| HIV
drug guide
Thanks to TPAN for all of your wonderful
publications, but especially the drug
guides. They are so useful for us here in the HIV Health
Library. I wanted to express my gratitude for this most excellent
resource.
James Apt, HIV Health Specialist, AIDS
Action Committee, Boston
Publications manager Jeff Berry responds:
James, thanks for your e-mail. The Drug Guide is a labor of
love and a lot of hard work goes into it. It’s nice to
hear your kind words and to know that all our efforts are
appreciated.
Just permit me to say that I really appreciate
the 2004 Eighth Annual HIV Drug Guide. I cannot imagine the
work that went into this. This guide once again speaks to
why Chicago has some of the best AIDS service organizations
in the world and why TPAN leads the pack. Thank you so much
for your hard work and dedication.
Janice (Jano) Layne, Program Coordinator/Kevin’s
Room Project, Chicago Department of Public Health
Hepatitis C
I just wanted to applaud the article
on co-infection treatment by Gerald Moreno (November/December
2003). I appreciate his candor on how difficult the treatment
is. I would like to see more people discuss their experiences
on HCV meds. I am HCV positive (no HIV). Tomorrow I take my
last dose of ribavirin. I will be completing nine months of
hell. For starters, I am a genotype 3. It took me 20 weeks of
treatment to reach undetectable. My viral load was low pre-treatment.
I was non-responsive at 12 weeks. I was ready to stop with the
first set of labs.
Nothing has been as all the literature
reports. I did not get symptoms after my first injection. I
started with body aches and chronic fatigue two weeks in. It
was all downhill from there. By 10 weeks I had nausea, vomiting,
blurred vision, vertigo, rigor and a mental breakdown. (I had
started antidepressants pre-treatment). The anemia started at
about six weeks but did not get severe until 10. My hemoglobin
has not to date returned to normal, even with Procrit.
The powerlessness of not knowing what
day of the week I would be sick made functioning difficult.
I tried charting common denominators and they did not coincide.
It was day, then night, then Monday, then Friday… there
were no “normal” symptoms.
At twelve weeks I started with petit
mal seizures. I had to limit my driving and stop riding my
motorcycle. My bike is one of my greatest stress relievers.
I began missing work and became totally out of control with
my emotions.
I am also clean and sober 12 years.
I came closer to relapsing on treatment than at any other time
in my sobriety. When my body hurts my brain says I know how
to feel good. I also have a needle fetish with the idea of “fixing.”
Thank God I also had a wonderful recovery support system.
After this experience I really feel
we are treating people too soon. The drug companies are saying
you need three to six months clean before treatment. You’re
not clean in that time frame, at least not clean enough to endure
the psychological roller coaster of these medications. I know
there is a movement to treat active users. I wonder if we aren’t
creating a bigger problem. Are we putting dirty needles on the
street? What happens if someone is treated, clears the virus
and gets re-infected?
The best treatment for HCV is no drugs,
no alcohol. We have the time to really evaluate each individual.
HCV does not require immediate medication. If you are in that
severe of a state, you may not be a good candidate for treatment
anyway.
I am not saying don’t treat. I
am saying wait and do better evaluation. Most people can get
through treatment with the right support system. The problem
is those supports are not in place for most patients. I have
seen medication and syringes prescribed with no education on
injections. I have also seen medication prescribed to individuals
who were in the 15% who cleared virus.
We are still too early in research.
I want to see everyone with HCV healthy, not set up for bad
results. More will be revealed on the horizon. I would like
to see us return to the early intervention strategies we used
in the early days of HIV—learn how to slow the disease
progression.
Keep up the good work.
Christina L. Hurst, MSW, Arizona
Androgel
While “I
Love My Androgel” was informative and well-written
(November/December 2003), it did overlook one additional complication
with Androgel therapy: possible testicle shrinkage. While only
cosmetic, at least as far as I understand, it can be more than
disconcerting and is often glossed over.
While the potential gains of testosterone
replacement therapy with Androgel far outweigh this one issue,
it’s worth noting so the individual accepting the therapy
can be prepared for all the results, including the negative.
Terry Hemphill, San Francisco
Carlos Perez replies: Thank you for
writing to us—this is an important issue to discuss.
Testicles will not shrink from using testosterone or Testim
since the dosage is so low. The only way the testicles will
shrink is by injecting testosterone and by using very large
doses. Believe me, I know of a few who have and they shrunk,
but they were “popping” large doses and going at
it alone through the black market or by overdosing a prescription.
