HIV and Hepatitis C News

The CDC cooperated with Thai officials and found that giving PreExposure Prophylaxis (PrEP) worked in intravenous drug users like it did in previous studies with preventing HIV in those who were not using condoms when they took Truvada™, but in this case they took one of the ingredients, tenofovir (Viread™). I’ve been thinking about this. Maybe those of you who refuse to wear condoms and feel you can be 100% perfect in taking the pills might be good candidates for PrEP. Maybe your insurance can cover it. If your provider feels they are not very familiar with this concept and medication, then they can call their local HIV expert. This is a waste of money and time if you miss pills. Sex is many times unplanned so be prepared with condoms in your wallet or be on PrEP. Condoms are much less expensive and easily obtainable. This medication is not like an antacid, you take every day, not only when you need it. If you are using drugs with needles, it is a good idea to be on this medication daily. There are no condoms for needles.

In a national database study they showed that those 25-34 years old were less likely to be aware of their HIV infection and linked to care compared to those 55-64 years old. It is logical that the viral load of the younger group would be higher than the older group. This is dangerous since the younger group may be having more unprotected sex than the older group, spreading the virus.

The New York City Department of Health and Mental Hygiene has recommended meningitis vaccine if you are attending the NYC Gay Pride Parade. Risk factors are kissing, smoking, close living quarters, and visiting bars. Maybe this is just hitting mainly the gays since they hang out together. They found very low amounts of the meningitis bacteria in the rectal and urethral secretions, so that doesn’t seem to be the route of transmission.

It is very important to plan to graduate teens with HIV from the pediatrician to the adult provider when the hit the age of adulthood. I have seen a few youth panic and become ill; one died. I did work with the youth HIV specialist at Children’s Hospital in LA to receive them when they turned into adults and am attempting the same relationship in my area. It is best if you make plans many months in advance to lessen the trauma. Leaving your pediatrician is like leaving a family; it can be emotionally stressful. There are some new guidelines helping this process.

Those who have an undetectable viral load and have no sexually transmitted infections (STIs) in Switzerland are to be treated as HIV negatives, that is, condoms are not emphasized. But this study surveyed those who drink alcohol or have new STIs and found that their viral loads were in a danger zone for transmission. In addition, alcohol and other substances cloud the mind and judgment and contribute to “forgetting” the condom.

Patients with thin limbs on AZT/3TC (Combivir™) had their arms and legs measured for fat content. Those who switched to Tenofovir/FTC (Truvada™) had more fat so they looked more normal.

Cirrhosis is the replacement of liver tissue with scar tissue so that the liver doesn’t function causing bleeding, swelling, and confusion. There are 3 stages before you reach this stage 4 which is cirrhosis. A biopsy is best at determining if you can wait for treatment or if you need it now. Since it is a needle and has a rare complication of bleeding and infection, less accurate methods are available: CAT scanning, ultrasound, and a mix of lab tests are used to help determine which stage your liver is in. They are accurate in roughly the order presented here.

Many do not get a viral load test (HCV RNA) after testing positive for Hepatitis C. 20% have cured the Hepatitis C on their own and do not need treatment or further testing. Get tested for Hepatitis C if you are a baby boomer (born between 1945 and 1965) or are having anal sex.

A large meta-analysis (large study pooling the results of many smaller studies) showed that Pegasys™ is somewhat better than PEGintron™ in terms of curing Hepatitis C. Of course we all hope that the new treatments are better than using these injectable medications. So far the studies are quite promising in those who also have HIV and those who don’t.

Hepatitis C can cause liver cancer, even if the treatment cures the virus. A large database study showed that those on the bad cholesterol lowering drugs, Statins (e.g. Lipitor™ -atorvastatin, Pravachol™-pravastatin) had lower risk for developing this cancer. It is too early to recommend routine use as a preventive medication.

Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS

Associate Clinical Professor of Internal Medicine, Loma Linda University
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
HIV Researcher, Desert AIDS Project