COKE AND M
I had learned years ago that using stimulants, e.g. cocaine or meth doubles the virus’s destruction of your immune system. A new study at UCLA found that cocaine wakes up Tcells to infect them. These CD4 cells are dormant, in storage, ready to come out when needed. It seems that cocaine brings them out earlier and infects them and then, of course, uses these fresh cells become an HIV factory. This results in an increase in viral load and faster destruction of immunity. They plan on studying crystal meth soon, which they suspect does the same thing. JUST SAY NO!
AIDS CANCERS DOWN, OTHER CANCERS UP
Cancers, such as Kaposi’s Sarcoma, associated with HIV are on the decline with the great treatments we have now, but other cancers are popping up more. This seems to be due to the longer lives of HIV patients and the fact that more HIV patients smoke than HIV negative patients. This certainly promotes lung cancer, which along with prostate and anal cancer were the top three highest cancers in HIV patients. We have discussed screening for anal cancer with rectal exams and whether an anal pap smear is really helpful in HIV patients in previous columns.
EVEN HIGHER CANCER RISK
HIV patients not on antivirals are at higher risk for cancers. The cancers mentioned above along with testicular cancer and breast cancer are the main players.
BEST ANTIVIRAL WHEN YOU HAVE CANCER
The integrase inhibitors work by stopping the viral DNA getting attached to our DNA which would take over the cell to make it a virus factory. These drugs are Raltegravir (Issentress™), Dolutegravir (Tivcay™), and Elvitegravir present in Stribild™. Raltegravir was studied in Houston, and it was more effective than the protease inhibitors and non-nucleoside inhibitors in suppressing HIV while the patients were given chemotherapy for their cancers. This class of antivirals also has much less drug-drug interactions; this may explain its superiority in this setting.
INTENDING NOT TO MISS PILLS HELPS ADHERENCE
There was a study in Houston that showed that those who intended to take their antivirals were better at not missing a dose. We make a point of offering a couple of regimens of antivirals that would fit the lifestyle, preferences, and medical needs of the patient. If the patient is not committed to the treatment, then it will most likely fail. As Dr. Koop, the former Surgeon General, said, “Drugs don’t work in patients who don’t take them.”
If the viral load is undetectable, then changing from multiple pills to a three-in-one pill was successful according to a study presented at a major conference recently. Of course it is important to note if you are allergic to any of the components of the triple pill and if you might have resistance before switching.
GENITAL WARTS
I am so happy that we can now protect young people from the wart virus with the vaccine series. I keep a special eye out for those 26 years old and under to start the series. This will protect them from getting anal, cervical, penile, and oral cancers. Remember Michael Douglas had esophageal cancer caused by this virus. Please ask for this vaccine from your medical providers if you are not yet 27 years old!
The treatments available are:
Podophyllin (available in a strong solution the provider can put on, or a weaker one the patient can apply. It can cause skin irritation so it must be washed off after a period of time that your provider can tell you.
Thermal injury: either cautery (burning), or freezing. The freezing can be accomplished with an over the counter refrigerant or in the provider’s office. Freezing is less painful since freezing has some numbing effects.
Imiquimod (Aldara™) is an immune enhancer and is safe to apply inside the rectum and vagina; it does not irritate the tissues.
Surgery is needed for extensive lesions or those inside a body cavity.
I use a combination of freezing followed by podophyllin and increase the duration of the time before washing it off by 2 hours until we get to 12.
HEPATITIS C TREATMENTS KEEP GETTING BETTER
Sofosbuvir and ribavirin for 6 months had a 90% cure rate according to recent presentation at a major conference. Remember that the old regimen was ribavirin, another pill (telapravir or bocepravir), and interferon. The interferon, which is injected weekly, was responsible for many feeling poorly during the year of therapy. It is important for sexually active gay men to have a periodic Hepatitis C and an HIV test so that early treatment can be started.
Hepatitis C can also be associated with a strange rash condition (porphyria cutanea tarda)f, fatigue, kidney disease, mental slowing, and depression.
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