HIV Plus Magazine #84

The Best HIV Stories Ever Told / HGTV’s David Bromstad / Are Meds Making You Old?

H E A L T H + S P I R I T + C U L T U R E + L I F E

La Familia Bonita

Latino families deal with HIV together

september/october 2011 www.hivplusmag.com

250

475 500

750

500 T-CELLS

OR LESS. IT’S TIME

TO TAKE ACTION.

Talk with your doctor and consider all the factors about starting treatment.

HIV treatment is now recommended for everyone with a T-cell count of 500 or less and should be considered when T-cells are higher than 500, according to the DHHS* and the IAS-USA†. Starting treatment early may help protect your immune system and vital organs. Today’s medicines may have fewer, more manageable side effects. They may help you live a longer, healthier life. Receive helpful information about living with HIV that you should know. Call toll free 1-888-451-5723, or visit TREATHIVNOW.COM. *DHHS = Department of Health and Human Services †IAS-USA = International AIDS Society USA. ©2011 Gilead Sciences, Inc. All rights reserved. UN9722 07/11

PREZISTA IMPORTANT SAFETY INFORMATION AND INDICATION Talk to your healthcare ABOUT PREZISTA professional about the PREZISTA® (darunavir) is a signs and symptoms of liver prescription medicine. It is one problems. These may include treatment option in the class of yellowing of your skin or whites HIV (human immunodeficiency of your eyes, dark (tea-colored) virus) medicines known as urine, pale-colored stools protease inhibitors. (bowel movements), nausea, PREZISTA is always taken with vomiting, loss of appetite, and at the same time as ritonavir or pain, aching or sensitivity on (Norvir®), in combination with other your right side below your ribs HIV medicines for the treatment of • In a small number of patients, HIV infection in adults. PREZISTA PREZISTA has been reported should also be taken with food. to cause a severe or life• The use of other medicines active threatening rash. Contact against HIV in combination with your healthcare professional PREZISTA/ritonavir (Norvir®) may immediately if you develop increase your ability to fight HIV. a rash.

Your healthcare professional will Can PREZISTA be taken with work with you to find the right other medications? combination of HIV medicines • Taking PREZISTA with • It is important that you remain certain medicines could under the care of your healthcare cause serious and/or lifeprofessional during treatment with threatening side effects PREZISTA or may result in loss of its effectiveness. Do not take PREZISTA does not cure HIV PREZISTA if you are taking infection or AIDS, and does not the following medicines: prevent passing HIV to others. alfuzosin (Uroxatral®), dihydroergotamine (D.H.E.45®, Please read Important Safety ® Migranal ), ergonovine, Information below, and talk to ergotamine (Wigraine®, your healthcare professional Ergostat®, Cafergot®, Ergomar®), to learn if PREZISTA is right methylergonovine, cisapride for you.

(Propulsid®), pimozide (Orap®), oral midazolam, triazolam IMPORTANT SAFETY (Halcion®), rifampin (Rifadin®, INFORMATION Rifater®, Rifamate®), sildenafil (Revatio®) when used to treat What is the most important pulmonary arterial hypertension, information I should know indinavir (Crixivan®), lopinavir/ about PREZISTA? ritonavir (Kaletra®), saquinavir • PREZISTA, together with (Invirase®), lovastatin (Mevacor®, Norvir®, has been observed Altoprev®, Advicor®), pravastatin in a small number of (Pravachol®), simvastatin (Zocor®, patients to cause liver Simcor®, Vytorin®), salmeterol problems which may be life(Serevent®), or products threatening. Your healthcare containing St. John’s wort professional should do • Before taking PREZISTA, tell your blood tests prior to starting healthcare professional if you combination treatment are taking sildenafil (Viagra®), including PREZISTA. If you vardenafil (Levitra®), tadalafil have chronic hepatitis B or (Cialis®, Adcirca®), atorvastatin C infection, your healthcare (Lipitor®), atorvastatin/amlodipine professional should check (Caduet®), rosuvastatin (Crestor®), your blood tests more or colchicine (Colcrys®). This often because you have is not a complete list of an increased chance of medicines. Be sure to tell developing liver problems

your healthcare professional about all the medicines you are taking or plan to take, including prescription and nonprescription medicines, vitamins, and herbal supplements

• As with other protease inhibitors, taking PREZISTA may strengthen the body’s immune response, enabling it to begin to fight infections that have been hidden.

Patients may experience signs and symptoms of inflammation that can include swelling, tenderness, or redness • Tell your healthcare professional if you are taking estrogen-based • The most common side effects contraceptives (birth control). related to taking PREZISTA include PREZISTA might reduce the diarrhea, nausea, rash, headache, effectiveness of estrogen-based stomach pain, and vomiting. Other contraceptives. You must take important severe side effects additional precautions for birth include inflammation of the liver control, such as condoms or pancreas and increased blood fat levels.

What should I tell my • This is not a complete list of healthcare professional all possible side effects. If you experience these or other side before I take PREZISTA? effects, talk to your healthcare • Before taking PREZISTA, tell your professional. Do not stop taking healthcare professional if you have PREZISTA or any other medicines any medical conditions, including without first talking to your allergy to sulfa medicines, healthcare professional diabetes, liver problems (including You are encouraged to report hepatitis B or C), or hemophilia negative side effects of • Tell your healthcare professional prescription drugs to the FDA. if you are pregnant or planning Visit www.fda.gov/medwatch, to become pregnant, or are or call 1-800-FDA-1088 breastfeeding Please refer to the ritonavir (Norvir®) - The effects of PREZISTA on Product Information (PI and PPI) pregnant women or their unborn for additional information on babies are not known. You and precautionary measures. your healthcare professional Dosing Information: will need to decide if taking PREZISTA is right for you For adults taking HIV meds for the first time and for many - Do not breastfeed if you are adults who have taken HIV meds taking PREZISTA. You should in the past: PREZISTA 800 mg not breastfeed if you have (two 400-mg tablets) must be taken HIV because of the chance of at the same time with 100 mg passing HIV to your baby Norvir® once daily every day.

PREZISTA must be taken with food.

What are the possible side For some adults who have taken effects of PREZISTA? HIV meds in the past: • High blood sugar, diabetes or PREZISTA 600 mg/Norvir® 100 mg worsening of diabetes, and must be taken twice daily at the increased bleeding in people with same time every day with food. hemophilia have been reported in Your healthcare professional can patients taking protease inhibitor determine which dose is right for you. medicines, including PREZISTA Please see Important Patient • Changes in body fat have been Information on the next page seen in some patients taking HIV for more information, or visit medicines, including PREZISTA. www.PREZISTA.com.

The cause and long-term health effects of these conditions are not If you or someone you know needs help paying for medicine, call known at this time 1-888-4PPA-NOW (1-888-4772669) or go to www.pparx.org.

www.PREZISTA.com Distributed by: Tibotec Therapeutics/Division of Centocor Ortho Biotech Products, L.P., Titusville, NJ 08560

©2011 Tibotec Therapeutics

05/11

28PRZDTC10035R

ONCEDAILY PREZISTA

EXPANDED ONCE-DAILY DOSING FOR PREZISTA For adults who have not taken HIV medications before and ALSO for many adults who have taken HIV medications in the past Once-Daily PREZISTA 800 mg (two 400-mg tablets) must be taken with Norvir速 100 mg and food at the same time every day, as part of combination HIV therapy.

Talk to your healthcare professional about your HIV treatment options and ask if Once-Daily PREZISTA is right for you.

Please read Important Safety Information and dosing information on adjacent page.

www.PREZISTA.com Registered trademarks are the property of their respective owners.

IMPORTANT PATIENT INFORMATION PREZISTA (pre-ZIS-ta) Darunavir ALERT: Find out about medicines that should Not be taken with PREZISTA. Please also read the section “Who should not take PREZISTA?”.

Read this Patient Information before you start taking PREZISTA and each time you get a refill. There may be new information.This information does not take the place of talking to your doctor or healthcare provider about your medical condition or your treatment.

