RADIATION TO CURE HIV?
A New York study showed in mice, that attaching some radiation molecules on to an antibody that will seek out HIV will zap and kill the HIV where it hides and sleeps (in sanctuary cells, dormant). This population of HIV in dormant CD4 cells is hard to kill since our current medications only work on active cells. Dr Dadachova made an antibody that would attach only to non-human targets, thus avoiding some side effects. More work needs to be done but this looks quite promising. Remember we talked about the other cure strategy under investigation: getting these dormant HIV infected cells active to kill them.
HIGH FATS
High Cholesterol, especially the bad (LDL=low-density lipoprotein) cholesterol promotes hardening of the arteries which causes strokes and heart attacks. Triglycerides, if quite high and not brought down with a low fat diet should be treated. The newest way (per the 2011 guidelines from the American Heart Association) suggest checking fats when NOT fasting. If they are high, then consider checking them after fasting. If they are still high, then try using diet to control them. If they are still high consider medication. We used to treat any high triglyceride (the other fat, not cholesterol) if it was higher than normal, but the 2011 guidelines suggest treating only if greater than 500 since treating them with medication if less than 500 really didn’t prolong life or prevent strokes or heart attacks. I have taken many people off gemfibrozil, fenofibrate, and fish oil (the 3 medications to treat high triglycerides) without problems. Of course I have not followed them for 20 more years since 2011 to see if they have less risk of heart attacks and strokes, but I trust the studies and the panel making the recommendations.
I recently read an article in Medscape stating that the triglycerides need to be treated with medications above the old level. I guess they weren’t aware, as many providers, of the new recommendations. As with popular thinking of taking vitamins (rather than eating healthily) and with over-diagnosing breast and prostate cancer, more medical interventions are not necessarily better and in fact can be harmful. Instead of “don’t just stand there, do something” and “more is better”, we are told to “don’t just do something, stand there!” which is the opposite of our culture.
TIVICAY™
Tivicay™ plus Epzicom™ is as good as Atripla™ and it avoided the few kidney problems of Atripla™ in one study. Tivicay™ is a new integrase inhibitor like Issentris™, but taken once daily.
PRIMARY CARE IS GOLDEN IN HIV, NEW OBAMA CARE CHANGES.
Many of you are taken care of by an infectious disease specialist and a primary health care provider. This splitting of care may cause problems of communication, duplication of tests, and delay of care. The ideal situation is for you to be taken care of by a primary care provider who also specializes in HIV. There are many available. The infectious disease provider many times, spends their time in the hospital taking care of uncommon infections and has very few hours for HIV patients in the office. Therefore the office does not have the numerous staff to help you with your non-physical problems. I have worked for community clinics during my 25-year HIV career and having a large amount of staff to help with the non-medical problem s is a wonderful help: examples of these types of clinics in Southern California are: Family Health Centers, AIDS Healthcare, AltaMed, THE Clinic, Oasis Clinic, San Bernardino and Riverside County Public Health Clinics, USC-LA County 5P21, CARE clinic in Long Beach, Desert AIDS Project. I don’t know them all, but you can ask your local AIDS Project for one close to you.
With many of you going to Medi-Cal soon, you should double check what type of clinic you have been assigned to and please change it if you are not satisfied.
LOST TO FOLLOWUP
This is the title we give patients who don’t show up for a time despite a few phone calls. A recent study showed that in New York, sending workers out to contact them and solve problems got many of them to get back into the clinic, controlling their HIV, preventing illness and transmission of HIV. What a great benefit.
Many of the larger clinics I mentioned above have outreach programs to re-engage these lost patients.
2, NOT 3 DRUGS FOR HIV?
One study showed that Prezista™ boosted by Norvir™ combined with only 1 other drug, Selzentry™, did not control the HIV well since it had only 2 active drugs. Another recent study showed that 2 drugs worked well: Kaletra™ twice a day, and Epivir™. This worked even for those with a very high pre-treatment viral load. I’m impressed!
HIV PREVENTION
There are many studies looking at prevention techniques: taking Truvada™ or Selzentry™ only when needed, using microbicide gels, vaginal rings (some combined with contraceptives). These gels give much drug where needed (I’m talking sex here) and less to the body, where pills send medication to the entire body and a little to the sex parts.
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