Forum on Mental Health and HIV

Therapist...NYC area

Tue, 09 Jan 2018 01:12:18 -0400

Q: Senior...66 yrs. Old...HIV + diagnosed 2008...VL undetectable for several years now...CD4 350s...overall good healthy eating habits and overall light exercise...sharing house with 87 yrs old uncle...need therapist in NYC area...mid Manhattan if possible that honors Medicare-Primary and Emblem Health-Secondary...Sensitive to aging issues...HIV + Issues....men's issues...building community issues for when I find myself living alone...Not in relationship...Health Status a barrier to intimacy...Ther...

A: Thanks for your question. You are fortunate to live in a city that has lots of resources for those living with HIV although I am not aware of a specific list of therapists with such experience. There are, however, several options you might try:GMHC has numerous groups and programs and might be able to provide you with some specific recommendations.The Lesbian, Gay, Bisexual and Transgender Community Cente
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HIV Quality of Life.

Tue, 09 Jan 2018 00:56:32 -0400

Q: A google search on HIV these days usually takes one to a BBC article saying that people with HIV live near normal life expectancies and only take a pill a day. I feel there is something missing here and was hoping you could give me more of the reality. How much does HIV change every day life after years of dealing with the drugs and virus? Bone density issues, toxic medication, vivid dreams kidney issues, taking tons of pills due to drug resistance? Constant doctor visits. What is daily life ...

A: Hello,Thanks for your thoughtful question. It is one that I am, despite being an aging long-term survivor, unable to answer in any definitive way.It is true that people diagnosed with HIV today will have a normal lifespan, although treatment (as you know) currently involves daily medications to suppress the virus. The long-term effects of this are unknown but these medications are becoming less toxic. Hopefully someday soon there will be an actual cure and daily meds will no longer be required.F...

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Escitalopram and Lamivudine Efavirenz Tenofovir

Tue, 09 Jan 2018 00:43:00 -0400

Q: Hey hey hey Dr. Fawcett! hello, its me again. Thank you for answering my question about developing OCD after taking antiretrovirals. That was very kind of you.I took your advised and began studying self help guides about CBT and made an effort to go out more and talk to people.I did notice an improvement but i think its just wishful thinking but I made a commitment to push through.Before my question, I like you to know that since I was diagnosed 2 years ago with HIV, the information from this we...

A: Hello,Thanks for your follow-up question. Escitalopram (Lexapro) is not recommended with efavirenz (one of your component drugs). This is due not so much to drug resistance in the long run but rather to rare but dangerous irregular heart rhythms that can result from this combination. You should seek medical help immediately if you experience sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations.Of course, I am not a physician and hopefully your provider has take...

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Memory issues, 'HAND' Quality of life

Tue, 09 Jan 2018 00:22:06 -0400

Q: I am happy to hear people can expect to life until about 75 with HIV. I was hoping for more information though about quality of life...How common will HIV fatigue and memory issues be for those taking modern antivirals for 20 years?

A: Predicting quality of life with long-term survival, and particularly with HAND (HIV Associated Neurocognitive Disorder), is really impossible. Symptoms (memory loss, balance, fine motor coordination) can be relatively mild and impossible to distinguish from other cognitive concerns common with aging.Of course it is important to remain undetectable. Additionally, in my experience people report better quality of life if they are actively engaged in cognitive tasks (using your brain to learn new th...

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Complera psychiatric side effects

Tue, 09 Jan 2018 00:14:52 -0400

Q: Dear Dr Fawcett,I've been on Complera for about 5 months, since then I'm feeling somehow depressed and my mood changes continuously. I know rilpivine can have some psychiatric side effects. I also been recently diagnosed and coping with this kind of diagnosis.Do you think that this emotional issues are caused more by the meditation or by the emotional consequences of being +?Can you give me any kind of hint on how to distinguish between depression caused by medication?Many thanks,Nicolas

A: Hello,Thanks for your question. I'm sorry you are experiencing mood changes and some depressive symptoms. You are correct that Complera has been associated with some increased symptoms of depression.I'm afraid there is no definitive way to distinguish the cause of depressive symptoms short of ruling out Complera by switching to a different regimen. Of course, such a change is often complicated by other factors.You don't mention how long you have known of your HIV positive status. I have found th...