What is the most important information I should know about PREZISTA? PREZISTA, together with NORVIR® (ritonavir), has been observed in a small number of patients to cause liver problems which may be life-threatening.

Your healthcare provider should do blood tests prior to initiating combination treatment including PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems. Talk to your healthcare provider about the signs and symptoms of liver problems. These may include yellowing of your skin or whites of your eyes, dark (tea colored) urine, pale colored stools (bowel movements), nausea, vomiting, loss of appetite, or pain, aching or sensitivity on your right side below your ribs.

In a small number of patients, PREZISTA has been reported to cause a severe or life-threatening rash. Contact your healthcare provider immediately if you develop a rash.

Please also read the section “What are the possible side effects of PREZISTA?” What is PREZISTA? PREZISTA is a prescription anti-HIV medicine used with other anti-HIV medicines used to treat adults. PREZISTA is a type of anti-HIV medicine called a protease (PRO-tee-ase) inhibitor. PREZISTA is used with ritonavir and other anti-HIV medicines to treat people with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

How does PREZISTA work?

PREZISTA blocks HIV protease, an enzyme which is needed for HIV to multiply. When used with other anti-HIV medicines, PREZISTA can help to reduce the amount of HIV in your blood (called “viral load”) and increase your CD4 (T) cell count. HIV infection destroys CD4 (T) cells, which are important to the immune system. The immune system helps fight infection. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system and, thus, reduce the risk of death or infections that can happen when your immune system is weak (opportunistic infections).

PREZISTA is always taken with and at the same time as ritonavir (NORVIR®), in combination with other anti-HIV medicines. PREZISTA should also be taken with food.

Does PREZISTA cure HIV or AIDS? PREZISTA does not cure HIV infection or AIDS. At present, there is no cure for HIV infection. People taking PREZISTA may still develop infections or other conditions associated with HIV infection. Some of these conditions are pneumonia, herpes virus infection, and Mycobacterium avium complex (MAC) infections. Because of this, it is very important for you to remain under the care of a healthcare provider. Although PREZISTA is not a cure for HIV or AIDS, PREZISTA can help reduce your risks of getting illnesses associated with HIV infection (AIDS and opportunistic infection) and eventually dying from these conditions.

Does PREZISTA reduce the risk of passing HIV to others?

PREZISTA does not reduce the risk of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with any body fluids such as semen, vaginal secretions, or blood. Never re-use or share needles.

Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people.

What should I tell my doctor before I take PREZISTA? PREZISTA may not be right for you. Before taking PREZISTA, tell your doctor or healthcare provider if you: • are allergic to sulfa medicines.

• h ave diabetes. Anti-HIV medicines, such as PREZISTA, might increase sugar levels in the blood.

• have liver problems, including hepatitis B and/or C. • have hemophilia. Anti-HIV medicines, such as PREZISTA, might increase the risk of bleeding.

• are pregnant or planning to become pregnant. The effects of PREZISTA on pregnant women or their unborn babies are not known. You and your healthcare provider will need to decide if taking PREZISTA is right for you. If you take PREZISTA while you are pregnant, talk to your healthcare provider about how you can be included in the Antiretroviral Pregnancy Registry.

• are breastfeeding. Do not breastfeed if you are taking PREZISTA. You should not breastfeed if you have HIV because of the chance of passing HIV to your baby. Talk with your healthcare provider about the best way to feed your baby. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby.

Who should not take PREZISTA?** Together with your healthcare provider, you need to decide whether taking PREZISTA is right for you.

Do not take PREZISTA if you: • are allergic to darunavir or any of the other ingredients in PREZISTA • are allergic to ritonavir (NORVIR®) • take any of the following types of medicines because you could experience serious side effects: – alfuzosin (Uroxatral®) – dihydroergotamine (D.H.E. 45®, Migranal®), ergonovine, ergotamine (Cafergot®, Ergomar®), methylergonovine – cisapride – pimozide (Orap®) – oral midazolam, triazolam (Halcion®) – St. John’s wort (Hypericum perforatum) – lovastatin (Mevacor®, Altoprev®, Advicor®), simvastatin (Zocor®, Simcor®, Vytorin®) – rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) – sildenafil (Revatio®) when used to treat pulmonary arterial hypertension Can PREZISTA be taken with other medications?** Tell your healthcare provider about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. PREZISTA and many other medicines can interact. Sometimes serious side effects will happen if PREZISTA is taken with certain other medicines (see “Who should not take PREZISTA?”).

Tell your healthcare provider if you are taking estrogen-based contraceptives (birth control). PREZISTA might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control such as a condom.

Tell your healthcare provider if you take other anti-HIV medicines.

PREZISTA can be combined with some other anti-HIV medicines while other combinations are not recommended.

Tell your healthcare provider if you are taking any of the following medicines: – bepridil, lidocaine, quinidine, amiodarone (Cordarone®), digoxin (Lanoxin®), flecainide (Tambocor®), propafenone (Rythmol®) – warfarin (Coumadin®) – carbamazepine (Tegretol®, Carbatrol®), phenobarbital, phenytoin (Dilantin®, Phenytek®) – trazodone (Desyrel®), desipramine (Norpramin®) – colchicine (Colcrys®) – clarithromycin (Biaxin®) – ketoconazole (Nizoral®), itraconazole (Sporanox®), voriconazole (Vfend®) – rifabutin (Mycobutin®), – metoprolol (Lopressor®, Toprol-XL®), timolol (Betimol®, Combigan®, Istalol®, Cosopt®, Timoptic®) – midazolam administered by injection – felodipine (Plendil®), nifedipine (Adalat®), nicardipine (Cardene®)

IMPORTANT PATIENT INFORMATION – dexamethasone, fluticasone (Advair Diskus®, Cutivate®, Flonase®, Flovent Diskus®) – bosentan (Tracleer®) – atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) – cyclosporine (Sandimmune®, Neoral®), tacrolimus (Prograf®), sirolimus (Rapamune®) – salmeterol (Serevent®) – Methadone, buprenorphine, buprenorphine/naloxone – risperidone (Risperdal®, Risperdal® Consta®, Risperdal® M-TAB®), thioridazine – sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) – tadalafil (Adcirca®) – paroxetine (Paxil®), sertraline (Zoloft®) Tell your healthcare provider if you are taking any medicines that you obtained without a prescription.

This is not a complete list of medicines that you should tell your healthcare provider that you are taking. Know and keep track of all the medicines you take and have a list of them with you. Show this list to all of your healthcare providers and pharmacists any time you get a new medicine. Both your healthcare provider and your pharmacist can tell you if you can take these other medicines with PREZISTA. Do not start any new medicines while you are taking PREZISTA without first talking with your healthcare provider or pharmacist. You can ask your healthcare provider or pharmacist for a list of medicines that can interact with PREZISTA. How should I take PREZISTA? Take PREZISTA tablets every day exactly as prescribed by your healthcare provider. You must take ritonavir (NORVIR®) at the same time as PREZISTA. • Do not change your dose of PREZISTA or stop treatment without talking to your healthcare provider first.

• Take PREZISTA and ritonavir (NORVIR®) with food.

• Swallow PREZISTA tablets whole with a drink.

What should I do if I miss a dose?

People who take PREZISTA one time a day: • If you miss a dose of PREZISTA or ritonavir (NORVIR®) by more than 12 hours, wait and then take the next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time. If you miss a dose of PREZISTA or ritonavir (NORVIR®) by less than 12 hours, take your missed dose of PREZISTA and ritonavir (NORVIR®) right away. Then take your next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

People who take PREZISTA two times a day • If you miss a dose of PREZISTA or ritonavir (NORVIR®) by more than 6 hours, wait and then take the next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

• If you miss a dose of PREZISTA or ritonavir (NORVIR®) by less than 6 hours, take your missed dose of PREZISTA and ritonavir (NORVIR®) right away.

