Forum on Managing Side Effects of HIV Treatment

Is it safe to get tattoos to cover KS lesions?

Thu, 29 Dec 2016 17:17:15 -0400

Q: After 2 years if chemo, the KS is out of my vital organs, however I still have many remaining lesions. Is it safe to get tattoos over them?

A: Interesting question. I am unaware of any published quality data on that subject. I have had some patients cover residual skin color changes with tattoos without any obvious problem. If any reader knows of a reference on the subject or relate their personal experience please post. KH

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Triumeq & nausea

Wed, 28 Dec 2016 15:36:06 -0400

Q: I just recently stopped Genvoya for a month due to some unmanageable side effects and decided to start Triumeq again. This time i've been having nausea which i didn't experience the last time I tried this medications, i just had some GI side effects, however it's been almost two weeks and i am still having nausea since on Triumeq, my doctor gave me some ondansetron but it's not helping like I thought it should. Is the nausea going to subside or is this most likely going to be a ongoing side effe...

A: You are unlucky if the nausea is due exclusively from the single table regimens since intractable severe nausea is infrequent (< 1-5%). In many cases nausea will subside if you can bear waiting that out for 1-2 months. A trial of boosted darunavir or atazanavir, raltegravr, doleutegravir, or rilpivirine with various NRTI backbone regimens might be other options to consider if the problem persists. KH

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Sprem Count

Wed, 28 Dec 2016 15:31:57 -0400

Q: I am a 50 year old male with AIDS. My CD4 count is 1100 and my viral load is under 20. I am taking Descovy, Sustiva, Metformin, Gabapentin, and multivitamins. My semen is clear and watery and limited when I ejaculate. How can I increase my sperm count and appearance of it?

A: Sperm/ejaculate appearance depends on many factors including frequency of sex, diet, hydration status, hormone levels, age, other medications and conditions. HIV infection per se has variable but often minor effect on semen. Data is limited regarding effect of your HIV regimen on semen characteristics. Studies with that regimen and my own experience with many patients suggest that the HIV regimen has only a modest effect on semen in most patients. It often is not simple to increase semen volu...

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Lamivudine 300 mg VS Emtricitabine 200 mg

Wed, 28 Dec 2016 15:25:08 -0400

Q: Dear Doc,Hope this email finds you well. I really need your advise.My viral load is undetectable now with CD4 500 plus.But if from time to time I switch my meds : Efavirenz+Lamivudine+Tenofovir disoproxil fumaratewith TEEVIR (Efavirenz+Emtricitabine+Tenofovir disoproxil fumarate) would that be a problem??I heard both are atripla, yet sometimes the meds are not available, so I switch between those two options. Would there be any side effect?Or do you recommend just stick to only one type of meds?...

A: In most cases persons can switch between those fairly comparable regimens (main difference is between the emtricitabine and lamivudine) with minimal side effect difference or change in viral control. KH

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Off Complera for 4 month

Wed, 28 Dec 2016 15:23:06 -0400

Q: I have been off complera for 4 months and wondering would I be resistant to the drug now? I also have noticed some swollen Lymph nodes in my neck, and groin area. Should I be concerned? I was off meds because I lost insurance and was not able to get new unsurance until Jan 1.

A: It you were doing OK (suppressed viral levels) while on Complera and then stopped it abruptly due to no insurance status (pitiful for the US having such a complicated lousy insurance system)you likely would not have developed drug resistance since being off meds. Viral levels would be expected to rebound off meds (not due to resistance but to having no active medication in your blood any longer after stopping) and sometimes that is associated with enlargement of lymph nodes. KH

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High Blood Pressure and body aches

Wed, 28 Dec 2016 15:12:17 -0400

Q: Hi I am HIV positive since April 2016. I started ART immediately I.e.Emtricitabine and Tenofovir Disoproxil Fumarate and Raltegravir. In November 2016 my viral load is undetectable and CD4 is 794. I was doing well but since last week of November 2016 I am suffering from mild body pain and high blood pressure. Sometimes it went 170/90. My doctor is saying it's is because of tension and anxiety. I have done all blood tests CBC, LEFT, Blood sugar, lipid profile, all reports are good. Please help, w...