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Hand and life expectancy

Tue, 26 Dec 2017 15:58:27 -0400

Q: I have noticed that life expectancy is now in the mid 70s for people with HIV. I have also heard that HAND is causing major issues for half of HIV+ people as they age. Has there been any breakthroughs in medicine to stop Hand and improve the quality of life for those 20+ survivors? Will most of us have severe memory issues after 20+ years even though we are undetectable?

A: Thanks for writing. More powerful antiretroviral therapies have significantly reduced HIV associated neurocognitive disorders from the severe dementia common in the early days of the epidemic to more subtle concerns such as HAND, HIV-Associated Neurocognitive Disorders.You are correct that up to 50% of those of us living with HIV for many years will develop HAND, although in many cases there will be no evident symptoms. When there are, they will include some impairment of motor activity (sloppie...

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Depression and Triumeq

Tue, 26 Dec 2017 15:43:35 -0400

Q: A friend is diagnosed bipolar and dissociative.. He takes triumeq and escitalipram 20mg 1x and divalproex 250 mg 3x. Triumeq is his first hiv med.. He says that after taking it,.he gets queasy and cant eat for a bit.. I take triumeq as well and feel odd for an hour after taking.. it I'm considering a switch to juluca.. what are your thoughts on triumeq with these meds and the side effects reported vs a change to juluca? thanks

A: Thanks for writing. To my knowledge, stomach issues and queasiness are not common with Triumeq. I would definitely have your friend speak with his healthcare provider (and you too) about this symptom. One word of warning, especially for your friend. Tivicay, a component drug of Triumeq, has been reported to cause rare but very severe depression in persons with a history of psychiatric diagnoses. He should definitely consult with his psychiatrist about that and carefully monitor for any changes i...

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Developed OCD while HIV positive

Mon, 27 Nov 2017 17:50:30 -0400

Q: First of all, thank you for all the effort you guys put into answering the questions here. I live in a country where HIV assistance and guidance is not as easily accessible and our support systems are still at its infancy compared to the US. This is really comforting reading answers to questions I often asked myself.My question isIt has been 2 years since I started taking my ARV (3 in 1 tablet, Lamivudine, Tenofovir, Efavirenz) and 6 months ago I started developing symptoms of anxiety. I often f...

A: Hello and thanks for your question. I'm sorry to hear that you developed symptoms of obsessive compulsive disorder (OCD) after becoming HIV positive. Since you don't report any prior history of OCD prior to starting HIV meds, I suspect it might be related to efavirenz. I hear this a lot anecdotally and there is at least one study documenting efavirenz related to the development of OCD.I'm not sure what other medicatio...

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Can I still take psych meds with HIV?

Mon, 27 Nov 2017 17:38:26 -0400

Q: I suffer from mild psychosis and a personality disorder. Now recently diagnosed HIV positive. My question is Will I still be able to take my anti-psychotic medication? Or will I have to stop or change meds now that I have to take HIV meds?

A: Hello and thanks for your question. If you have been diagnosed with psychotic symptoms, no matter how mild, it is extremely important that you maintain regular contact with a mental health professional. In most cases this will require medication to control these symptoms and, like your HIV meds, it is extremely important that you take the antipsychotic medication as prescribed.There has not been an adequate amount of research done in this area, but we do understand that antipsychotics and antire...

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Am I in the later stages of hiv?