Then take your next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

If a dose of PREZISTA or ritonavir (NORVIR®) is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZISTA or ritonavir (NORVIR®) at any one time.

What are the possible side effects of PREZISTA? PREZISTA can cause side effects. The following is not a complete list of side effects reported with PREZISTA when taken either alone or with other antiHIV medicines. Do not rely on this leaflet alone for information about side effects. Your healthcare provider can discuss with you a more complete list of side effects.

PREZISTA, together with NORVIR® (ritonavir), has been observed in a small number of patients to cause liver problems which may be life-threatening.

Your healthcare provider should do blood tests prior to initiating combination treatment including PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems.

Talk to your healthcare provider about the signs and symptoms of liver problems. These may include yellowing of your skin or whites of your eyes, dark (tea colored) urine, pale colored stools (bowel movements), nausea,

vomiting, loss of appetite, or pain, aching or sensitivity on your right side below your ribs.

Rash has been reported in 10.3% of patients receiving PREZISTA. In a small number of patients, PREZISTA has been reported to cause a severe or life-threatening rash. Contact your healthcare provider immediately if you develop a rash.

Other relevant severe side effects were inflammation of the liver or pancreas, increased blood fat levels, diabetes, and changes in body fat.

The most common side effects include diarrhea, nausea, rash, headache, abdominal pain and vomiting.

Other side effects of PREZISTA include the following: • high blood sugar (hyperglycemia) and diabetes. This can happen in patients taking PREZISTA or other protease inhibitor medicines. Some patients have diabetes before starting treatment with PREZISTA which gets worse. Some patients get diabetes during treatment with PREZISTA. Some patients will need changes in their diabetes medicine. Some patients may need new diabetes medicine.

• increased bleeding in patients with hemophilia.

• changes in body fat. These changes can happen in patients taking anti-HIV medicines, including PREZISTA. The changes may include an increased amount of fat in the upper back and neck, breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The exact cause and long-term health effects of these conditions are not known.

• immune reconstitution syndrome. In some patients with advanced HIV infection (AIDS) and a history of opportunistic infection, signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment, including PREZISTA, is started.

Tell your healthcare provider promptly about these or any other unusual symptoms. If the condition persists or worsens, seek medical attention.

This medication is prescribed for your particular condition. Do not use it for any other condition or give it to anybody else. Keep PREZISTA and all of your medicines out of the reach of children. If you suspect that more than the prescribed dose of this medicine has been taken, contact your local poison control center or emergency room immediately.

This is a brief summary of information about PREZISTA for adult patients with HIV. If you have any questions or concerns about either PREZISTA or HIV, talk to your healthcare provider.

For additional information, you may also call Tibotec Therapeutics at 1-877-REACH-TT or 1-877-732-2488. ** The brands listed are the registered trademarks of their respective owners and are not trademarks of Tibotec Pharmaceuticals

Manufactured for Tibotec, Inc. by: JOLLC, Gurabo, Puerto Rico Distributed by: Tibotec Therapeutics, Division of Centocor Ortho Biotech Products, L.P., Raritan NJ 08869 NORVIR® is a registered trademark of its respective owner.

PREZISTA® is a registered trademark of Tibotec Pharmaceuticals © Tibotec, Inc. 2006

Revised: December 2010

10101712P

TABLE OF CONTENTS SEPTEMBER / OCTOBER 2011

STATUS SYMBOLS 6 A BRIGHT SPOT Ghana aims to empower women and end the stigma of HIV.

8 Retreats for the Soul

26

Need a holiday? Consider a vacation designed with you in mind.

8 Judgment Day Activists want government funding for foreign HIV organizations—without having to condemn sex workers.

9 youth market A Chicago prevention campaign works to reach a high-risk minority group.

H-EYE-V 14 YANGON U.S. senator John McCain visits a private HIV clinic in Myanmar.

HAART BEATS 41 Turning Results Into Reality

36

23

Using Truvada to help prevent HIV transmission among high-risk heterosexuals.

42 Age Acceleration Your antiretroviral drugs may be hastening the natural aging process.

43 all aboard Antiretroviral drugs are becoming more available worldwide, but not all are being administered correctly.

HIVers using certain treatment regimens should also watch their insulin levels.

COLUMNS 44 MIND + MOOD Stress and sadness can make the first part of your day the hardest—here’s how to get up and get moving.

46 MESSAGE IN A BOTTLE HIV-positive and looking for answers, River Huston travels to the Caribbean.

ALSO 48 ASK & TELL: David Bromstad

26 La Familia Bonita

Family is often described as the cornerstone of Latino culture. So what does that mean for Latinos with HIV?

23 imitationS of life

From An Early Frost to Precious, a time line of the 15 best HIV stories ever told.

36 Power of the People

Having HIV as a Latino presents its own singular challenges, but some are working to ease the struggle of being a double minority.

COVER Son: George Doyle; father: JupiterImages; mother and daughter: Stockbyte

clock wise from top: Comstock ; courtesy hbo; jack hollingsworth

43 Stop Diabetes Before It Starts

NOW ON

HIVPlusMag.com Editor in chief

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managing Editor Winston

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senior director, client services

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integr ated marketing director

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Watch the Best HIV Stories Ever Told

Starting with The Normal Heart (pictured, above), we've compiled a list of the most acclaimed HIV dramatizations (page 23).

Watch clips from these films, TV shows, and Broadway sensations on HIVPlusMag.com.

Age Is a State of Mind

Check back regularly for new columns from HIV Plus writer Robert Levithan (The New 60), who tracks his journey to stay vibrant well into his sunset years.

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NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, just email our circulation department at Jeff.Lettiere@HereMedia.com. what’s your story?

Do you have an interesting story about yourself or someone you know that you want to share? You might be a candidate for a profile in one of our departments or another section. We want to hear from you, and we want to know what you’ve been up to. So email us at mail@HIVPlusMag.com or write us at HIV Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. We’ll even take faxes at (310) 806-4268.

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HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2011 by Here Publishing Inc. All rights reserved. Printed in the USA.

SEPTEMBER /OCTOBER 2011 HIV PLUS

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STATUS SYMBOLS

A volunteer health worker takes a blood sample from a patient in Ghana for an HIV detection test.

6 | HIV PLUS september /october 2011

A Bright Spot

AFP/Ge t t y Images

In just a decade, Ghana’s HIV rates have been cut in half. Now the country aims to empower women and end the stigma of HIV many point to the entire continent of Africa as an example of devastatingly high rates of HIV transmission.

But Ghana has been able to break from its neighbors, becoming the only African country to drastically reduce the rate of infection.

In June, Ghana’s vice president, John Dramani Mahama, visited the U.S. for a United Nations gathering called the High-Level Meeting on AIDS, in which he boasted that his country’s HIV prevalence has been slashed roughly in half in the past few years. In 2003, 3.6% of Ghana residents had HIV. As of 2009, the figure was down to 1.9%.

The effort to lower those HIV rates began with a national strategy plan and the establishment of the Ghana AIDS Commission. After a massive public education campaign and collaborations with community-based organizations, the country is now looking to eradicate all mother-to-child transmissions of the virus. The government has also set its sights on another lofty goal: ending stigma against people with HIV. “There existed a misunderstanding of what the disease was about, and so people were afraid to eat from the same plate with an HIV-infected person because they thought they could get infected [by] sharing things together,” he told National Public Radio. Educational initiatives “dispelled a lot of the misunderstanding of the sickness, and we are encouraging… counseling and testing, you know, so, that people can go and test and know what their status is.”

Another key to reducing HIV rates, Mahama says, is the important task of nation building. By the 1990s, many African countries were left in shambles from the legacy of colonization, which had led to famine, disease, and lack of education.

Since then, countries such as Ghana have worked to redevelop infrastructure, end military dictatorships, encourage media freedom, and adopt more environmentally friendly practices.