At 5 or 10 grams per serving, as the transdermal application
serves, testicle shrinkage can’t really happen unless
they got a hold of more than the prescribed amount and just
lathered and bathed in it.
There is a very easy, simple, cheap and
effective way to increase one’s testosterone level. It’s
a generic pill called clomiphene citrate, 50 mg every other
morning. The drug is actually a fertility drug for men and
women, which is not something you’d normally be interested
in, except that it has an almost universal side effect in
men and women—it raises one’s testosterone level.
I use it. It works. And it has very few other side effects
or drug interactions (i.e., it’s not metabolized through
P450). I hope you will try it.
Ross Thomas, AIDS Survival Project volunteer,
Atlanta
Carlos Perez replies: Mr. Thomas, Now
here is something new and truly different! I never heard of
clomiphene, its use in fertility or its advantage as a testosterone
booster. I’ll pass this news around here at the office
and I will ask my doctor next time we meet. Thank you for
your input.
Crystal meth
Considering that I have been addicted
to meth as well as serving an 87-month sentence for distribution,
I can certainly relate to every word in your article (My Kind
of Life, “Crystal
Death-amphetamine,” July/August 2003). Although I have
been incarcerated since 2000, I was taken back to the smells,
the tweaks, the loss of jobs, the coming up financially, the
coming down emotionally, the incredible and erotic sexual experiences
that lasted for days and finally the harsh realization in December
of 2000 that I was HIV-positive. As of today, my viral load
is zero and my CD4 is around 875, due to Viracept and Combivir
and of course, my higher power, which I choose to call God.
When one comes to prison, it seems as though everyone forgets
about you, especially living with a disease that only you and
your doctor know about. It can be quite lonely. I want to thank
Carlos Perez for the obvious hard work he puts into his articles
and to let you know how much I respect and appreciate all the
staff at TPAN for publishing such a fine magazine.
Name and institution withheld by request,
Florida
Exercise
Editor’s note: Greg Braxton, author
of Positive Empowerment (“I
Get Blessings, I Get Lessons,” July/August 2003), responds
to a reader who wanted to know if he believes it was his exercise
routine that reversed his lipodystrophy.
The answer is a very big yes! For a
while I was walking around looking like Kermit the Frog. I had
very small arms and legs while entertaining a huge mid-section.
I was also very weak. Today I am as solid as a rock and full
of energy. I also sleep very soundly. I get so many benefits
from exercise, which include stress reduction, self-esteem and
confidence. I feel great in spite of the fact that my last T-cell
count was 20 and viral load around a million copies.
I understand that you are going through
some difficult times as I was. If you decide to start a routine,
I suggest that you start out very slow and gradually increase
your time as well as intensity. Always listen to your body.
It will communicate if you are pushing it too much by producing
pain. If you experience pain, slow down or stop. I would also
suggest a balanced workout that includes cardio, strength and
flexibility training. It is also wise to enlist the help of
an experienced trainer or some other knowledgeable person to
ensure that you are performing the exercises properly so that
not only will you get the best bang for the buck, but will less
likely get injured in the process.
The best advice is to consult your physician
before you start. Also, make sure you drink plenty of water
before, during, and after your routine. If you add exercise
with a sensible diet you will be amazed at the results. Consistency
is key.
I am so glad that you found my article
helpful. Your reply gives me the incentive to continue the fight.
Thanks and good luck.
Vietnam
After reading “Finding
a Voice in Vietnam” (November/December 2003), it
reminds me of something that my mother has told me time and
time again since I was a child. Good things always come from
what we think or perceive as being bad things. The story touched
me deeply. I have been HIV-positive since 1985 with no major
complications and currently with treatment have an undetectable
viral load and a T-cell count that hovers around 375.
I worked in the tour industry in the
past and have been able to visit many of the poorest areas in
Central America and Thailand as well as some of the more affluent
areas worldwide. As 9/11 took its toll, I lost my job. I didn’t
know what I was going to do and fell into a deep depression
until one day a friend talked me into going back to school at
the age of 40. I’m currently a Certified Nursing Assistant
and working to become a Registered Nurse. I plan to work for
a temporary agency six to nine months of each year and donate
the rest of my time to an organization that gives free health
care to people living in developing countries.
I thank Michael McColly and James Tuong
Nguyen for taking the time to document their life experiences.
It is because of people like them that I can be inspired and
find the inner strength to reach my goal.
Rick Fores, Milwaukee
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