Ask Doc Apr


I recently attended the Conference on Retroviruses and Opportunistic Infections meeting in Boston along with 4,000 other HIV experts and researchers. So this issue and the next will be devoted to what I learned there. Next month I’ll have a section on Transgenders—much to mention.

Did you know that there are more cells of bacteria in and on you than the number of cells you have? Therefore, you are a walking village of microorganisms (microbes)! There are good and bad ones. Most studies are on the gut, that is the poop. The good bacteria break down the large molecules and help you get them inside your body so you can use them. You measure the amount and kinds of bacteria by examining the poop. Gay poop has more bad kinds of bacteria than straight poop. HIV poop has even more bad bacteria. This is not affected by what types of sex they have or whether they use certain lubes. HIV poop in Africa is worse than HIV negative poop there but better than HIV poop from the U.S.A. The bad bacteria get inside your blood from the gut and go to the liver and some from there go to other lymph nodes which are the immune filters. In HIV more of this happens so you are continually fighting these wayward microbes. That causes the inflammation in HIV that even occurs when the virus is well controlled. Probiotics can provide more good bacteria (Kefir—a yogurt drink—seems to be the best). I have a kefir, kale, banana, orange smoothie daily.

As you recall, getting the dormant HIV woken up from their sanctuaries to kill them is a strategy that is being researched more and more. Many chemicals have been tried to shock them out of their dormant state. Adding an antibody that flags the infected CD4s for destruction and/or a vaccine may be a good idea. One of these antibodies is in testing now.

For those who won’t wear condoms, PrEP works great if you take it. Some PrEP takers showed resistance, but after analysis, the resistance was from a donor (sex partner) and they weren’t taking the PrEP well and got infected. There is a new long-acting combination that has passed the initial testing, Cabotegravir and rilpivrine. They are thinking of giving it as an injection every 2 months. But a problem is for a few months after there is a little drug left in the system and that may cause resistance (like missing your antiviral doses on and off). So they may decide to give Truvada® for the first month and then for 12 months after starting the injectable PrEP. Some may think this is too much of a hassle. Women can’t miss any Truvada® since they need higher levels than men who can miss a couple a week and still be protected. The anal secretions have 100 times more Truvada® than the vaginal secretions. But taking it every day seems best. There are regimens to take 1 Truvada® the day before, the day of and each of the 2 days after sex but that is not in a guideline yet.
STIs (like chlamydia and gonorrhea) were common (50%!) in the PrEP group than in the condom group in a San Francisco study. There were no HIV transmissions but there were 2 Hepatitis C transmissions. They asked them how their condom use changed on PrEP and 50% had no change, 41% used them less, and 3% used them more.
Another study found more STIs that didn’t cause symptoms. They checked their throats, urine, and anuses with a swab to find the infections.

There hasn’t been much action on using gels and films (like those breath mint films). Some of the films also have a medicine to prevent herpes. You put them on before the penis goes in. There is a new ring that fits around a woman’s cervix every few months or so in testing that has most of it leaking Truvada® and a small part leaking a birth-control hormone.

Gaining wt is common with HIV meds or is it just treating the HIV effectively? This is proven even with avoiding the medications that put on fat more than others. A Healthy lifestyle helps control the weight some.

Gene therapy can deliver DNA into our cells via a mild or benign virus. Then your cells can make drugs to hurt HIV or block entry into your cells or its effects. This is still in the early stages.

Osteoporosis is poorly-made/weak bones. Occcasionally this is made worse by medications; the one that causes it the most is tenofovir which is in Truvada®. They showed that if those on PrEP stopped the Truvada® then their bone strength loss returned to normal. Another group gave an IV infusion once to patients about to start Truvada® and that prevented the bone loss.

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