As part of the major United Nations meeting on HIV, the U.N. General Assembly adopted a far-reaching joint action plan to fight the epidemic, including goals of eliminating mother-to-child transmission by 2015 and keeping mothers alive. The plan covers all low- and middle-income countries but focuses on the 22 nations with the highest estimate of HIV-positive pregnant women, including Ghana, Côte d’Ivoire, Democratic Republic of the Congo, India, and, South Africa.

These countries helped develop the plan and signed on to implement it. The declaration emphasizes the protection of women’s rights and empowerment of women to address their own health issues.

This new joint action plan came with some U.S. support: millions of dollars in funding from foundations and corporations. The Bill and Melinda Gates Foundation, Chevron, and Johnson & Johnson together pledged an additional $75 million on top of the approximately $300 million that the President’s Emergency Plan for AIDS Relief already provides annually for prevention of mother-tochild transmission. ✜

september /october 2011 HIV PLUS

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STATUS SYMBOLS

Judgment Day American AIDS groups no longer have to condemn sex work in order to receive government funding—now activists want the same for foreign HIV organizations

Retreats for the Soul

Need a holiday? Want to make friends with other people living with HIV? Consider a retreat designed with you in mind while a person’s hiv status is only a part of who they are, those in need of a getaway from everyday life might want to consider a regenerating vacation designed specifically for HIVers—an escape in which disclosure is never an issue.

Regardless of whether you enjoy the serene beauty of the great outdoors or the pampered luxury of a cruise ship, there are plenty of exciting vacation options in which people are all in the same boat, sometimes literally. And it’s never too early to start planning a vacation.

Boys in the Woods: For those who enjoy roughing it, the HIV Campground Project is a nonprofit AIDS education, prevention, awareness, and social group, and its website offers information and links to several outdoor weekend getaways—most aimed at gay men—throughout the United States. HIVCampground-Project.org; $10 and up Rocky Mountain Highs: Mountain lovers might enjoy the affordable sights provided by the Retreat at Shadowcliff in Grand Lake, Colo. The three-day weekend romps, which happen in July and August at a lodge nestled 8,600 feet high on cliffs adjacent to Rocky Mountain National Park, offer plenty of time for nature walks. They also have a full program of interactive workshops

8 | HIV PLUS SEPTEMBER /OCTOBER 2011

and educational seminars, plus a variety of body therapies, providing an empowering and relaxing experience. OnTheTen.org; $80 and up Women Only: Each spring and fall, Women Organized to Respond to Life Threatening Diseases holds a three-day retreat for HIV-positive women in Northern California that provide guests with a holistic experience that includes treatment education workshops, stress management, art activities, support groups, safer-sex information, and discussions on various topics, including disclosure and stigma. All retreats are held within two hours of Oakland, and first-time attendees pay only $40.

WomenHIV.org; $40 and up Luxury Seekers: Vacationers who’ve been socking away funds in order to travel in high style should check out the Hetero Poz Cruise Retreat. The seven-day November journey from Fort Lauderdale, Fla., to tropical ports throughout the Caribbean is a bit costlier than other getaways, but it promises a week to remember. Plus, a portion of the proceeds from each cruise goes to various HIV organizations and charities.

A spring cruise is planned as well, leaving from Long Beach, Calif. PositiveCruise. com; $659 and up

For the past eight years, U.S.-based HIV organizations providing services overseas were forced to formally denounce sex work, and if they didn’t, Uncle Sam closed his checkbook to them. On July 2, the Second U.S. Circuit Court of Appeals struck down the Bushera policy, and many HIV organizations and sex worker advocacy groups praised the decision.

“Organizations that offered services to sex workers were forced to not provide services unless they said, ‘You must get out of prostitution,’ ” explains Norma Jean Almodovar, the executive director of the Los Angeles office of Call Off Your Old Tired Ethics, a lobbying group for current and former prostitutes. “But many times there are no options for sex workers because there are no jobs.” The law was dangerous because it discouraged sex workers in foreign countries from receiving treatment, Almodovar says.

“Can you image if gay rights organizations said to people, ‘You can’t have a gay lifestyle’?” asks Almodovar, who is also the president and founder of the International Sex Worker Foundation for Art, Culture, and Education. “You can imagine how that would harm communities.”

The court’s decision doesn’t apply to foreign HIV organizations that use U.S. funds, but sex advocacy and HIV organizations are pushing to remove the denunciation requirement for international groups as well, Almodovar says.

The recent court decision is a reminder of an ironic turn of events regarding the antiprostitution oath.

Randall Tobias, who became the U.S. global AIDS coordinator in 2003, zealously supported the oath. He was forced to resign in 2007 after he admitted patronizing a Washington, D.C., escort service.

Youth Market

A Chicago prevention campaign works to reach a high-risk minority group the rate of hiv infection among young Latinos is a serious problem, but raising this population’s awareness about the disease doesn’t have to be dull and downbeat.

“Our mode of outreach has to be very fun and engaging,” says Dianna Manjarrez, program coordinator for Generation L, a HIV awareness and prevention campaign run by the Vida/SIDA project of Chicago’s Puerto Rican Cultural Center.

Launched last December with a fiveyear grant from the Centers for Disease Control and Prevention, Generation L seeks to spread the safer-sex message with events held at nightclubs, in conjunction with drag pageants at colleges and universities, and in other fun venues throughout the city. Its primary target is gay, bisexual, and transgender Latinos aged 18 to 24.

“There’s a need for a program” for these youths, says Manjarrez, and the numbers back her up: Figures from the CDC indicate that the rate of new HIV infections among Latinos is 2.5 times the rate among whites.

Men who have sex with men represent the

majority of the new diagnoses among Latinos, and within the population of Latino MSM, the largest number of diagnoses is among those under 30.

Some observers attribute HIV’s disproportionate impact on Latinos partly to this population’s discomfort in discussing sex and sexuality. Generation L aims to make such conversations more comfortable with its distribution of safer-sex information at recreational events as well as business-and-pleasure mixers like the Loud & Proud event held during Pride season, which offered speakers and workshops on how to avoid HIV, along with free food and raffles for iPods.

Generation L also invites interested youths to attend periodic meetings where safer-sex issues are discussed, has a dropin space available throughout the week, and encourages participants to do informal outreach to friends and family members to help them make healthy decisions. So far, Manjarrez estimates, the various components of the program have reached 300 people—and that’s just the beginning.

Day to Day September 18 is National HIV/AIDS and Aging Awareness Day, but there are many more days to note. Which one is for you?

“National HIV/AIDS Awareness Days are important opportunities for our nation and local communities to talk about HIV prevention, education, and linking people to care,” says Miguel Gomez, the director of AIDS.gov, which promotes these governmentbacked days of recognition. The days are designed to reach different audiences and help them create customized long-term goals and projects for education and prevention.

Mark your calendars: September 18: National HIV/AIDS and Aging Awareness Day

opposite page (from top): Thomas Northcut, AFP/Ge t t y Images; this page (from top): Ryan Mc Vay, courtesy generation l

September 27: National Gay Men’s HIV/AIDS Awareness Day October 15: National Latino AIDS Awareness Day December 1: World AIDS Day February 7: National Black HIV/ AIDS Awareness Day March 10: National Women and Girls HIV/AIDS Awareness Day March 20: National Native HIV/ AIDS Awareness Day May 18: HIV Vaccine Awareness Day May 19: National Asian and Pacific Islander HIV/AIDS Awareness Day June 8: Caribbean American HIV/ AIDS Awareness Day June 27: National HIV Testing Day

For more resources visit AIDS.gov/ Awareness-Days/#Event-Calendar

SEPTEMBER /OCTOBER 2011 HIV PLUS

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ATRIPLA Important Safety Information and Indication INDICATION ATRIPLA (efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate [DF] 300 mg) is a prescription medication used alone as a complete regimen or with other medicines to treat HIV-1 infection in adults.

ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others. The long-term effects of ATRIPLA are not known at this time.

People taking ATRIPLA may still get infections that develop because the immune system is weak or other conditions that happen with HIV-1 infection.