Thu, 09 Nov 2017 18:42:56 -0400

Q: Hi, I have recently been diagnosed with hiv. I am currently awaiting the western blot test. This wait has been the most antagonizing wait ever. I am very stressed because I am displaying certain hiv symptoms which from what I read, appear in the later stages of hiv. Firstly, I have had fungus infection on my scalp for about a year. Previously I thought nothing of it as I was unaware of my condition. Recently, I notice some white dots below the surface of my lips. They have no feeling. I am now ...

A: Hello and thanks for writing,I'm sorry to hear you have been diagnosed with HIV, although that does not carry the very worrisome consequences it did years ago. One point for clarification: usually the Western blot is done to confirm an initial positive test result. There are cases with a false positive. If you are waiting for that confirmation I encourage you to take this one step at a time. I understand it's enormously difficult to patiently wait for that result but I encourage you to keep you...

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I'm positive and my boyfriend negative can we live as a couple?

Sun, 22 Oct 2017 19:07:52 -0400

Q: I'm hiv positive but my fiance is giving negative. I'm scared we can't live together as a normal couple. My CD4 moved from 350 to 700 and I'm yet to get the results of my viral load. If there is a possibility of us living together and having kids without infecting my partner and my kids, would you please tell me.

A: Hello and thanks for writing. The answer is yes, yes, yes - you and your HIV negative partner can absolutely live as a couple without risk of HIV and can have children, as well.It's very good that your CD4 count is rising but the more important lab result for you to monitor is your viral load. If you take your medication as prescribed and maintain an undetectable viral load you cannot pass the HIV virus to your partner. This is huge news that has recently been endorsed by every major medical org...

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Am I in danger?

Fri, 06 Oct 2017 20:07:33 -0400

Q: I have been married for a year now, my wife tested HIV positive and I tested negative, in these year August, I conducted other test like Elisha test, window period test, RVS test they all sure no symptoms of virus and that it all shows negative, so what are my chances of being positive in future

A: Thanks for writing. With proper precautions you should have no risk for HIV. It is very important for your wife to take her HIV medications and to maintain an undetectable viral load. When she is undetectable it will be impossible for her to transmit the HIV virus to you. If it is available where you live you should also ask your doctor about PrEP (pre-exposure prophylaxis). This is a dose of HIV medication that you take as an additional precaution to protect you if you were to somehow be expose...

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Finding fulfillment single

Fri, 06 Oct 2017 19:57:19 -0400

Q: Hi, I was diagnosed HIV positive a year ago. I am undetectable and have been quite good about taking care of myself. (need to start going back to the gym though) Career-wise, I am also pursuing my dreams and have just started a PhD program in science. I've gotten to the point where I don't really know if looking for love or pursuing any type of intimacy seems pointless. I know a part of me idealizes the whole long-term relationship and marraige etc, but I know its really a rare thing even for HI...

A: Hi and thanks for writing. Your question is more of a philosophical variety which can't really be answered by anyone but yourself, but I do have some thoughts.You mentioned you were diagnosed a year ago and are undetectable. Congratulations on that. I think it is great you are pursuing your dreams (data show a sense of purpose leads to better health outcomes). All that said, adjusting to living with HIV is a long process that, in my experience, is a nuanced and layered experience. In the long ar...

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Newly diagnosed and need information about HIV

Fri, 06 Oct 2017 19:40:24 -0400

Q: I just got to know that I'm HIV 1 possitive. Can you please someone help me what I have to do now. How many years i can live if i take treatment and maintain good diet. Please help. Thanks

A: Hello and thank you for writing. I'm sorry to hear about your HIV diagnosis but I want to assure you that, with good medical care and attention on your part, your health will be fine and that your lifespan will not be affected by HIV.It is important for you to be in regular medical care with the goal of reducing your viral load to "undetectable" and increasing your t-cell count. To do this you must take your HIV medications exactly as prescribed. You will need regular labs and doctor visits (usu...

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Meth and HIV

Fri, 08 Sep 2017 19:06:23 -0400

Q: Does smoking meth and having HIV kill you faster.

