What’s in the HIV news?

I’d like to summarize and comment on a few new journal articles that just came out.

It is well known that depression causes poor adherence to HIV medications and it seems to be worse in those of African descent in the USA. If the depression is treated, that increases the adherence. As you know, poor adherence (sticking to the instructions you get from your medical provider) can cause viral resistance to the medications, causing failure.

Also, it seems the more time we spend with the new antidepressants we find that they are not necessarily better than the old ones, but they do cause less side effects. Drug treatment for depression is not that great compared to psychological counseling (cognitive behavioral therapy) unless the depression is severe. I have been trying to get my patients to wean off antidepressants slowly to see if they really need it if they have been on it more than 6-12 months. If you are on one, you may want to discuss weaning off with your provider. If you come off too fast you may get a rebound depression from withdrawal, not because you still are depressed.

We know that meth is used to enhance the sexual experience. But sharing pipes with cracked lips may cause HIV and Hepatitis C transmission. So be careful.

Male circumcision has been shown to be effective in lowering the risk (not eliminating) of HIV transmission for about 5 years so far.

Lab animals seemed to be smaller in length and weight when exposed to Tenofovir (in Viread®, Atripla®, Truvada®). New information shows that this is not the case with human babies.

Lipodeposition (fat gain) or Lipoatrophy (fat loss) can be from HIV, medications, or just genetics. Serostim® and Egrifta® can help but are injectable and very expensive. Many times there are insurance coverage issues.
Liposuction can work if the fat is under the skin, as it is in a buffalo hump. Most large abdomens are from fat around the organs and sucking this fat out is too dangerous. Resistance (weights or fighting gravity) and aerobic cardiovascular exercises (power walking, swimming, biking) has been shown to reduce this weight and have many health benefits (treating depression, giving energy, helping sleep). Doing this about 80 minutes 3-4 times a week is helpful.

Lipoatrophy can be disfiguring and embarrassing also. Changing antivirals may stop the process or minimally improve it (ask your provider). Zerit® and Zidovudine® (AZT) are possible causes along with heredity and HIV alone.

There are temporary fillers that can be injected but must be repeated periodically. Permanent fillers are hard to remove if there is a problem. These are expensive and there may be insurance coverage problems. Examples are Collagen, Sculptra®, and Radiesse®. There are patient assistant programs and discounts available. Check them out on the Internet. There are some permanent fillers such as Gore-Tex® which cost about $2,000 per cheek.

We all want the easy fix, the short cut. So we sometimes ignore the facts. E.g. losing weight happens through good nutrition, lower calories, and more exercise. The good advice is hard so we are anxious to hear of a quick and easy way to take care of our problem; this opens us up to conspiracy theories and fraud. I have heard of many conspiracies over the years. There is so much money put into the hard work of thousands of scientists all over the world trying to find a cure, a vaccine, a better medication that for some miracle to go unnoticed is really a stretch of reality.

If John and Jane get better on it, you can too. This is not a study. Mark and Mary got sick on it but they are not quoted. Look for a study, ask your provider. Red flags should go up if you read or hear the following phrases:
• Quick cure for a wide range of ailments
• Miraculous, Secret
• Discovered in another country, only available outside the USA
• Available for a short time only or only one place, pay in advance
• Paying to take an experimental treatment

Ask for written information or a website your provider can look over. Why isn’t it approved by the FDA? Where can we see the published results of trials? What are the side effects and risks?
Don’t be so desperate that you fall into a trap and waste your time and money on something useless or harmful.

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

Association Between Race, Depression, and Antiretroviral Therapy Adherence in a Low-Income Population with HIV Infection. Meg C. Kong, Milap C. Nahata, Veronique A. Lacombe, Eric E. Seiber and Rajesh Balkrishnan.

JOURNAL OF GENERAL INTERNAL MEDICINE. 2012, DOI: 10.1007/s11606-012-2043-3
U.S. Centers for Disease Control and Prevention, U.S. National Institutes of Health, The Well Project,