Do not stop taking ATRIPLA unless directed by your healthcare provider.

See your healthcare provider regularly. ®

IMPORTANT SAFETY INFORMATION Contact your healthcare provider right away if you get the following side effects or conditions associated with ATRIPLA: • Nausea, vomiting, unusual muscle pain, and/or weakness. These may be signs of a buildup of acid in the blood (lactic acidosis), which is a serious medical condition.

• Light-colored stools, dark-colored urine, and/or if your skin or the whites of your eyes turn yellow. These may be signs of serious liver problems.

• If you have HIV-1 and hepatitis B virus (HBV), your liver disease may suddenly get worse if you stop taking ATRIPLA. Do not take ATRIPLA if you are taking the following medicines because serious and life-threatening side effects may occur when taken together: Vascor® (bepridil), Propulsid® (cisapride), Versed® (midazolam), Orap® (pimozide), Halcion® (triazolam), or ergot medications (for example, Wigraine® and Cafergot®).

In addition, ATRIPLA should not be taken with: Combivir® (lamivudine/zidovudine), EMTRIVA® (emtricitabine), Epivir® or Epivir-HBV® (lamivudine), Epzicom® (abacavir sulfate/lamivudine), SUSTIVA® (efavirenz), Trizivir® (abacavir sulfate/lamivudine/zidovudine), TRUVADA® (emtricitabine/tenofovir DF), or VIREAD® (tenofovir DF), because they contain the same or similar active ingredients as ATRIPLA. ATRIPLA should not be used with HEPSERA® (adefovir dipivoxil).

Vfend® (voriconazole) or REYATAZ® (atazanavir sulfate) with or without Norvir® (ritonavir) should not be taken with ATRIPLA since they may lose their effect and may also increase the chance of having side effects from ATRIPLA. Fortovase® or Invirase® (saquinavir) should not be used as the only protease inhibitor in combination with ATRIPLA. Taking ATRIPLA with St. John’s wort or products containing St. John’s wort is not recommended as it may cause decreased levels of ATRIPLA, increased viral load, and possible resistance to ATRIPLA or cross-resistance to other anti-HIV drugs.

This list of medicines is not complete. Discuss with your healthcare provider all prescription and nonprescription medicines, vitamins, or herbal supplements you are taking or plan to take.

Tell your healthcare provider if you: • Are pregnant: Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects have been seen in children of women treated during pregnancy with one of the medicines in ATRIPLA. Women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control, while on ATRIPLA and for 12 weeks after stopping ATRIPLA. • Are breastfeeding: Women with HIV should not breastfeed because they can pass HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby.

• Have liver problems, including hepatitis B or C virus infection.

• Have ever had seizures: Seizures have occurred in patients taking a © 2011 Bristol-Myers Squibb. All rights reserved. ATRIPLA is a registered trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, VIREAD, and TRUVADA are registered trademarks of Gilead Sciences, Inc. SUSTIVA and REYATAZ are registered trademarks of Bristol-Myers Squibb. All other trademarks are the property of their respective owners.

697US11AB02302 04/11

component of ATRIPLA, usually in those with a history of seizures. If you have ever had seizures, or take medicine for seizures, your healthcare provider may want to switch you to another medicine or monitor you.

• Have ever had mental illness or use drugs or alcohol.

Contact your healthcare provider right away if you experience any of the following serious or common side effects: Serious side effects associated with ATRIPLA: • Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of suicide, and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness.

• Kidney problems (including decline or failure of kidney function). If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider should do regular blood tests. Symptoms that may be related to kidney problems include a high volume of urine, thirst, muscle pain, and muscle weakness.

• Other serious liver problems. Some patients have experienced serious liver problems, including liver failure resulting in transplantation or death.

Most of these serious side effects occurred in patients with a chronic liver disease such as hepatitis infection, but there have also been a few reports in patients without any existing liver disease.

• Bone changes. Lab tests show changes in the bones of patients treated with tenofovir DF, a component of ATRIPLA. Some HIV patients treated with tenofovir DF developed thinning of the bones (osteopenia), which could lead to fractures.

Also, bone pain and softening of the bone (which may lead to fractures) may occur as a consequence of kidney problems. If you have had bone problems in the past, your healthcare provider may want to check your bones.

Common side effects: • Dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams. These side effects tend to go away after taking ATRIPLA for a few weeks. These symptoms may be more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery.

• Rash is a common side effect that usually goes away without any change in treatment, but may be serious in a small number of patients.

• Other common side effects include: tiredness, upset stomach, vomiting, gas, and diarrhea.

Other possible side effects: • Changes in body fat have been seen in some people taking anti-HIV-1 medicines. The cause and long-term health effects are not known.

• Skin discoloration (small spots or freckles) may also happen.

• If you notice any symptoms of infection, contact your healthcare provider right away.

• Additional side effects are inflammation of the pancreas, allergic reaction (including swelling of the face, lips, tongue, or throat), shortness of breath, pain, stomach pain, weakness, and indigestion.

You should take ATRIPLA once daily on an empty stomach. Taking ATRIPLA at bedtime may make some side effects less bothersome.

ATRIPLA is one of several treatment options your doctor may consider.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see Patient Information on the following pages.

With ATRIPLA,

You’re in good company Most doctors choose ATRIPLA — with nearly 3.8 million prescriptions written in the US since 2006, ATRIPLA is the #1 prescribed HIV regimen*

Alone or with other HIV medications.

Real ATRIPLA patients.

ATRIPLA: • The first to combine 3 HIV meds in 1 pill daily • The only DHHS† guidelines-preferred HIV regimen available as one pill daily for patients new to therapy • Proven to lower viral load to undetectable‡ in approximately 7 out of 10 patients new to therapy, with high or low viral load§ when starting treatment, through 3 years of a clinical study.ll ATRIPLA does not cure HIV-1 and has not been shown to prevent passing HIV-1 to others.

Selected Important Safety Information: Some people who have taken medicine like ATRIPLA have developed the following: a serious condition of acid buildup in the blood (lactic acidosis), and serious liver problems (hepatotoxicity). For patients with both HIV-1 and hepatitis B virus (HBV), hepatitis may suddenly worsen if ATRIPLA is discontinued.

Please see detailed and additional Important Safety Information, including the bolded information to the left. * Wolters Kluwer prescription data, March 2011; † Department of Health and Human Services January 10, 2011; ‡ Undetectable was defined as a viral load of less than 400 copies/mL; § High viral load is defined as greater than 100,000 copies/mL. Low viral load is defined as less than or equal to 100,000 copies/mL; ll In this study, 227 patients took the meds in ATRIPLA.

Ask your doctor about ATRIPLA — the #1 prescribed HIV regimen.

To learn more, visit www.ATRIPLA.com

FDA-Approved Patient Labeling Patient Information ATRIPLA® (uh TRIP luh) Tablets ALERT: Find out about medicines that should NOT be taken with ATRIPLA (efavirenz/emtricitabine/tenofovir disoproxil fumarate).

Please also read the section “MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA.” Generic name: efavirenz, emtricitabine and tenofovir disoproxil fumarate (eh FAH vih renz, em tri SIT uh bean and te NOE’ fo veer dye soe PROX il FYOU mar ate) Read the Patient Information that comes with ATRIPLA before you start taking it and each time you get a refill since there may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment. You should stay under a healthcare provider’s care when taking ATRIPLA. Do not change or stop your medicine without first talking with your healthcare provider. Talk to your healthcare provider or pharmacist if you have any questions about ATRIPLA. What is the most important information I should know about ATRIPLA? • Some people who have taken medicine like ATRIPLA (which contains nucleoside analogs) have developed a serious condition called lactic acidosis (build up of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get the following signs or symptoms of lactic acidosis: • You feel very weak or tired.

• You have unusual (not normal) muscle pain.

• You have trouble breathing.

• You have stomach pain with nausea and vomiting.

• You feel cold, especially in your arms and legs.

• You feel dizzy or lightheaded.