A: Raltegravir can sometime cause a myopathy with muscles aching so you might want to check your muscle enzyme levels. High blood pressure strictly from your HIV regimen would be unusual-regardless if it is high then it needs to be managed despite your age. If no other explanation found for the hypertension a trial on a different HIV regimen might be worth discussing. HIV superinfection would be rare from the situation you describe and would be very rare for a superinfection to cause hypertension....

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Changing from 9am and 9pm to 9:30am and 9:30pm

Wed, 28 Dec 2016 15:07:31 -0400

Q: Hello, im jap i am hiv positive.I would like to know how can i change my time schedule of taking my arv meds. I taking it 9am lamizido and 9pm lamizido ang efav. I would like to change the time of taking it to 9:30am and 9:30pm..Please instruct me.Thanks.

A: Changing the time you take your HIV medications (zidovudine + lamivudine twice daily and efavirenz once daily) by 30 minutes should pose no problem-just do it. Recommend informing your HIV provider so she/he can monitor for any unexpected issues. KH

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skin error

Mon, 26 Dec 2016 15:18:42 -0400

Q: I was to inquire if my skin will get better cz am hiv positive since 2001 when I found out but my parents never told me from when I was a kid that I was born with the virus but then I got skin issues and my skin has been bad since and never been better.I have spots which make me feel insecure most times.I don't know what will help cz I have swallowed the medicine since 2001 but no change. What should I do doctor?

A: There are numerous skin issues in HIV+ persons, sometimes helped and sometimes aggravated by particular HIV medications. Since children and adolescents also have many skin problems it is best to see a skin specialist to make the best diagnosis possible since many of the potential skin conditions are treatable and often will get better over time or with aging. KH

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Does GHB lower the amount of stribild in bloostream?

Mon, 26 Dec 2016 15:16:14 -0400

Q: Can the use of GHB lower the amount of Stribild or ather arv's in user blood and therefore lead to resistance

A: Though to my knowledge not formally studied, protease inhibitors and the cobisistat in Genvoya may increase blood levels of GHB (a.k.a. gamma-Hydroxybutyric acid, known as the date rape drug -- not approved for any use in USA) due to an interaction in the liver. I would not expect that GHB would decrease the effectiveness of Genvoya but again not formally assessed in any published study.KH

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Blood Pressure

Fri, 23 Dec 2016 14:41:39 -0400

Q: Hello,For five years, I was on a coctail of Norvir, Epivir, Isentress, and Prezista. In September, my ID doctor changed my prescription to Descovy and Tivicay.At this point, the virus is undetectable. My cholesterol and sugar are very good. The problem is sudden high blood pressure readings. My doctor is asking that record my readings for two weeks and then inform him.What is your take on this?

A: Sustained blood pressure spikes attributed to Descovy + dolutegravir are uncommon. Checking blood pressure readings at home and when relaxed in a diary as requested are a good means to assess the situation. If blood pressure increase is sustained and in the absence of other new drugs or contributing factors then a trial switch to another regimen or reversion to your older regimen with ongoing blood pressure checks merits consideration. KH

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Stribild to Genvoya spike

Fri, 23 Dec 2016 14:31:45 -0400

Q: I habe been undetectable for over 3years on Stribild. Recently, my Dr recommended Genvoya for its same efficacy but less side effects. While finishing up my first month on Genvoya, ive had regular labs drawn. My follow up 2weeks later, Dr informed me Cd4 levels all time high, great kidney functions but ive tested a viral load of 60 copies!! Im truly worried about this as ive maintained undetectable so long... Dr recommends another lab draw in 6weeks to see if Genvoya will have suppressed back to...

A: 60 copies/ml would be considered a viral blip and usually is of little to no clinical consequence. In the setting of good drug adherence, a switch from Stribild to Genvoya very rarely results in sustained viral rebound/drug failure. In most cases your next HIV level likely to be < 50 copies/ml. KH

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Life expectancy in HIV patients after infection.

Fri, 23 Dec 2016 14:29:11 -0400

Q: Hello doctors and experts, thanks for the care and love you give us. Here follows my question. Please answer me.What could be the average life expectancy of an HIV positive from the date of acquisition if he is 24 years and starts proper medications after six weeks of infection, ensures healthy diet and physical exercises?