A: Thanks for writing. That is a very short question that requires a longer answer.In short, yes, smoking meth (or ingesting it any other way) increases your risk of life-threatening complications for anyone whether through physical complications like stroke, heart attack or pulmonary hypertension to psychological concerns like paranoia and psychosis. For someone with HIV, meth additionally complicates things in a number of ways.The biggest complication is adherence to your HIV medications. Many pe...

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Depressed, ovewhelmed. and unsure of the cause

Fri, 08 Sep 2017 18:53:18 -0400

Q: I found out I was HIV + 3 years ago. It was a drunken one-night stand, my only one in my life. I was unlucky. Apparently there's a 1 in 90 chance of catching it this way. Maybe I should pick some lottery numbers? Anyway, this happened a month after my best friend (and ex boyfriend) got sick with some bad allergy and had to be hospitalized. He got worse and then started having terrible fevers and got a rash. He told everyone he had dengue. He died 2 months later from AIDS and TB and obviously I f...

A: Hi and thanks for writing. I'm sorry to hear about all you've been through. There's a lot of grief and trauma there, so it's not really surprising that you are feeling very depressed.I'm glad to hear that you are on medications. We know that the sooner one starts the less risk there is for complications down the line. The medication should help your HIV.Now about the rest. Sadness and grief is a normal response given all you've been through. When we have those feelings and suppress them with add...

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HIV positive woman with HIV negative man

Fri, 08 Sep 2017 18:20:36 -0400

Q: My boyfriend and I have been dating for a year and a month now and I recently found out that I am HIV positive. We have been using condom in most of our intimacy and he got tested and is negative, we now are in a situation where we trying to make this work because we both love each other but he is scared to be intimate with me, I am not on treatment yet as my CV4 count is still high... how can we go about being intimate as intimacy is our way of getting closer, I feel now like I am losing him an...

A: Thank you for writing. The best way for you to protect your boyfriend is to get your viral load to undetectable. For this you need to be on medications. The standard recommendation is no longer to wait until your CD4 count drops to a certain level but to start medications as soon as you are diagnosed. The sooner you start medications (even if your CD4 count is high), the less likely you are to have complications in the future. I am not sure what country you are writing from but I encourage you t...

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Disoriented

Sun, 03 Sep 2017 14:27:33 -0400

Q: Hiv undectectable for 17 years. Today 8/7/17 i got the news that i have syphilis but doctor dont know how long since he never did the test for me before n i never had any symptoms of anything. He decided to run that test now just to check, i got my 1st treatment n need to go for 2 more n then another blood test in 3 months. Im upset because i always play safe until a couple of days ago. That i was invited to a sex party n decided that why not. Now im afraid to play with anyone n its driving me c...

A: Thanks for writing. I understand your concern and frustration. It's a good idea to regularly include a test for syphilis (RPR) in your routine bloodwork - that way you can catch it quite soon.Since you always play safe it seems likely that you acquired it just a few days ago and it was caught early. Because there are areas where drug-resistant syphilis is on the rise it is important to monitor your symptoms carefully and follow your doctor's recommendations.Depending on where you live your docto...

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Undetectable untransmitable

Sun, 03 Sep 2017 14:18:16 -0400

Q: Hello I am from Mexico and I have 7 years being positive with good levels of CD4 around 32% and VL undetectable and I have a couple he is also positive with the same numbers, recently we have been having sexual relations with no protection but never cumming inside. What are the real risk of having this behavior? I have read about the U=U study but it doesn't mention about a hiv couple. Could you give me please your opinion or advise.Plead and thank you. I hope not to have a terrible English.

A: Hello and thank you for writing. There is now agreement that if you are undetectable there is no chance of trasmitting the virus to your partner. You can read more here. This is especially important for couples where one is living with HIV and the other is not. This is good news for you.You should remember several other things: you and your partner can still get other sexually transmitted infections. You should also speak with yo...