• You have a fast or irregular heartbeat.

• Some people who have taken medicines like ATRIPLA have developed serious liver problems called hepatotoxicity, with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get the following signs or symptoms of liver problems: • Your skin or the white part of your eyes turns yellow (jaundice).

• Your urine turns dark.

• Your bowel movements (stools) turn light in color.

• You don’t feel like eating food for several days or longer.

• You feel sick to your stomach (nausea).

• You have lower stomach area (abdominal) pain.

• You may be more likely to get lactic acidosis or liver problems if you are female, very overweight (obese), or have been taking nucleoside analog-containing medicines, like ATRIPLA, for a long time.

• If you also have hepatitis B virus (HBV) infection and you stop taking ATRIPLA, you may get a “flare-up” of your hepatitis. A “flare-up” is when the disease suddenly returns in a worse way than before. Patients with HBV who stop taking ATRIPLA need close medical follow-up for several months, including medical exams and blood tests to check for hepatitis that could be getting worse. ATRIPLA is not approved for the treatment of HBV, so you must discuss your HBV therapy with your healthcare provider.

What is ATRIPLA? ATRIPLA contains 3 medicines, SUSTIVA® (efavirenz), EMTRIVA® (emtricitabine) and VIREAD® (tenofovir disoproxil fumarate also called tenofovir DF) combined in one pill. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and SUSTIVA is an HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI).

VIREAD and EMTRIVA are the components of TRUVADA®. ATRIPLA can be used alone as a complete regimen, or in combination with other anti-HIV-1 medicines to treat people with HIV-1 infection. ATRIPLA is for adults age 18 and over. ATRIPLA has not been studied in children under age 18 or adults over age 65.

HIV infection destroys CD4+ T cells, which are important to the immune system. The immune system helps fight infection. After a large number of T cells are destroyed, acquired immune deficiency syndrome (AIDS) develops.

ATRIPLA helps block HIV-1 reverse transcriptase, a viral chemical in your body (enzyme) that is needed for HIV-1 to multiply. ATRIPLA lowers the amount of HIV-1 in the blood (viral load).

ATRIPLA may also help to increase the number of T cells (CD4+ cells), allowing your immune system to improve. Lowering the amount of HIV-1 in the blood lowers the chance of death or infections that happen when your immune system is weak (opportunistic infections).

Does ATRIPLA cure HIV-1 or AIDS? ATRIPLA does not cure HIV-1 infection or AIDS. The long-term effects of ATRIPLA are not known at this time. People taking ATRIPLA may still get opportunistic infections or other conditions that happen with HIV-1 infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infection. It is very important that you see your healthcare provider regularly while taking ATRIPLA. Does ATRIPLA reduce the risk of passing HIV-1 to others?

ATRIPLA has not been shown to lower your chance of passing HIV-1 to other people through sexual contact, sharing needles, or being exposed to your blood.

• Do not share needles or other injection equipment.

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) •

Do not share personal items that can have blood or body fluids on them, like toothbrushes or razor blades.

• Do not have any kind of sex without protection. Always practice safer sex by using a latex or polyurethane condom or other barrier to reduce the chance of sexual contact with semen, vaginal secretions, or blood.

Who should not take ATRIPLA? Together with your healthcare provider, you need to decide whether ATRIPLA is right for you.

Do not take ATRIPLA if you are allergic to ATRIPLA or any of its ingredients. The active ingredients of ATRIPLA are efavirenz, emtricitabine, and tenofovir DF. See the end of this leaflet for a complete list of ingredients.

What should I tell my healthcare provider before taking ATRIPLA? Tell your healthcare provider if you: • Are pregnant or planning to become pregnant (see “What should I avoid while taking ATRIPLA?”).

• Are breastfeeding (see “What should I avoid while taking ATRIPLA?”).

• Have kidney problems or are undergoing kidney dialysis treatment.

• Have bone problems.

• Have liver problems, including hepatitis B virus infection. Your healthcare provider may want to do tests to check your liver while you take ATRIPLA or may switch you to another medicine.

• Have ever had mental illness or are using drugs or alcohol.

• Have ever had seizures or are taking medicine for seizures.

What important information should I know about taking other medicines with ATRIPLA? ATRIPLA may change the effect of other medicines, including the ones for HIV-1, and may cause serious side effects. Your healthcare provider may change your other medicines or change their doses. Other medicines, including herbal products, may affect ATRIPLA. For this reason, it is very important to let all your healthcare providers and pharmacists know what medications, herbal supplements, or vitamins you are taking.

MEDICINES YOU SHOULD NOT TAKE WITH ATRIPLA • The following medicines may cause serious and life-threatening side effects when taken with ATRIPLA. You should not take any of these medicines while taking ATRIPLA: Vascor (bepridil), Propulsid (cisapride), Versed (midazolam), Orap (pimozide), Halcion (triazolam), ergot medications (for example, Wigraine and Cafergot).

• ATRIPLA also should not be used with Combivir (lamivudine/zidovudine), EMTRIVA, Epivir, Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), Trizivir (abacavir sulfate/lamivudine/zidovudine), SUSTIVA, TRUVADA, or VIREAD. • Vfend (voriconazole) should not be taken with ATRIPLA since it may lose its effect or may increase the chance of having side effects from ATRIPLA. • Do not take St. John’s wort (Hypericum perforatum), or products containing St. John’s wort with ATRIPLA. St. John’s wort is an herbal product sold as a dietary supplement. Talk with your healthcare provider if you are taking or are planning to take St. John’s wort. Taking St. John’s wort may decrease ATRIPLA levels and lead to increased viral load and possible resistance to ATRIPLA or cross-resistance to other anti-HIV-1 drugs.

• ATRIPLA should not be used with HEPSERA® (adefovir dipivoxil).

It is also important to tell your healthcare provider if you are taking any of the following: • Fortovase, Invirase (saquinavir), Biaxin (clarithromycin), Noxafil (posaconazole), or Sporanox (itraconazole); these medicines may need to be replaced with another medicine when taken with ATRIPLA. • Calcium channel blockers such as Cardizem or Tiazac (diltiazem), Covera HS or Isoptin (verapamil) and others; Crixivan (indinavir), Selzentry (maraviroc); the immunosuppressant medicines cyclosporine (Gengraf, Neoral, Sandimmune, and others), Prograf (tacrolimus), or Rapamune (sirolimus); Methadone; Mycobutin (rifabutin); Rifampin; cholesterol-lowering medicines such as Lipitor (atorvastatin), Pravachol (pravastatin sodium), and Zocor (simvastatin); or Zoloft (sertraline); these medicines may need to have their dose changed when taken with ATRIPLA. • Videx, Videx EC (didanosine); tenofovir DF (a component of ATRIPLA) may increase the amount of didanosine in your blood, which could result in more side effects. You may need to be monitored more carefully if you are taking ATRIPLA and didanosine together. Also, the dose of didanosine may need to be changed.

• Reyataz (atazanavir sulfate) or Kaletra (lopinavir/ritonavir); these medicines may increase the amount of tenofovir DF (a component of ATRIPLA) in your blood, which could result in more side effects. Reyataz is not recommended with ATRIPLA. You may need to be monitored more carefully if you are taking ATRIPLA and Kaletra together. Also, the dose of Kaletra may need to be changed.

• Medicine for seizures [for example, Dilantin (phenytoin), Tegretol (carbamazepine), or phenobarbital]; your healthcare provider may want to switch you to another medicine or check drug levels in your blood from time to time.

These are not all the medicines that may cause problems if you take ATRIPLA. Be sure to tell your healthcare provider about all medicines that you take.

Keep a complete list of all the prescription and nonprescription medicines as well as any herbal remedies that you are taking, how much you take, and how often you take them. Make a new list when medicines or herbal remedies are added or stopped, or if the dose changes. Give copies of this list to all of your healthcare providers and pharmacists every time you visit your healthcare

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) provider or fill a prescription. This will give your healthcare provider a complete picture of the medicines you use. Then he or she can decide the best approach for your situation.

