I recently attended the Conference on Retroviruses and Opportunistic Infections in Seattle for 4 days.
TRANSACTIONAL SEX
This happens more where there is poverty in any country. This is sex for money, drugs, services…. In Africa, if you count women who have several truck drivers staying with a lady in exchange for money or supplies, and also count sex workers then the prevalence of HIV in all of these is up to 9% of those having transactional sex. Up to 30% of sex workers in Asia have HIV. In Zimbabwe “stable” couples are the main source of HIV transmission to others. Obviously, someone in that relationship has had sex with others in the past or currently. Think twice before you fly and don’t forget your condoms.
Sex worker interventions can have a major improvement of a country’s HIV prevalence. If sex work were legal, that would reduce about half of the world’s HIV transmission. The reason would be that sex workers could insist on condoms and not be threatened with arrest. Police, in some countries, take away condoms from sex workers and rape them. The sex workers with HIV would more likely take treatment and the negative ones might also take PrEP (pre-exposure prophylaxis).
SEROSORTING
Seroadaptive behavior is any strategy relating to avoiding getting HIV or trying to get HIV. Such behaviors can include: being the bottom if you are positive (less risky), withdrawing before full ejaculation, only having sex when the viral load is undetectable, or when the negative is on PrEP.
Of course, another adaptive behavior is for a person to not have sex or start wearing condoms once they are positive. Many men and women who are newly HIV positive stop having sex or start wearing condoms.
HIV NEGATIVES TAKING WEIRD ANTIVIRAL COMBINATIONS
There was a study done in Africa presented where the blood of HIV negative people who were relatives or friends of the positive person was tested and they had HIV medication levels in their blood, but they were in strange combinations. Other newly HIV positive people had resistance to some of the antivirals. This needs to be further investigated to find out if some people at risk take or “borrow” from one or more of their HIV positive friends’ antiviral bottles so that the combination they are on is not a recommended one and the levels are low so that they only cause resistance and don’t prevent the virus from making a home inside of them. This resistance may cause their first or later antiviral regimen to fail and cause further resistance. If these pass on their resistant virus to others through needles or sex, then the recipient is at risk for resistance. In conclusion, please remember that the HIV positive patient has enough medicine for one person only, and that prevention and treatment should be guided by experts.
HIV RISK FOR HEART ATTACK AND STROKE
Those with HIV, even those with undetectable virus, are more prone to have the plaques in the arteries that rupture and float down the line to block a small artery in the heart or brain. The cholesterol lowering medications work well at reducing the amount of plaque in HIV positives. And here’s a bonus: these same medications were found to slow liver deterioration in Hepatitis C
TREATMENT VERY EARLY
Treating during acute infection is an advantage but it is amazing how fast the virus spreads and starts acute inflammation in multiple places in the body. Remember that treating at the acute phase may mean they need to take medicine for only a year. Get to a specialist if you think you may have early HIV symptoms (rash, fever, lymph nodes, fatigue,flu-like symptoms).
RESISTANCE STRATEGY
If someone has resistant HIV from missing medications or unprotected sex or needle use, we usually give new medications based on a resistance test. Some have too many resistances so we have to give partially effective medications along with fully effective medications. After the viral load dropped in a group of these patients, the investigators stopped the partially effective medications and the patient did well on less pills. This is a little scary to adopt for most clinicians outside of a study. We don’t want to risk more resistance when it doesn’t work.
WHO GETS A LIVER TRANSPLANT
Currently those with late stage liver disease are placed higher on the transplant list. This staging is based on an image (MRI, Ultrasound, CT scan, Fibroscan) or laboratory values (Fibrosure). A large European group has come up with a new scoring system to predict death better, so they can more accurately line the candidates up for a transplant.
HIV DEMENTIA
Certain medications seem to work better than others. If you or your friend might have HIV Dementia, see if your provider knows which antivirals work better on this problem.
MARIJUANA AND LIVER FIBROSIS.
In a women’s study, marijuana had no effect on worsening liver cirrhosis.
AGING AND HIV.
HIV makes you age a little faster, and even faster than that if you have hypertension, diabetes, strokes, heart attacks, chronic lung disease, obesity, cancer, or liver disease. Now you see why I can’t help myself in mentioning healthy lifestyle (exercise, diet, no substances, tobacco…..) to prevent these other diseases. They can see that the strings in a cell that pull the genes apart when the cells divide are shorter in HIV which shows that the cells look older than they should in HIV.
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
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
REFERENCES: Medscape®