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IDV 1and2 blood tests

Sun, 13 Aug 2017 17:16:37 -0400

Q: What are idv 1 and2 blood tests?.why these tests are performed?.if the idv 1&2 blood tests result shows non reactive means HIV positive or negative.pls help with better answer

A: I am not familiar with this test or what it measures.

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Difference being being Positive and having AIDS

Tue, 08 Aug 2017 19:39:15 -0400

Q: I still don't understand the difference or has things changed over the years ? my friend VL was 25 when he was diagnose as having AIDS. Then through the years of treatment.his VL got up to 840 and he is healthy undetectable. Now the same doctor tells him he is now positive and no longer have AIDS. Confusing! can you help?

A: Thanks for writing. HIV is the virus which can be transmitted through blood-borne contact (we have HIV tests, not AIDS tests). AIDS is the medical syndrome that can develop once someone has been exposed to HIV, if that development is not controlled. Once someone has moved from HIV to AIDS (more on that in a minute) that person will remain diagnosed with AIDS no matter how high his t-cell count goes.How does someone move from living with HIV to having a diagnosis of AIDS? There are several ways t...

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The proper answer

Tue, 08 Aug 2017 19:16:34 -0400

Q: In response to your recent answer to the question: "Should I say "HIV positive" or "I have AIDS?" and the People First Language, would it be correct for an undetectable person to say "recent tests show no signs of HIV?"

A: Thanks for your considerate inquiry. The intent of using People First language with HIV is to reduce stigma, and that would include moving toward a status neutral stance. In such cases I think it's best to avoid "positive" or "negative" although I understand the resulting phrases can make for some awkward language.You can find more information, including suggested phrases, here.T...

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Hiv symptoms and mood swings

Thu, 03 Aug 2017 15:40:01 -0400

Q: Hi.. I'm just wondering if an undiagnosed hiv infection may be causing one's mood swings towards their partner. The person with mood swings believes its some witchcraft attack... but i suspect hiv infection. However they 're not keen on getting tested yet.Thanks

A: Thanks for writing. HIV can impact mood, but usually at a more advanced point. Anxiety and depression are common in people living with HIV, both because of some physiological factors that are not totally understood, and (probably mostly) from the psychosocial stressors of living with HIV.I think it's very possible that mood swings toward you may indicate that the other person has lots on their mind, for example, they may alo have a feeling that they have been exposed to HIV, or have other behavi...

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HIV Positive Husband and wife

Thu, 03 Aug 2017 15:29:18 -0400

Q: We both have positive HIV ..Check only 5 days back ....His volume 670 and my volume. 140.. but I have a little girl baby this age 2year but she is negative . Can she positive in future and how to protect her......Next Q my wife have 5 months pregnant........Is the posible ....Newborn baby with come positive .....Then baby worn with positive Hiv ? How to protect her.........Sir please give me these Q ans......I wating......Thank u so much sir

A: Hello and thank you for writing,Congratulations on building your family! As for your little girl who is negative, there is no risk that she will seroconvert (become HIV positive) at this point. She will be fine.The important lab value for you both to be aware of (especially you at 5 months pregnant) is your viral load. This should be undetectable, meaning that the levels of HIV in your blood are very low. If you are undetectable, you cannot pass on the virus. It is very important that you work w...

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Should I say "HIV positive" or "I have AIDS"?

Sun, 02 Jul 2017 16:03:38 -0400

Q: I became positive in 1990, had AIDS in 1995, I am undectable. The question is do say I have AIDS or that I am positive? I don't know how to answer that question honestly. Thank you for any thoughts.

A: Hello and thanks for writing,As another person living with HIV for many years, I congratulate you on surviving through so many stages of this epidemic. I trust you are taking steps for self-care to address any remnants of the struggles and traumas of those early days.I appreciate your sensitivity to language which can be especially powerful (even inadvertently) in conveying stigma. I refer you to a concept called "People First Language" which is described in Read More