How should I take ATRIPLA? • Take the exact amount of ATRIPLA your healthcare provider prescribes. Never change the dose on your own. Do not stop this medicine unless your healthcare provider tells you to stop.

• You should take ATRIPLA on an empty stomach.

• Swallow ATRIPLA with water.

• Taking ATRIPLA at bedtime may make some side effects less bothersome.

• Do not miss a dose of ATRIPLA. If you forget to take ATRIPLA, take the missed dose right away, unless it is almost time for your next dose. Do not double the next dose. Carry on with your regular dosing schedule. If you need help in planning the best times to take your medicine, ask your healthcare provider or pharmacist.

• If you believe you took more than the prescribed amount of ATRIPLA, contact your local poison control center or emergency room right away.

• Tell your healthcare provider if you start any new medicine or change how you take old ones. Your doses may need adjustment.

• When your ATRIPLA supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ATRIPLA and become harder to treat.

• Your healthcare provider may want to do blood tests to check for certain side effects while you take ATRIPLA. What should I avoid while taking ATRIPLA? • Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping it. Serious birth defects have been seen in the babies of animals and women treated with efavirenz (a component of ATRIPLA) during pregnancy. It is not known whether efavirenz caused these defects. Tell your healthcare provider right away if you are pregnant. Also talk with your healthcare provider if you want to become pregnant.

• Women should not rely only on hormone-based birth control, such as pills, injections, or implants, because ATRIPLA may make these contraceptives ineffective. Women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control. Efavirenz, a component of ATRIPLA, may remain in your blood for a time after therapy is stopped. Therefore, you should continue to use contraceptive measures for 12 weeks after you stop taking ATRIPLA. • Do not breast-feed if you are taking ATRIPLA. The Centers for Disease Control and Prevention recommend that mothers with HIV not breast-feed because they can pass the HIV through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby. Talk with your healthcare provider if you are breast-feeding. You should stop breast-feeding or may need to use a different medicine.

• Taking ATRIPLA with alcohol or other medicines causing similar side effects as ATRIPLA, such as drowsiness, may increase those side effects.

• Do not take any other medicines, including prescription and nonprescription medicines and herbal products, without checking with your healthcare provider.

• Avoid doing things that can spread HIV-1 infection since ATRIPLA does not stop you from passing the HIV-1 infection to others.

What are the possible side effects of ATRIPLA? ATRIPLA may cause the following serious side effects: • Lactic acidosis (buildup of an acid in the blood). Lactic acidosis can be a medical emergency and may need to be treated in the hospital. Call your healthcare provider right away if you get signs of lactic acidosis. (See “What is the most important information I should know about ATRIPLA?”) • Serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly) and fat in the liver (steatosis). Call your healthcare provider right away if you get any signs of liver problems. (See “What is the most important information I should know about ATRIPLA?”) • “Flare-ups” of hepatitis B virus (HBV) infection, in which the disease suddenly returns in a worse way than before, can occur if you have HBV and you stop taking ATRIPLA. Your healthcare provider will monitor your condition for several months after stopping ATRIPLA if you have both HIV-1 and HBV infection and may recommend treatment for your HBV. ATRIPLA is not approved for the treatment of hepatitis B virus infection. If you have advanced liver disease and stop treatment with ATRIPLA, the “flare-up” of hepatitis B may cause your liver function to decline.

• Serious psychiatric problems. A small number of patients may experience severe depression, strange thoughts, or angry behavior while taking ATRIPLA. Some patients have thoughts of suicide and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness. Contact your healthcare provider right away if you think you are having these psychiatric symptoms, so your healthcare provider can decide if you should continue to take ATRIPLA. • Kidney problems (including decline or failure of kidney function). If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider should do regular blood tests to check your kidneys. Symptoms that may be related to kidney problems include a high volume of urine, thirst, muscle pain, and muscle weakness.

• Other serious liver problems. Some patients have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects

ATRIPLA® (efavirenz/emtricitabine/tenofovir disoproxil fumarate) occurred in patients with a chronic liver disease such as hepatitis infection, but there have also been a few reports in patients without any existing liver disease.

• Changes in bone mineral density (thinning bones). Laboratory tests show changes in the bones of patients treated with tenofovir DF, a component of ATRIPLA. Some HIV patients treated with tenofovir DF developed thinning of the bones (osteopenia) which could lead to fractures. If you have had bone problems in the past, your healthcare provider may need to do tests to check your bone mineral density or may prescribe medicines to help your bone mineral density. Additionally, bone pain and softening of the bone (which may contribute to fractures) may occur as a consequence of kidney problems.

Common side effects: Patients may have dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams during treatment with ATRIPLA. These side effects may be reduced if you take ATRIPLA at bedtime on an empty stomach. They also tend to go away after you have taken the medicine for a few weeks. If you have these common side effects, such as dizziness, it does not mean that you will also have serious psychiatric problems, such as severe depression, strange thoughts, or angry behavior. Tell your healthcare provider right away if any of these side effects continue or if they bother you. It is possible that these symptoms may be more severe if ATRIPLA is used with alcohol or mood altering (street) drugs.

If you are dizzy, have trouble concentrating, or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery.

Rash may be common. Rashes usually go away without any change in treatment. In a small number of patients, rash may be serious. If you develop a rash, call your healthcare provider right away.

Other common side effects include tiredness, upset stomach, vomiting, gas, and diarrhea.

Other possible side effects with ATRIPLA: • Changes in body fat. Changes in body fat develop in some patients taking anti-HIV-1 medicine. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), in the breasts, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these fat changes are not known.

• Skin discoloration (small spots or freckles) may also happen with ATRIPLA. • In some patients with advanced HIV infection (AIDS), signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is started. It is believed that these symptoms are due to an improvement in the body’s immune response, enabling the body to fight infections that may have been present with no obvious symptoms. If you notice any symptoms of infection, please inform your doctor immediately.

• Additional side effects are inflammation of the pancreas, allergic reaction (including swelling of the face, lips, tongue, or throat), shortness of breath, pain, stomach pain, weakness and indigestion.

Tell your healthcare provider or pharmacist if you notice any side effects while taking ATRIPLA. Contact your healthcare provider before stopping ATRIPLA because of side effects or for any other reason.

This is not a complete list of side effects possible with ATRIPLA. Ask your healthcare provider or pharmacist for a more complete list of side effects of ATRIPLA and all the medicines you will take.

How do I store ATRIPLA? • Keep ATRIPLA and all other medicines out of reach of children.

• Store ATRIPLA at room temperature 77 °F (25 °C).

• Keep ATRIPLA in its original container and keep the container tightly closed.

• Do not keep medicine that is out of date or that you no longer need. If you throw any medicines away make sure that children will not find them.

General information about ATRIPLA: Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use ATRIPLA for a condition for which it was not prescribed. Do not give ATRIPLA to other people, even if they have the same symptoms you have. It may harm them.

This leaflet summarizes the most important information about ATRIPLA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ATRIPLA that is written for health professionals.

Do not use ATRIPLA if the seal over bottle opening is broken or missing.

What are the ingredients of ATRIPLA? Active Ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate Inactive Ingredients: croscarmellose sodium, hydroxypropyl cellulose, microcrystalline cellulose, magnesium stearate, sodium lauryl sulfate. The film coating contains black iron oxide, polyethylene glycol, polyvinyl alcohol, red iron oxide, talc, and titanium dioxide.

March 2011 ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, TRUVADA, HEPSERA and VIREAD are trademarks of Gilead Sciences, Inc. SUSTIVA is a trademark of Bristol-Myers Squibb Pharma Company. Reyataz and Videx are trademarks of Bristol-Myers Squibb Company. Pravachol is a trademark of ER Squibb & Sons, LLC. Other brands listed are the trademarks of their respective owners.

