Ask the Doctor

Medical News 

Hearing Loss. A recent article states that musicians are at much higher risk of hearing loss and tinnitis (ringing in the ears) than non-musicians.  We already know that loud music, especially when listened to through earphones or loud equipment/machines are big risk s for hearing loss too. We already will have worse hearing as we get older, let’s not speed up the process. Put those earplugs in.

Working with Children. Another study showed that if you use nouns, like “Helper” instead of verbs, “help” that children will respond better to the noun.  Maybe they see the verb as a command but see the noun as something good to become.

Bad Flus. There is a new study of the lethal 1918 flu that killed 50 million people. Those who are older had some immunity to an older, similar flu so they didn’t die as much unless they had another major disease.  The very young mount a great immune response to this virus so they didn’t die as much.  People in their 20s were at greatest risk since they had no protection, so many of this group died.  This virus came from a bird to humans, went from pigs to humans, combined in humans with another flu to make a lethal hybrid.  Today, with receiving multiple flu vaccines over t he years, many get long lasting protection to flus.

Weight Loss. I have many patients who are overweight and resist the advice of cutting calories, eating healthy, and exercising.  It is hard to change. But I have a good number of those who follow this advice and start losing weight. They say they have more energy, are happier, and enjoy food more. Some of these are over 300lbs. It is actually easier to lose more weight when you are that size than 10lbs overweight. It takes a lot of food to maintain a 300lb body so cutting down moderately doesn’t cause suffering, but causes quite the opposite, a higher quality life. It will take a long time for them to get down to their healthy weight at the comfortable rate of 1/2-2lbs lost per week, but these changes in lifestyle are not major and can be maintained for years, hopefully the rest of their lives.

HPV vaccine worked in women up to 35 years old and it was safe. First the women were checked to make sure they didn’t have immunity to the HPV types in the vaccine. This study was performed in 3 countries.

TB resistance test in 2 hours.  There is a test that is this fast and doesn’t take 2 months. It only checks for one drug. This is a big step in the management of TB.

Hep C. Hep C can be cured since this virus doesn’t get inserted into the nucleus, unlike HIV and Hep B.  Hep C comes in genotypes 1-6. Different drugs work differently on each genotype. How far along is your disease, barely bothering your liver or in the last stage of cirrhosis? Physical exam, talking to you, blood tests, scans, and maybe a biopsy are needed to stage your liver.  The new drugs work without the injected interferon so there isn’t the risk of the flu-like side effects.  Instead of low rates of cure with a year of treatment, we now have high rates of cure with much shorter treatments. There are 2 new drugs approved that many liver specialists are using to treat Hep C. Soon there will be more. The question now is not what to take, but who will pay for it?

At the office where I treat Hep C patients, we have gotten Medi-Cal and some private insurances to pay for the treatments.  The list price may be around $100,000 per treatment.  This is way too expensive for all to get treatment. Of course if an HIV patient is taking about $2,000 worth of medicines a month for 50 years, that would reach $2.4 million. The Hep C medications were very expensive to develop and manufacture but I am not equipped to determine if the prices are fair. There will be many meetings between the pharma companies and the insurance/government groups.

Losing Muscle Mass as We Age.  Some age faster than others. Those who use substances, especially injectable substances are at risk for losing muscle mass earlier. Being overweight or having a large frame was protective. Testosterone and anabolic steroids can be dangerous, causing heart disease and strokes. This type of therapy needs close monitoring.


Condoms really necessary? There was a large study showing that discordant couples with a partner who has undetectable virus has a very low risk of spreading virus to the other partner when no condom is used. Condoms and faithfulness are still recommended, but the risk of transmission is now thought to be much lower. The partner with HIV must not miss antiviral medications and they must be sexually faithful to keep the transmission risk very low.

TasP Treatment as Prevention has been shown to work in South Africa and Vancouver, BC, Canada.  By getting as many people on antiretrovirals as possible, the number of new infections has dropped and the life-expectancy has increased.

In South Africa, since so many patients are on antiretrovirals, transmission has dropped so that the number of new HIV cases/year is not going up but is coming down! This is a tipping point.

PrEP Truvada did worsen the kidney function in some HIV negatives taking it for prevention. But this condition resolved when they stopped the prevention medication.

Another study showed that those having high risk sex also engaged in low risk sex sometimes, so the PrEP isn’t needed every day of the year, just when they are planning or anticipating high risk sex for a time, like when looking for a new relationship, becoming depressed, or restarting substance abuse. Subjects older and younger than 30 engaged in some high risk sex.

Cured Mississippi Baby. At 3 years old and not on antiretrovirals, this baby is still showing an undetectable viral load. Babies should be started on medications at less than 48 hours old.

Keep those questions coming. Be Safe!


Daniel Pearce, D.O., FACOI, AAHIVS
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
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside