Questions from HIV Patients

We recently held an “Ask the Doctor” session for Spanish-speaking HIV consumers. I’d like to share the questions and comments, since you may have the same questions. Pharmacy students under the direction of J.T. Lam, PharmD from Loma Linda University, School of Pharmacy helped research some of these answers.

What is the best diet to boost the immune system?
That would be a balanced diet with 5 portions/servings of fruits and vegetables a day to keep you at your best weight and limit empty calories (fast food). It is fascinating to me that the entrepreneurs pull nutrients out of food, put them in a pill and sell them to us at a high price. What is fascinating is that recent studies have shown in some groups that multivitamins or antioxidants did not help the patients as much as eating the food that contained the nutrients. It seems the interactions between the nutrients have a greater benefit than the individual nutrients by themselves. This makes sense since humans evolved eating whole grains, fruits, and vegetables. Those who were weak, died without children. Those who did well on this diet and exercise program lived to have children, and eventually….us. Studies have shown that a balanced diet helps the immune system but that effect is far less than killing the virus with effective medications.

Abuse of alcohol, tobacco, stimulants (meth and coke), and narcotics do bring the immune system down.

If you just won’t eat more than 3 servings of fruit and vegetables, then take a multivitamin with minerals. Prenatal vitamins are in this group; your pharmacist can recommend a good, cheap one. If you only have 1 serving or less, then take the vitamin twice a day, knowing it is a poor substitute for good nutrition, but better than your present intake.

Does having sex too often hurt the immune system?
No it doesn’t unless this is a sex addiction or the sex is unsafe so that diseases are transmitted. There are many psychological and physical benefits to good sex, that is sex with love involved. It can increase antibody levels, relieve pain, Burns calories (about 200, a normal size cookie).

What is the long-term effect of Atripla?
Most of this medication’s possible side effects are up front, during the first month: dreams, feeling intoxicated, rash. Many have no side effects at all. Your provider should watch the fats in the blood to see if there should be a dietary adjustment or another medication added, or a change in your antivirals. Also, watch the kidney blood test for early signs of poor function.

Can an HIV negative woman have a baby from an HIV positive man?
Yes, of course. The woman can turn positive and then she can pass it to the baby during the pregnancy, birthing process, or through breast feeding.

So we recommend condoms (or abstinence) until the time to get pregnant. The man should have his viral load below detection since it lowers the risk of transmission greatly. The mother should be tested for HIV after 2-3 months of pregnancy. If positive, then getting her viral load below detection will greatly reduce the risk of transmission to the baby. If the viral load is high, then a Caesarian section lowers the risk. With these strategies, only a very small number of HIV positive babies have been born in the USA.

Can a baby from an HIV positive mother be HIV negative? Yes, if no treatment is given to the mother, there is a 25% risk of being positive and if the mother and baby are treated, the risk is near zero. “There were no pediatric cases of HIV or AIDS reported in 2010”. (Riverside County Health Statistics). San Bernardino County also reports none for 2010 also. There certainly were pregnant HIV patients. It is routine to check for HIV when a woman is pregnant.

An HIV positive woman and her newborn were given AZT 14 months ago and the baby is HIV negative. Are there any side effects to the AZT we should expect? I know of no hidden, delayed side effects that a brief exposure to AZT will cause.

Many of these children have already reached their late teens and are without problems from the brief AZT exposure.

Can one take Complera and then develop resistance to Atripla? Yes. They share the same sensitive spots on their targets. So if their target changes from mutation, then both drugs won’t be able to jam the target. Missing pills is the main cause of resistance.

What are the treatments for lipodystrophy?
For the problem of gaining too much weight, there is a new drug, Egrifta, which may help, it is injected under the skin twice a day; it looks like you will gain the weight back if you stop. If the testosterone level is low in a male, then taking some may help.

To treat fat loss, there are expensive injections of fillers. We rarely use the antivirals most likely to cause these problems unless a patient has missed pills of the safer meds and now must take something more toxic to control the virus due to resistance developing.

When should you start medications?
This is based mainly on CD4 counts:
CD4>500 if you desire
<500 may help <350 helpful <200 life-saving Of course treatment is needed if there is an AIDS-defining illness, a pregnancy, Hepatitis B needing treatment, or HIV-kidney disease. Treating early makes sense to kill the invader but there are possible complications of long term treatment such as resistance and fat changes mentioned above. Why does an HIV positive person get Herpes?
For the same reason HIV negatives do. Having great immunity may not be enough protection. Humans get Herpes.

What is Growth Hormone for?
It is prescribed for wasting, poor muscle weight gain, and it can help with lipodeposition (gaining fat). It is very expensive and most insurances won’t pay for it without much paperwork.

What is the risk of my getting a super-infection from my partner if I and my partner have an undetectable viral load?
The risk is low, but present, so we still recommend condoms. At one moment the viral load was undetectable, maybe at another it is higher due to a cold coming on or other reasons. The semen, vaginal secretions, and rectal secretions do not have the same drug levels as the blood, and therefore may have more virus at times and this virus may be resistant. Studies have shown virus in these secretions when the blood shows none in some patients. Of course, sores or irritation promote transmission.

What is the difference among CD4 versus CD8 and why is important to keep track of those?
CD8 cells are Killer cells and kill opportunists. The Guidelines do not mention CD8 cells. Most HIV specialists do not act on them. The ratio of CD4/CD8 can give you an idea of how ill a person is, but does not change the treatment recommendations .

Send me your questions. Be safe and wise. Please send your medical questions to Adelante.

Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department