TruvadaTM prevented 90% of transmissions when it was taken to prevent catching HIV in the Iprex trial. In looking at the data further the investigators found that those who took the TruvadaTM didn’t take more risks during sex. Now, keep in mind, that these people were being followed by researchers and had frequent discussions with them, so this finding may not apply to people not on such a study.
STARTING ANTIVIRALS EARLY INCREASES CD4s BETTER BUT DOES IT HELP THE PATIENT?
Two new studies confirm that the CD4s will rise closer to or become normal if medication is started early. On the other hand, is it worth taking medicine for years when it may not translate into longer life or better quality of life. Having CD4s a little low may not be that bad for you compared to taking medication for years. It is an individual decision. Many focus on the numbers and not how the patient feels. We used to treat high blood pressure and overdiagnose breast and prostate cancer, looking only at the tests. But when watching the patients for years, we found that over reacting is not good either. It would be difficult to watch patients for 20-50 years to see which ones did better, those treated with high CD4s or those with slightly low ones.
This does not take into account the prevention and stopping of HIV. If all who have it are treated and take their medicine well and see the provider on time, then we could stop HIV quickly. Poverty, mental illness, immaturity, substance use all get in the way of this strategy working as planned. Working with humans can be messy. It will take a few years to find out if a good enough number of patients who start early stay on medicine and achieve the goals of prevention,
One of the studies treated the patients very early, right after they just got infected, and that seemed to keep the CD4s up high. Early infection signs are fever, lymph nodes, rash. So if you feel ill after having unprotected sex, then it would be a good idea to see a provider to check for early HIV infection, but many times this acute infection is quite minor or shows no symptoms; these don’t know to see the provider. Prevention is best!
HOW DOES HIV CAUSE CD4 DESTRUCTION?
In addition to taking over the CD4 and turning it into an HIV-making factory, Some recent research shows that when HIV tries to enter the CD4 cell, some of the cells start a self destruction plan.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases is encouraged. He has been a main leader in HIV research for the government for years and has my greatest respect. This will give researchers a new target to try to attack since the main problem with HIV is loss of CD4s and what they do to protect from infections.
There is an anti-seizure drug that seems to block the cellular suicide and studies are being planned. This medication may also flush out the sleeping CD4s out so they can’t hide the HIV from antivirals. These types of studies take at least 5 years to help the general public, and many of them don’t work out. I am hopeful and happy that many bright people are working on this and that they have funding.
ADOLESCENTS AND HIV
About 2.1 million adolescents are infected with HIV and the death rate rose by 50% recently. For the general population, deaths decreased by 30%. This group needs special attention and that is why the World Health Association calls for special programs for adolescents for testing, treating, keeping in care, and education. [so I moved this paragraph to the top of the page!]
Many consider adolescents to be those up to age 24 or 26 since their brains are not fully formed and many of them seem to make impulsive decisions that have negative consequences impacting the rest of their lives, e.g. decisions regarding smoking, drugs, sex, street racing. On the other hand, witness that a few in this age group made impulsive positive decisions, e.g. there are a few new millionaires under 30!
Clostridium difficile is the most commonly reported infectious diarrhea in HIV-infected patients in the US. Its nickname is C. dif. We have discussed before that viruses are the main cause of diarrhea from foods and other bacteria are spread when you don’t separate the meat cutting tools from the tools working with other foods in the kitchen. “Reportable” means that the providers had to fill out a form for serious, contagious infections to send to the public health department. So the vast majority of diarrhea is not reported since it does more good to teach people how to prepare and cook meat well.
C. dif is very common in hospitals and nursing homes. This study only found 8 cases per 1000 patient years, that is 8 cases per year for a thousand patients or 16 cases for 500 patients over 2 years, etc. But for those few this was an important diagnosis. The risk factors for the HIV patients that made them more prone to get it were a CD4 count less than 50 (the most dangerous level), being in the hospital, being on antibiotics, taking stomach acid medication, or medications that lower immunity (e.g. we give some of these to treat asthma, meningitis, or severe pneumonias).
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
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside