Anonymous Asked
QuestionDoctor Gallant, I´ve been on ART - undetectable and with a high CD4 count for more than a year. If I ever need to have a surgery or any event that will stop me from taking my meds for a about a week or more, is that going to make my virus replicate? Or - due to my high level of adherence - that isn´t going to happen? Answer

It would be unusual to have to stop ART for a week because of surgery.  A day or two maybe, but except in the case of major abdominal surgery, a week would be unusual.  It often takes two weeks or more for the viral load to rebound, so even if you were off for a week, your viral load might very well remain suppressed.

I’m taking a wild guess here, but I’ve received three questions in a row asking about bad things that might happen to someone with an undetectable viral load.  I suspect they call came from you.  Anxiety is a treatable condition!

Anonymous Asked
QuestionDr Gallant, I´m on combivir + nevirapine (undetectable VL and CD4 above 900). My doctor says my regimen will work well for about eleven years, but then the virus will get resistant and my regimen will have to be changed. I´d thought a successful regimen would last a lifetime. Can you clarify that for me? Answer

I don’t like to say this , but your doctor is quite wrong. The longer a regimen works, the more likely it is to keep on working. When failure occurs, it typically occurs early because of poor adherence. People whose viral load remains undetectable after a year or two are the adherent ones, and there’s no reason their regimen would ever fail.

That being said, Combivir has AZT in it, which can have significant long-term toxicity.  Therefore, while there’s no reason you should ever need to switch because of failure, I hope you’ll eventually switch to prevent side effects.

Anonymous Asked
QuestionDoctor, two questions: if someone who´s on therapy (and is undetectable) does an anti-HIV test, will that test still show the antibodies against HIV? And can an HIV+ person (with an undetectable VL) donate blood to someone in need? Answer

Yes, and no.

Anonymous Asked
QuestionThanks for the link to the HIV meds interaction database. When I checked out my new script for Stribild and the other meds I take, I got a few results which said monitoring/possible dose adjusting. I assume you have many patients on Stribild and taking various meds. Have you had patients having issues with commonly prescribed meds like ones for depression, bp, pain, statins, anxiety, cold/flu meds, etc? If so, are these just feeling more drowsiness, than usual? Or, getting sick from them? Answer

The Stribild interactions are similar to the Norvir interactions, which were scary at first. Eventually we became familiar with them and learned how to work our way around them when necessary.  I can’t generalize about drug interactions because the details depend on the medication, but here are some of the ones that come up most often:.

1. Statins: if using atorvastatin (Lipitor) or rosuvastatin (Crestor), start with low doses (10-20 mg). Pravastatin (Pravachol) is safe, but it’s a less effective drug. Don’t use simvastatin or lovastatin.

2. Steroids: Avoid fluticasone (Flonase, Advair).  Of the inhaled or nasal steroids, beclamethasone (Beconase AQ, QVar) is the safest.  Avoid having steroids injected into joints if possible

3. Benzos: I hate them all, with or without Stribild, but avoid triazolam (Halcion), which is rarely used these days. Midazolam (Versed) is used only as an anesthetic for surgical procedures. Mixing Stribild with midazolam can result in a very long nap and should be avoided.

4. Rifamycins: If you ever needed to take rifampin or rifabutin for TB or some other reason, you’d presumably be under the care of an infectious disease doctor, who would know about the interactions with Stribild.

5. Blood pressure medications: While not absolutely contraindicated, I generally avoid calcium channel blockers (amlodipine, nifedipine, diltiazem, verapamil) if possible.

Anonymous Asked
QuestionDear Dr, this might sound silly. Is a fever of 37.5 degrees at night time, worrisome for someone with HIV? What should I look for? Answer

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If you look up “fever” on Wikipedia, you’ll find that 37.5 is not a fever, it’s in the upper end of the range for a normal temperature.  There are other things to worry about at nigh time, like monsters under the bed.

Anonymous Asked
QuestionDr, Do people with HIV/ AIDS suffer a lot of pain in the late stages? How do you help them? Answer

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In the developed world, the idea of “late stage” HIV/AIDS has become a somewhat obsolete concept: We help people by not letting them progress to that stage in the first place, or by treating them so they recover. However, I remember all too well the pain and suffering that people experienced in the bad old days, and people in resource-limited settings may still progress to develop advanced disease because of lack of effective therapy.

The are a number of palliative treatments for pain. Drugs like gabapentin, pregabalin, and tricylic antidepressants can treat neuropathic pain, and opiates (e.g. oxycodone, morphine) should be used to treat pain that isn’t controlled by other measures. The importance of providing appropriate palliative care in resource limited settings has become a global priority.

Anonymous Asked
QuestionSorry Dr, my mistake for not telling you my medicine. I have been on Atripla for 4 months Answer

There are no specific drug interactions, but you always have to be careful taking this kind of medication (non-steroidal anti-inflammatory drug) when you’re taking tenofovir (a part of Atripla) because both can hurt the kidneys. Avoid high doses and get your kidney function checked regularly.

Anonymous Asked
QuestionDear Doctor Gallant, my boyfriend was on different HIV regimens for the last 10 years. Now he is taking Stribild. His CD4 count keeps falling and he is approaching a dangerous level, less than 100. What causes this, even when he is adherent to his treatment? What should we do? Answer

It’s hard to answer wiithout knowing his viral load and where his CD4 count was before.

Anonymous Asked
QuestionDear Dr, if two people are infected with the same strain, but they both have detectable VL , can they have unprotected sex with each other (monogamous)? Answer

I think I just answered this question a few days ago.  Scroll down!

Anonymous Asked
QuestionDear Dr, I have swelling and severe pain in finger joints and wrists. Can I take Diclofenac with my HIV medication. Is there any drug interaction? Answer

I generally avoid answering questions about drug interactions because the number of combinations you could ask about is virtually infinite, and this information is all available on-line (see http://www.hiv-druginteractions.org/). But when you ask a question about drug interactions and you don’t tell me which HIV meds you’re taking, then I lose all motivation!