir can be used as a complete treatment for HIV treatment.) Because of toxicity risks, nevirapine should not be used as a medication for HIV prevention.Hope that's helpful,BY

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Juluca

Tue, 16 Jan 2018 16:58:59 -0400

Q: I'm ready to drop triumeq and switch to juluca. ( always hi cd4 and <20vl) your opinion? are your patients switching?

A: Happy New Year and thanks for posting.Juluca is the new two-drug, single pill regimen that includes dolutegravir (part of Triumeq, or Tivicay) and rilpivirine (Edurant, part of Complera and Odefesy).Juluca was recently FDA-approved for people who are virologically suppressed on ART and whose virus does not have drug resistance (especially to either of the two drugs in Juluca). The approval was based on the results of the two large Read More

truvada isentress and omeprazol

Tue, 09 Jan 2018 15:02:47 -0400

Q: hello I have been recently prescribed wit Truvada Isentress as pep is there any negative interaction if I take esomeprazol40 mg ? thanks

A: Hello and thanks for posting.It's good to ask about potential drug-drug (or drug-supplement) interactions. I recommend using online tools, such as hiv-druginteractions.org or ePocrates. There are no significant drug-drug interactions between your PEP medications (Truvada and Isentress). Be well,BY

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Genvoya

Sun, 07 Jan 2018 16:21:49 -0400

Q: Hi i ve been undetectable hiv positive patient for 3 years. last week my doctor switched my med to genvoya from stribild is there a chance of increasing viral load during this exchange processThank you

A: Hello and thanks for posting.In short, no. Stribild and Genvoya contain the same antiretroviral medications and differ only by the form of tenofovir in the pill. Stribild contains tenofovir DF (or TDF), the original formulation while Genovya contains tenofovir AF (or TAF). TAF is better absorbed and has lower risks of kidney or bone toxicity than TDF and in our clinic (and others) has largely replaced TDF for HIV treatment (but not PrEP). In head to head clinical trials that compared Stribild...

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Medical Marijuana?

Sun, 07 Jan 2018 02:08:22 -0400

Q: Hi All, I just want to ask if anyone ever tried using medical cannabis as an alternative meds? I have read many articles about medical marijuana and how it can help you in terms of chronic pain, bone injuries, eating disorder/anorexia, anxiety disorders and panic attacks, inflammation, even cancer and a lot more. Cbd and thc are also new to me and I don't even smoke. If this is true I cant find any solid conclusive evidence that speaks to its efficacy. Any personal experience or testimonial woul...

A: Hello and thanks for posting.Really? More than few have tried marijuana for medical purposes.Living and working in Colorado, a state with many years of legalized medical, and more recently, recreational marijuana, I can say that many in our patient community have used marijuana products- including (most commonly) the smoked bud or processed CBD (cannabidiol) and THC (tetrahydrocannabinol) products (edible products). Overall, most patients derive some if not much benefit-for years used for appet...

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Missed a dose of Genvoya

Sun, 07 Jan 2018 01:50:39 -0400

Q: Ive been recently diagnosed and have taken my medication everyday as required for the past three months and just missed a dose. Wont get my next dosage until I pick up my meds tomorrow am. Will I be at risk for resistance to the meds?

A: Hello and thanks for posting.Relax. You're at no risk. A single missed dose means about 89/90 doses or 98.9% adherence. That's far above the 90% minimum target for adherence to medications.Any single missed dose has no impact on viral suppression or risk of developing viral drug resistance.I hope that's helpful,BY

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once daily dosing of isentress

Sat, 06 Jan 2018 15:46:02 -0400

Q: Hello Dr. I know Isentress is available for once-daily dosing. This new dosage is two 600-mg tablets taken once a day. I am currently on 400 mg tablets taken twice a day. Although it would be easier to take a medication just once a day, wouldn't I be better off to continue to take it twice a day if I can get the same effect but have to take 400 mg less of the drug daily? Wouldn't that be a little easier on my kidneys to have to process less of a drug?

