by: Daniel Pearce, D.O., FACOI, AAHIVMS
I attended the major HIV meeting of the year recently and took some notes. So this will be a heavily HIV article today. The virtual meeting was The Conference on Retroviruses and Opportunistic Infections. Usually held in Boston and sometimes Seattle. Less than a week before last year’s conference, Covid broke out in Boston and flooded the hospitals so they abruptly changed it to a virtual meeting and told those flying in to turn around. Jet Blue gave me a coupon for the future and the hotel gave me a refund. They really had to scramble to the suddenly change to a virtual meeting. This year the virtual meeting was much smoother and next year maybe we will have the 2 options: virtual and in-person.
HIV HELPED COVID
The HIV researchers, past work, networks and systems set up were a natural fit for the Covid problems. These same people were ready and jumped in quickly. For example, the mRNA vaccine work against HIV has proceeded for years, setting the stage for the Covid vaccine. Covid is a less complex virus than HIV so it was easier to make a vaccine against. A successful HIV vaccine has been difficult to make for over 30 years. These leaders are anxious to get back to HIV their work.
ANTIVIRALS
1. WEIGHT GAIN
Each of these: Tivicay®, or Evotaz®, or Prezcobix®/(Symtuza®) plus Descovy® is associated with weight gain when giving antivirals for the first time, so this is a good reason to change to Dovato® after the viral load comes down nicely on another medication, e.g. Biktarvy.®.
2. SIMPLIFICATION
Using these medications as a s ingle agent had too many failures: Kaltra®, Prezcobix®, Evotaz®, Tivicay,® up to 15% failures, but if you add Epivir® then the two are powerful enough to control HIV. The most popular single pill is the Tivicay®/Epivir® pill which is Dovato® and many of us are switching patients to this. There are more and more months of proven good control on Dovato®. But Dovato® can’t bring down inflammation as swiftly as a triple combo so many are using Biktarvy first, and then switching over to Dovato®. Getting off Tenofovir (in Biktarvy®, Symtuza®, Truvada®, Descovy®) is a goal since long term it may have side effects of weight gain, kidney impairment, and osteoporosis.
Tenofovir also has been shown to shorten telomeres in some TCells which is a sign of premature aging.
Dovato® has been shown to still work well after 2 years and is expected to work for life. Dovato should not be used if a person has chronic Hepatitis B since the one of the two drugs in that combination is not very strong against Hepatitis B and the other has no Hepatitis B activity.
CHRONIC HEPATITIS B,C
Truvada® and Descovy® have tenofovir in them and that taken for 8 years has cured some of chronic Hepatitis B.
Curing Hepatitis C with the new medications was not affected by heavy alcohol use. Of course we don’t recommend heavy alcohol. Men: no more than 3 drinks/shots/12oz beers a day, and women: 2. Otherwise there is a little liver damage each time you go over this limit.
YOGURT FOR NEUROPATHIC PAIN AND WARTS
You might consider eating more yogurt to improve your good gut bacteria since that is associated with less neuropathic pain. This is not well proven.
The bacteria in yogurt was associated with curing venereal warts in women and some men who have sex with men. We’re not talking about putting yogurt on warts, but eating yogurt.
TRANSGENDER PEOPLE
Truvada® or Descovy® given for PrEP did not alter the hormones taken, e.g. testosterone or estrogen.
LONG LIFE
Diabetes, Heart Disease, Hypertension, Kidney Disease, etc were much more important in determining length of life than having HIV. So live a healthy lifestyle!
PrEP
PreExposure Prophylaxis with Truvada® or Descovy® (see some points above) does not show much side effects or resistance if taken over 2 years and 9 months.
METH AND MARIJUANA
Meth is associated with getting a second HIV infection on top of the last one and a second Hepatitis C infection after the first one is cured by medications.
Marijuana use is associated with missing antiviral doses and not having good control of HIV causing damage to brain and other organs and maybe resistance necessitating a medication switch.
TELEMEDICINE
California may stop reimbursing clinics for phone visits and maybe video visits. Those who do not have good wifi and have low quality cell phones or a computer are usually the ones who will gain the most from these visits. They are working hard and making little money and have little time to drive to the clinic.
Keep those questions coming and be safe!
dpearce@western.edu
Daniel Pearce, D.O., FACOI, AAHIVMS
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, Hepatitis B,C, Transgender, Suboxone Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto) Member, Coachella Valley Clinical Research Initiative
REFERENCES: My notes and materials from CROI, Medscape®