Dear AAHIVM HIV Specialist™:

I’ve been recently seeing AIDS/HIV flyers everywhere I turn, and I find myself constantly questioning my own recent experiences and freaking out. I had unprotected oral sex about 4–5 months ago with a woman who said she had been tested and was negative, but I can’t be sure. And I’ve also been reading mixed reports about oral sex and virus transmission. What are the chances that she may or may not have passed something on to me?

Jamal

Dear Jamal:
Being “freaked out” about the possibility of having HIV is a common reaction, but the best way to put an end to it is by being tested for HIV. The test now can often be done as a rapid test with preliminary results in 20 minutes and can use an oral swab to make it easier to test than a blood test.

The CDC issued new recommendations in September 2006, that all patients between ages 13 and 64 be tested for HIV at least once, removing any stigma in requesting an HIV test from your doctor. The new recommendations also suggest yearly testing for anyone who uses IV drugs, has sex with more than one partner in a year, has a partner who has sex with other people, is a male who has sex with other males, or any person who exchanges sex for money or drugs.

Oral sex does have some risk for transmission of HIV, but much less than other sexual activity. The Department of Health and Human Services in January of 2005 estimated that insertive oral intercourse carried with it a chance of being infected of 5/100,000 exposures, compared to 500/100,000 exposures of receptive anal sex, so oral intercourse is 100 times less risky than receptive anal intercourse. There is still the possibility of getting HIV from oral sex.

Many people, when they first become infected with HIV, have an acute retroviral syndrome, which is like having a bad flu, consisting of fever, sore throat, rash, muscle aches and fatigue. Not everyone will have such a reaction, however, so the best way to know is to get an HIV test.

David Piontkowsky, JD, MD, AAHIVS
Medical Director, Positive Health Clinic
Allegheny General Hospital
Pittsburgh, PA

Dear AAHIVM HIV Specialist™:

I have been HIV-positive since ’93. I’ve been on Crixivan, Viramune and Combivir for my HIV treatment. The lipodystrophy is annoying and is beginning to be a serious focus for me. My T-cells are at about 400 and I have no detectable viral load. I read recently that if you get off the drugs causing the lipo it can reverse over time. I have asked my specialist if I can change regimens so I can go from “less belly to more butt” someday.
What questions do I need to ask my doctor to get him thinking my way? Can you recommend a regimen that has been effective with others that were on mine? I have CAD, diabetes type II and take drugs for cholesterol and triglycerides as well. Any good data you could supply would be greatly appreciated. I expect to make a renewed effort for change after the New Year begins.

Regards,
Rodney

Dear Rodney,
I understand your concern about your regimen and the resulting lipodystrophy. Many patients and physicians continue to have this discussion. Unfortunately, there is no simple answer. Your T-cells and HIV viral load are doing well on this regimen and resistance testing was unsuccessful due to insufficient virus. You also mention your diabetes, lipid abnormalities and coronary artery disease (CAD) without further defining the problem. It is likely, then, that you may have “metabolic syndrome,” although you don’t mention your weight or blood pressure.

Remember that switching therapies without resistance testing is not recommended generally, but may be acceptable if you have been on the same regimen since you started treatment. If you both decide to take a chance and change, changing from AZT to tenofovir may help with the lipodystrophy. Also, a low-fat, high-fiber diet combined with both cardiovascular and resistance exercise can also have a positive impact. Using rosiglitazone [Avandia] to treat your diabetes, and possibly using testosterone supplementation depending on your tests, each might have small positive and additive effects.

The good news is we can effectively treat the virus. We still do face some challenges in treating problems associated with HIV, and with some of the side effects of otherwise effective antiviral therapy. Good luck to you! Because of the space limitations of a magazine column, I would be happy to provide more detailed explanations on any of the above recommendations, as well as any references for them that you or your physician may wish to receive.

R.H. Keller, MD, MS, FACP, AAHIVS
Hollywood, Florida

The American Academy of HIV Medicine (AAHIVM) is an independent organization of physicians, nurse practitioners, physician assistants and others dedicated to advancing excellence in HIV care through the HIV Specialist™ credentialing program, advocacy work and continuing education opportunities. E-mail your questions to aahivm@tpan.com.