A: The life expectancy for a 20 year old HIV+ person who is on HIV medications and has achieved and maintains good viral suppression and CD4 levels (such as > 500) is very good and depends on non-HIV factors (such as cigarette use, family history, presence of hepatitis or diabetes, exercise and diet habits and other factors). Overall life expectancy has been approaching (within 3 -10 years depending on the study) that of matched HIV negative controls (ie 68-75 years). KH

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Does antacids affect arvs

Fri, 23 Dec 2016 14:25:52 -0400

Q: I sometimes get so bloated and get terrible heart burn. When this happens I usually take Citro Soda antacid. Can this affect the effectiveness of my arvs. I am on Odimune.

A: Antacids can impact some HIV medications particularly when doses taken within 1-2 hours of each other (such as integrase inhibitors). Recommend discussing with your HIV provider or pharmacist. KH

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HIV+ and HIV- Relationship

Fri, 23 Dec 2016 14:24:28 -0400

Q: Hello, Doctor HenryMy female partner (long term relation with me)is HIV+ and she is on Attachement Inhibitor (Maraviroc), Fuzron and the third drug is Dolutegravir. She has MFR Virus but sensitive to this three drugs. I m taking Prep (Truvada 5 times per week). She is undetectable at this time. She has no side effects. But i have some bone pain. What can i do? Second question: sometimes we make it condomeless.. Is it ok if i use home HIV-Tests Dual(p24 and Antibody) , at https://www.hivtests.at/...

A: In some cases Truvada can cause bone problems so an assessment of your bone density and metabolics is recommended to determine the safety of continuing Truvada for PrE. The risk for transmission from an HIV+ person suppressed (< 50 copies HIV/ml) to a negative sexual partner is very low even without a condom. KH

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Side effects or it's just my immune system?

Fri, 23 Dec 2016 14:21:49 -0400

Q: Hello I was diagnosed hiv positive 4 months ago and taking arvAfter one month taking it. I had allergies of this med hospital decided to change my med. After few weeks i feel okay with my new med but really makes me dizzy. After that i had shingles and had lots of feverAfter a few weeks i noticed my discoloration of nails and weight loss really fast..Is this a side effect or its just my immune system? Please help me understand..

A: Those effects you describe can in some cases be due to specific HIV drugs as well as immune recovery or other conditions. Specifics regarding your medications, labs results, medical history, and exam findings are necessary to sort out the likely contributing factors to the nail and weight changes you have experienced. KH

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Symptoms Despite VL 46 CD4 1473

Wed, 21 Dec 2016 15:35:10 -0400

Q: I was diagnosed in April 2016. VL 64,300 CD4 885. Started Triumeq mid-June. The virus was not resistant to any meds. I had a 2 month symptomatic seroconversion. 7/28/16 VL 50 CD4 773; 10/28/16 VL 46 CD4 1473. I developed asthmatic bronchitis late November and have been on 2 rounds of azithromycin after toughing it out for 2 weeks with no antibiotic. I continue to tire easily have painful cervical lymph nodes, occasional diarrhea, joint and muscle soreness, low grade temp at night to 99.6. Any ...

A: Integrase inhibitors can sometimes cause a myopathy so checking muscle enzymes worthwhile. Bronchitis is most often due to a virus that wouldnt be improved by antibiotics-resolution often can be slow. Those symptoms overall would be unusual for HIV to cause but more common for other virus associated bronchitis with bronchospasm. If you are smoking have has some exposure to allergens or environmental air pollution that may prolong recovery. KH

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Dark facial complexion due to arvs.

Tue, 20 Dec 2016 23:43:38 -0400

Q: Can dark facial complexion be treated?

A: In some cases with input from a dermatoogist (skin specialist) and sometimes a switch in HIV meds often the dark facial complexion can be improved. Let me know what happens. KH

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syphilis and dizziness

Sun, 18 Dec 2016 15:39:58 -0400

Q: i am currently taking : lamivudine + zidovudine + atazanavir + ritonavir.then i got diagnosed whit syphilis. (it seems that i had it long time). they gave me penicillin and turns out that i was allergic. so docs gave me erythromycin (every 6 hours per 10 days). at the third day it was unbearable. nausea, diarrhea, and dizziness. a terrible dizziness, i kept going until the 5th day and stoped. that was 3 weeks ago, but the diziness and lost of balance are still there. is it normal ??? i am in the...

