Ask The Doctor

Ask The Doctor

Studies have shown that distracting the patient after surgery with TV, a movie, or a video game is helpful for acute pain from surgery. A new study showed that a 5-minute session in a virtual reality (with goggles) reduced pain completely for some, moderate for others and 30% had no pain relief. For those who improved, the effect lasted up to 2 days. Now that these goggles are getting cheaper, this may be a new, widespread treatment. I’ll see you on Pandora (this is for Avatar movie fans).
Those who participated more intensely seemed to have more relief. The virtual world, named “Cool!,” was made of ice which is the opposite of heat/hot/pain in some patients. Over half the patients had a side effect, Cyber-sickness and had to rest for 10 minutes to 3 hours to recover. It is like a 3D motion sickness.

A study showed that there were a high number of people with Hepatitis C who were born after the Baby Boom generation (1945-1965). HIV clinics usually test for this yearly. We also know that Men having Sex with Men (MSMs) are at higher risk than heterosexuals. Please consider getting tested for Hepatitis C.

As HIV patients age, they may pick up other diseases such as hypertension, diabetes, heartburn, obesity, gout, etc. This means that the medication list gets longer. Since medication errors are very common, please be patient as the provider goes through your medications. We find it helpful to make sure the dose and medication you are taking is correct. Looking at the medications also reminds us of a problem we may want to discuss; an inhaler reminds us about asthma which may be far from the mind of the patient. I have corrected many errors and discontinued unnecessary medications many times by going over the list or looking in the bag. Please bring all medications in a bag or a list with your description of the pill next to the name, e.g. “the blue football pill.”
A list I get from IEHP (our Inland Empire MediCal provider) also lists which provider prescribed each medication and the date. I can easily see if the patient has been getting narcotics from other providers or if they went to an Urgent Care or Emergency Department and forgot to mention it.

Gilead has made a new molecule that gets more of the drug to the cell targets than to the rest of the body compared with the old Truvada® (contains Tenofovir DF and Emtricitibine). The new molecule is Tenofovir AF. With the lower level in the body, there is less kidney problems and bone loss as with a small number of the old Tenofovir. The new one is now in the new Striblid®, called Genvoya® and in the new Complera® called Odefsy®. The old Tenofovir is also in Atripla® but no word if they plan on replacing that since it is falling in popularity. I use it along with Complera® as my two top medications since they forgive the patient if a dose is missed better than the other single (triple drug) tablets.

Just as the ingredients of old Truvada® are used in Hepatitis B infection, results show that the new Truvada® works just as well. But Dr. Sax on Medscape® says to be cautious about wholesale substitution of the new for the old in PrEP (pre-exposure prophylaxis) since the data there is not yet positive and may be negative. Its advantage is that it doesn’t saturate the rest of the body so the bones and kidneys are not as affected. Likewise, it may not saturate the rectal and vaginal secretions and semen the way the old Truvada® does.

The LA Times reports that a patient is suing Gilead since he feels they sat on this drug (while his bones became soft) to introduce it soon before the patent ran out so that Gilead could get the profits longer.

Our practice for many years is to get labs to see if the patient needs medication—not needed now sicne we treat al postives. Then we develop a relationship with the patient—treat when the patient is ready is the old saying. Counsel the patient regarding HIV, prevention, and the medication and then prescribe.
More evidence is showing that, since we are treating everyone who is positive and the medications are much more tolerable that treating within hours of diagnosis, more patients take the medications and do not fall off treatment due to many distractions and barriers.
We saw a video that showed a patient being tested and treated very quickly and had a speaker from that program address our County HIV staff.
Another advantage of this strategy is that the viral load drops sooner so that the patient has very low risk of infecting others. This, along with PrEP is the basis of the “Eliminate” HIV from New York or San Francisco programs.

Be Safe! Wear protection. Keep those questions coming.

Daniel Pearce, D.O., FACOI
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center