Ask the Doctor – HIV NEWS

No increase in meningitis has been seen. It should have spread as the first wave by 4/10/12. So this issue is closed.

We follow a number of partners of HIV patients and we get some negatives, but lately we have had a good number of HIV positive test results. We tell them to use condoms. Some say they are using and others say they are not. When they turn positive, we know that they were not using condoms. We try to not bully or intimidate them into using condoms; we share the risk information and leave the decision up to them. Some adults make bad decisions; we help them clean up the mess.

Some are using the Oraquick™ home test incorrectly. Please follow the instructions carefully and call the 24/7 hotline if needed. Of course we recommend being tested by a clinic or a clinic’s outreach team. 1 out of 12 of the oral tests are negative when the patient is truly positive. Also, when you use this test, you can say, “As of 3 months prior to the test, I was negative. I don’t know if I am still negative.” It doesn’t come out positive until your antibody level rises enough. Most clinics can run a test that tells us if you are positive at about 6 weeks. If you are positive on a home test, it is a good idea to have it confirmed at an HIV specialty clinic. Most community clinics have an arrangement with the government to have this confidential testing and counseling for free, and you can get checked for other sexually transmitted diseases. If you are having unsafe sex with more than a few people a month, then testing every 3-6 months is a good idea.

Many clinics offer this type of service. Sometimes they can arrange free medication for the month. You must take the medicine within 72 hours of exposure. Call as soon as you can. Friday night exposures are the worst in that much of the 72 hours is gone by Monday.

HIV patients have almost double the risk for cancers, but less than double if taking antivirals.

Lung cancer especially carries high risk, about 3½ times more risk than the general population. Of course it is known that a greater percentage of HIV positives smoke than HIV negatives so this may contribute. Please call 1800-NO-BUTTS or 1-800-45-NO-FUME for advice on stopping. If you have over 30 pack-years of smoking then a CT scan of your chest might be in order. E.g. if you have smoked 2 packs a day for 15 years or 3 packs a day for 10 years, you have a 30 pack-year smoking history.

Melanoma risk is also higher. Please avoid sunburns. Falling asleep in the sun when using drugs or alcohol can cause sunburn. Summer is coming so be careful, use sunscreen for UV-A, check the label…. etc.

Testicular cancer was about 3 times higher in HIV positives. So please check your testicles in the shower and report any hard nodules to your doctor. Go, now….We’re waiting!

There have been 13 trials on seven products to prevent transmission during vaginal sex. Tenofovir (in Viread™, Truvada™, Atripla™, and Stribild™) showed the most promise but the evidence is not strong enough to recommend it yet. I suspect that after an effective vaginal microbicide is found, then there will be a study using it in anal sex.

Those who have an HIV positive test but an undetectable viral load without treatment are elite controllers. I have had quite a few among the thousands of HIV patients I have treated.

There is a case in Africa where an elite controller’s wife became ill with HIV, then AIDS and she now has her husband’s virus. How did she get it and why is she sicker than him? Perhaps the infection took place when he was in the period 3-6 weeks after his initial infection where most have a very high viral load, and then it comes down. Perhaps elite controllers have a rise but bring the viral load down better. I speculate that the virus the man received was or evolved to a group of viruses, easily controlled in the blood by his immune system, but the virus that went to his prostate and semen was perhaps a more virulent (more disease-causing) subset.

A group of Tokyo researchers found that use of at least one of the medications that treat HIV and Hepatitis B ( tenofovir in Viread™, Truvada™, Atripla™, and Stribild™ and lamivudine in Epivir™, or Combivr™, or emtricitibine in Emtriva™, Truvada™, Atripla™, and Stribild™) in Hepatitis B negative patients prevented them from getting Hepatitis B. Nice bonus! Hepatitis B can be transmitted mainly through needles, sex, but sometimes through food by someone with Hepatitis B who does not wash their hands after having a bowel movement.

Keep those questions coming. Be Safe!

Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
HIV Researcher, Desert AIDS Project