A: High dose erythromycin can cause many of those side effects-they may need to try tetracycline instead--recommend calling (if possible) your HIV provider to discuss since treatment for syphilis is important-in some cases you can undergo a desensitization protocol to allow you to tolerated penicillin as another option. KH

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On Triumeq 5 months

Sun, 18 Dec 2016 15:23:08 -0400

Q: I started a daily regimen of Triumeq 5 months ago. At the beginning, I experienced almost-immediate, overwhelming nausea in addition to insomnia. At that point, I was taking it with breakfast. When the nausea persisted, I switched to taking my meds with dinner, because that's a larger meal and there's more food to absorb the medication. Now I wake up every single morning with an emergent need to poop. It burns and hurts and I have to go RIGHT then. I also still experience strange symptoms of nau...

A: Severely annoying gastrointestinal side effects from Triumeq are uncommon but can occur. If you have had a clinical evaluation for those symptoms (looking for gallbladder disease, liver or pancreatic problems, gut infections/parasites, lactose or gluten sensitivity and other conditions) and haven't found another likely explanation then a trial on an alternative regimen is worth considering. If you switched to an entirely different regimen and the symptoms resolve that would somewhat confirm that...

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Changing back to Atripla from Genvoya

Fri, 16 Dec 2016 14:43:12 -0400

Q: I was on Atripla for seven years and got to undetectable status and stayed there for years after I got there. However, my doctor changed my medicine to Genvoya. I need to change back, so can I?

A: Switching back and forth between Atripla and Genvoya in the setting viral suppression, good prior tolerability to both, and good renal and bone health rarely would be a problem. KH

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Dose

Fri, 16 Dec 2016 14:41:50 -0400

Q: Hi. My mum is traveling and during that time she couldn't take her HIV medicines. So she missed her dose for the day. Is there any effects for skipping a dose for a day? And can she continuethe next day normally?

A: Missing a single or several doses of HIV drugs occasionally rarely results in a problem (such as drug resistance). She should mention to her HIV provider so that she/he can monitor for anything unexpected. KH

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HIV-PEP

Fri, 16 Dec 2016 14:40:40 -0400

Q: Hello Dr. HenryI m male, 39, had /wanted to have sex with female sex worker but i could not penetrate in her anal area (completely, only tip). I came outside of "her"...This was of short duration and without condome. I received PEP with Truvada and Isentress. Was PEP in your opinion indicated? It is now day 7 and i have muscle pain. My doctor told me this combination is not toxic for short term (4 weeks?)What should i do? Please help me to decide.... Thanks a lot.

A: Both PrEP (usually with Truvada) and NPEP (post exposure prophylaxis usually with Truvada + another drug now often raltegravir or dolutegravir) have very low rates of serious persistent toxicity (4 week course-if problems develop they usually reverse after stopping). Risk of HIV infection after exposure like you describe is low and varies based on local HIV epidemiology and risk history of the sex partner. Raltegravir can cause muscle inflammation though rarely after 1 weeks (can usually detect ...

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10 Words or Less

Wed, 14 Dec 2016 15:23:01 -0400

Q: Good evening, please help me. I have missed my HIV medicine treatment for 5 days. Is there a big risk for my health?

A: In most situations missing doses of an effective HIV regimen for 5 days will be OK-inform your provider so that she/he can monitor. KH

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Changing times

Wed, 14 Dec 2016 15:21:38 -0400

Q: I would like to switch the time I take my meds from night to morning. Won't this be a problem.

A: In most cases switching the timing of taking a currently effective HIV regimen would go OK. You don't mention which regimen you are taking but most often that question comes up in reference to an efavirenz based regimen. The most common side effects from efavirenz involved the CNS (dreams, sleep problems, hung over feeling the next morning) so taking the drug at nite on a relatively empty stomach (fatty foods usually increase the efavirenz levels in the blood resulting in a higher rate of side e...

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Hiv Virus

Tue, 13 Dec 2016 15:55:39 -0400

Q: Hello Doc, i have been thinking about this. If one has the virus and start medication...the viral load decreases..and if you continue it becomes undetectable(which means some of the virus died). What i'm confused about is that why cant they die completely since the arv is capable of redusing the number?

A: Effective HIV treatment typically decreases the level of virus to < 50 copies/ml but more sensitive assays requiring lots of blood often will find persistent lower levels in the blood (such as 1-5 copies/mml) that are of little clinical consequence but demonstrate that the virus is still present. Most HIV virus resides in the tissues not the blood (termed the viral reservois) often in a resting state within various cells (like memory T cells) or as integrated DNA within cells. Current treatment...

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