A: Hello and thanks for posting.Yes, there is a new once-daily formulation of the HIV integrase inhibitor raltegravir, called Isentress HD. Isentress HD differs from the original twice-daily Isentress in formulation, resulting in better drug levels over a 24 hour period. Isentress HD is taken as 2, 600 mg tablets once daily while Isentress is 400 mg twice daily. The two cannot be interchanged. In a large clinical trial, there was no difference in effectiveness toxicity or side effect profile be...

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listeriosis

Thu, 04 Jan 2018 16:43:31 -0400

Q: I understand HIV+ persons have greater chance of getting listeriosis because of the weak immune systems. If you are undetectable and taking your meds religiously is your immune system still considered to be weak.

A: Hello and thanks for posting.Listeria is a bacteria that can cause a serious infection caused by eating contaminated food. It's generally thought that people with weakened immune systems (such as people living with HIV with abnormal CD4 counts) may be at greater risk of developing listeriosis. TheBody.com ran a nice summary article on HIV and Listeriosis a few years ago.BY

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Time for a new doc?

Thu, 04 Jan 2018 16:17:41 -0400

Q: So I changed from my HIV specialist to a ID Doc, I really like him and I am treated well however when I questioned him on why my CD4 percentages were no longer on my lab results, he said that they really aren't needed. This seems to go against everything I've read. I was under the impression that CD4 percentages were the best frame of reference over time? I did not want to argue with him but I am a bit concerned. I've been going there for about two years and he has told me he treats many people ...

A: Hello and thanks for posting.I'm in general agreement with your ID doc. I've transitioned the large majority of my patients to similar CD4 count test-free monitoring. In the modern era of HIV treatments, where attaining HIV suppression is both the goal and achievable, CD4 counts are no longer an important part of clinical care (at least for many people).Much unnecessary time and emotion is spent worrying about CD4 counts, and other than selecting and monitoring ART and viral loads, there's litt...

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10 Words or Less

Sun, 31 Dec 2017 01:58:17 -0400

Q: I have been testing the cd4 and viral load and the cd4 is 286 lower limit ,and vl 446,000 Aprox. Should I have to start treatment This is since 4 year .the change in the results is very small , and I have noticed that I am +ve since 14 years.Some time the cd4 is more up and vl is down !??What is you advise?

A: My recommendation is that you start HIV treatment now. Your HIV viral load is quite high and your CD4 count has been reduced by about 50% from normal, indicating some damage to your immune system. Starting HIV treatment will reverse that and get your immune system repaired.

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PEP toxicity

Fri, 29 Dec 2017 18:37:17 -0400

Q: By mistake for the last 5 days I have taken tenofovir 600 mg and lamivudine 600 mg every day as pep. Now I realise my mistake and read about kidney failure due to tenofovir. What should I do now? Should I continue normal dose for the coming 23 days? Thanks.

A: Hello and thanks for posting.It's not clear to me that you've made a mistake in starting PEP. Post-exposure prophylaxis (PEP) is very highly effective in preventing HIV infection after possible exposure- it must be started within 72 hours of the exposure and taken with good (though probably not perfect) adherence to be effective.Recommended PEP regimens differ from country to country, though most include the use of tenofovir and lamivudine (or emtricitabine) and usually with a third drug (here ...

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Transmission during cs

Fri, 29 Dec 2017 15:59:45 -0400

Q: Please,can a baby be infected with hiv during c section if the mother is hiv positive before pregnancy and not on hiv medication?

A: Hello and thanks for posting.Vertical transmission of HIV from mother to child isn't an absolute thing. Even among pregnant women not receiving antiretroviral treatments (ART), only about 30% of babies will become HIV infected. And while Cesarian sections are not generally recommended as a means of reducing HIV transmission for women on ART, they can reduce transmission among women with high HIV viral loads (generally >1000 copies/mL) or those with unknown viral load near the time of delivery....

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Getting Atripla through a state drug assistance program

Thu, 28 Dec 2017 16:26:27 -0400

Q: Hi, I'm an Italian citizen currently living in Mexico. I received an offer for a postdoc in UNC. I need some advice and information about the possibility to receive atripla, once I'll be in North Carolina. I hope you can support me providing all the necessary information during this change in my life.Thank you very much.

A: Congratulations on your postdoc opportunity! Many postdoc programs come with health insurance benefits, including prescription coverage. If yours does not, you may be able to get your medications through an AIDS drug assistance program depending on where you live. The National Association of State and Territories and Directors (NASTAD) and the federal Read More

Postdoc seeks information on getting medications

Thu, 28 Dec 2017 15:56:58 -0400

Q: Q: Hi, I'm a Ph.D and HIV+. I am moving to the states for a HIV research postdoc. In my cover letter, I'm disclosing my status. My question is if is better to avoid this information in my cover letter and if I get the job, will I be provided with HAART (ATRIPLA)? I'm very confused.

A: The question of disclosing your HIV status is a personal matter and depends on your unique circumstances. Before disclosing however, I urge you to consider why you want to disclose. Discussing your reasons with someone you trust may relieve some of your confusion. There is no shame in having a virus, such as HIV, but sharing your status can trigger unexpected events. You should be prepared for what may happen after you disclose. As a postdoc, you may be offered health insurance that will i...

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ATRIPLA

Wed, 27 Dec 2017 23:32:21 -0400

Q: Hello Im Planning to Go back to Philippines for good, Im on ATRIPLA Now..Is ATRIPLA is Now Available in the Philippines? if not what are my options .Thank you in advance,

A: Hello and thanks for posting.Atripla (or it's generic equivalents) are recommended by the World Health Organization as initial antiretroviral therapy for people living with HIV. The combination of tenofovir DF/ 3TC (or FTC)/ efavirenz is widely available in most low- and middle- income countries around the world, and I have no doubt that the medication is available in the Philippines.I hope that's helpful,BY

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Rash from septrin or genovya

Wed, 27 Dec 2017 19:21:40 -0400

Q: Recently diagnosed and tested with cd4 121, started septrin about two weeks ago and then 4 days later genovya. After 12 days I broke out in a red rash, hive like, that is itchy moves around my entire body plus low grade fever. Do you have a suggestion which medication to stop first to see if it is allergy? Should I stop one or is one more important than the other?

A: Hello and thanks for posting.First, from what you've described, your rash would seem to be a drug reaction, in that the rash involves all of your body, rather than just part. It's also good to make sure to rule out secondary syphilis, as this is a common cause of rashes in the poz community.Both your Septrim and Genvoya are important, but there are alternatives to (Septrim) trimethoprim/sulfa for Pneumocystis prophylaxis. Moreover, as your immune health (CD4 count) improves on ART (Genvoya), on...

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purbac and ARV

Tue, 26 Dec 2017 18:17:40 -0400

Q: Hi doctor is it safe to take purbac twice a day for my acne face while taking hiv treatment?

A: Hello and thanks for posting.Purbac (trimethoprim/sulfamethoxazole; also known as Co-Trimoxazole, Bactrim, Septra) is a widely used antibiotic. It's commonly used among people living with HIV to prevent Pneuocystis pneumonia or Toxoplasmosis.While it would be entirely helpful and relevant to know what HIV treatments you'r taking, A quick search of any online drug-drug interaction calculator (such as hiv-druginteractions.org would qu...

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Help

Tue, 26 Dec 2017 18:08:53 -0400

Q: My son is HIV and he does not want to take the meds I thought he was taking them but found out he hasnt taken them in like 7 are 8 months.

A: Hello and thanks for posting.First, a few thoughts on words. Your son might be living with HIV, but he's not the virus (or "HIV"). Calling people such can be seen as stigmatizing or in some places, even criminalizing. Using terminology that puts the people back into people living with HIV helps to destigmatize and honors the person.It's first important to try to understand why your son stoped taking his medications and why he doesn't want to take them. Today's HIV medications should be extre...

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Information for a friend

Tue, 26 Dec 2017 18:02:53 -0400

Q: My friend today told me he stopped taking his HIV meds 12-13 months ago. I'm worried. I've read that missing a single dose or even a few days will cause the t cells to go back into full dying off,and making the drugs resistant. I have told him i think this is true. Please inform me and him please. Thank you.

A: Hello and thanks for posting.Fortunately, you're mistaken. Neither a single missed dose, nor a prolonged treatment interruption results in viral drug resistance.Current HIV medications certainly allow for less than perfect adherence. We must get past the Puritanical view (once popular) that suggests that people living with HIV must now be perfect in order to survive with medications. Indeed, human imperfection works with today's medications, allowing for adherence as low as 90% without a meas...

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Titer of 1:1

Sun, 24 Dec 2017 17:56:46 -0400

Q: Hi, I got primary syphilis when i was 24 years old and got a corresponding treatment with penicillin injections. After the treatment I was told to have my vdrl test and the doctor told me I am cured. Presently, i am already 58 years old and out of curiosity I went for another vdrl test and got a titer of reactive 1:1, after 34 years of my my treatment. Is it ok at that range or does it mean my treatment before failed?

A: A VDRL can remain positive for years after successful treatment, as is the case here. There is no reason to repeat this test unless re-exposure is a concern.

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10 Words or Less

Sun, 24 Dec 2017 02:24:57 -0400

Q: What should I do if I miss taking a doze of one day ?

A: Hello and thanks for posting.Today's HIV medications do not require 100% adherence, nor stopwatch precision dosing in order to work optimally.If you've missed a dose of medication for a day, just resume taking your meds at the usual time.Though there's little science behind this, I routinely tell my patients that if you remember that you've missed the dose within 1/2 of the dosing interval (i.e., 12 hours for a once-daily or 6 hours for a twice daily regimen), then go ahead and take the "late" d...

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genvoya switch to truvada

Sat, 23 Dec 2017 17:42:58 -0400

Q: Dear Doctor Young, I have been taking Genvoya for about 2 years. I wonder if I could switch Genvoya to Truvada, since it is much easier and more affordable for me to get truvada now. thanks.

A: Hello and thanks for posting.While tenofovir and emtricitabine are in both Truvada and Genovya, Truvada alone is not a complete regimen for the treatment of HIV infection. You could take Truvada with an integrase inhibitor (to substitute for the elvitegravir/cobicistat in Genvoya) such as raltegeravir (Isentress, Isentress HD) or dolutegravir (Tivicay). If you're having difficulty paying for your medications, before switching (or even afterwards), it's good to check with the manufacturer's webs...

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Urine test

Fri, 22 Dec 2017 20:48:51 -0400

Q: Hi am on triumeg drugs , am asked to do urine test as part of my job , can it show in my urine that am taking triumeg ?? My boss doesn't know thank you

A: Hello and thanks for posting.The medications in Triumeq (abacavir, lamivudine and dolutegravir) do not result in positive urine drug toxicology tests.BY

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Gonorrhea

Fri, 22 Dec 2017 20:47:22 -0400

Q: I can't get a doctor appointment for 2 weeks. I have 500 MG penicillin. (Fish penicillin )this help Gonorrhea?

A: Hello and thanks for posting.While we now know that being on HIV treatment and having an undetectable viral load means that you can't transmit HIV (#UequalsU), other sexually transmitted infections, such as syphilis, chlamydia, hepatitis C or in your case, gonorrhea can be transmitted by condomless sex. Penicillin is not a recommended treatment for gonorrhea. According to the current US Centers for Disease Control and Prevention (CDC)
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