SF-B0001B-03-11

21-937-GS-008

TR9171

March 2011

Soe Than WIN/AFP/Ge tt y Images

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14 | H I V P L U S S E P T E M B E R / O C T O B E R 2 0 1 1

from top: TONY KARUMBA/AFP/Ge t t y Images; Emma Peios/WireImage

 Kisumu, Kenya: (top) A man sits in front of a mural promoting the benefits of circumcision in preventing the spread

of HIV while waiting to be seen at a clinic that offers the procedure as well as counseling about the disease.

London: (above) Costumed as characters from The Wizard of Oz, walkers prepare to take part in a 10-kilometer AIDS

fund-raising walk at Potters Field Park on June 5.

 Yangon, Myanmar: U.S. senator John McCain visits a private HIV clinic run by members of the National League for Democracy on June 2. McCain was in Myanmar (formerly Burma) to meet with democracy activist Aung San Suu Kyi to assess the nation’s political landscape after the handover of power to a nominally civilian government.

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ď ° New York City : (top) Demonstrators cheer at a rally outside the United Nations’ High-Level Meeting on AIDS at U.N. headquarters, June 8. Activists from Doctors Without Borders and other organizations rallied to call for full funding of worldwide HIV treatment and prevention.

Los Angeles: (above) Trey Songz performs at Lifebeat @ The BET Awards 2011, presented by BET, Lifebeat, AIDS

Healthcare Foundation, KWL, and Angels With Heart Foundation, June 24 at Playhouse Hollywood.

u Cape Town, South Africa: U.S. first lady Michelle Obama and retired South African archbishop Desmond Tutu

participate in an HIV awareness event at the Cape Town stadium June 23.

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from top: Mario Tama/Ge t t y Images; Leon Benne t t/WireImage

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credit

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clock wise from left: STAN HONDA/AFP/Ge t t y Images; MANAN VATSYAYANA/AFP/Ge t t y Images; RODGER BOSCH/AFP/Ge t t y Images

credit

: New Delhi: (top) An HIV-positive woman protests outside the Indian Health Ministry July

4, demanding that the HIV/AIDS Bill be presented in parliament. Prime Minister Manmohan Singh hailed the country’s success in slashing new HIV infections by half in the past decade.

Strand, South Africa: (above) Princess Charlene of Monaco hugs a child at Cotlands, a home for abandoned, abused, and very ill children, July 8. The princess and former archbishop Desmond Tutu are co-patrons of the Giving Organisation Trust, made up of 10 charities that focus on issues including HIV, children, and environmental protection.  New York City : Members of the New York City Gay Men’s Chorus walk down Fifth Avenue during the New York City gay pride parade June 26, past a banner memorializing those lost to AIDS.

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www.egrifta.com

Actual patient living with HIV since 2000

You HAVE YouR HIV unDER ConTRoL. noW, on To

HIV-RELATED EXCESS BELLY FAT. In two separate clinical trials of HIV-infected people with lipodystrophy, each lasting 6 months, EGRIFTA® reduced HIV-related excess belly fat by an average of 18% in the first trial, and 14% in the second trial.

This reduction in excess belly fat resulted in an approximate 1-inch reduction in waist size. Individual results may vary.

On average, patients on EGRIFTA® did not lose weight.

Like HIV, HIV-related excess belly fat is a chronic condition. In clinical studies: • People who used EGRIFTA® continuously for 1 year maintained their results over this time period • People who stopped taking EGRIFTA® after 6 months had their HIV-related excess belly fat come back EGRIFTA® is believed to work with your own body to produce natural growth hormone to reduce your excess belly fat.

Indication: EGRIFTA® is a daily injectable prescription medicine to reduce the excess in abdominal fat in HIV-infected patients with lipodystrophy.

Limitations of use: • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It’s not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • EGRIFTA® is not recommended to be used in children Important Risk Information: Do not use EGRIFTA® if you: • Have pituitary gland tumor, pituitary gland surgery or other problems related to your pituitary gland • Have or had a history of active cancer (either newly diagnosed or recurrent) • Are allergic to tesamorelin or any of the ingredients in EGRIFTA®, including mannitol or sterile water • Are pregnant or become pregnant Before using EGRIFTA®, tell your healthcare provider if you: • Have or have had cancer • Have diabetes • Are breastfeeding or plan to breastfeed • Have kidney or liver problems • Have any other medical condition • Take prescription or non-prescription medicines, vitamins, or herbal supplements EGRIFTA® may cause serious side effects, including: • Serious allergic reaction. Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: rash over your body, hives, swelling of your face or throat, shortness of breath or trouble breathing, fast heartbeat, feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes 110628-115709 7/11

• Injection-site reactions, such as redness, itching, pain, irritation, bleeding, rash, and swelling. Change (rotate) your injection site to help lower your risk for injection-site reactions The most common side effects of EGRIFTA® include: • joint pain • numbness and pricking • pain in legs and arms • nausea • swelling in your legs • vomiting • muscle soreness • rash • tingling • itching EGRIFTA® will NOT cure HIV or lower your chance of passing HIV to others.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see Consumer Brief Summary of EGRIFTA® on following page.

Ask your healthcare provider if EGRIFTA®, the first and only FDA-approved medicine for HIV-related excess belly fat, may be right for you.

For more information, visit www.egrifta.com or call the AXIS Center at 1-877-714-AXIS (2947).

S:6.625 in

Consumer Brief Summary for EGRIFTA® (tesamorelin for injection) EGRIFTA® (eh-GRIF-tuh) (tesamorelin for injection) for subcutaneous use Read the Patient Information that comes with EGRIFTA® before you start to take it and each time you get a refill. There may be new information. This leaflet does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is EGRIFTA®?

• EGRIFTA® is an injectable prescription medicine to reduce the excess in abdominal

fat in HIV-infected patients with lipodystrophy. EGRIFTA® contains a growth hormonereleasing factor (GRF).

• The impact and safety of EGRIFTA® on cardiovascular health has not been studied.

• EGRIFTA® is not indicated for weight loss management.

• It is not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications.

• It is not known if EGRIFTA® is safe and effective in children. EGRIFTA® is not recommended to be used in children.

Who should not use EGRIFTA®?

Do not use EGRIFTA® if you: • have pituitary gland tumor, pituitary gland surgery or other problems related to your pituitary gland • have or had a history of active cancer (either newly diagnosed or recurrent) • are allergic to tesamorelin or any of the ingredients in EGRIFTA®. See the end of this leaflet for a complete list of ingredients in EGRIFTA® • are pregnant or become pregnant. If you become pregnant, stop using EGRIFTA® and talk with your healthcare provider. See “What should I tell my healthcare provider before using EGRIFTA®?”

What are the possible side effects of EGRIFTA®?

EGRIFTA® may cause serious side effects including: • Serious allergic reaction. Some people taking EGRIFTA® may have an allergic reaction.

Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: – a rash over your body

will measure your blood sugar periodically.

• Injection-site reactions. Change (rotate) your injection site to help lower your risk for

injection-site reactions. Call your healthcare provider for medical advice if you have the following symptoms around the area of the injection site: – bleeding – redness – rash – itching – swelling – pain – irritation The most common side effects of EGRIFTA® include: – joint pain – nausea – vomiting – pain in legs and arms – rash – swelling in your legs – itching – muscle soreness – tingling, numbness and pricking Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of EGRIFTA®. For more information, ask your healthcare provider or pharmacist.

Call your healthcare provider for medical advice about side effects. To report side effects, contact EMD Serono toll-free at 1-800-283-8088 ext. 5563. You may report side effects to FDA at 1-800-FDA-1088.

Keep EGRIFTA® and all medicines out of the reach of children.

General information about the safe and effective use of EGRIFTA®: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use EGRIFTA® for a condition for which it was not prescribed.

Do not give EGRIFTA® to other people, even if they have the same symptoms you have.

It may harm them.

Do not share your EGRIFTA® syringe with another person, even if the needle is changed.

Do not share your EGRIFTA® needles with another person.

This Patient Information leaflet summarizes the most important information about EGRIFTA®. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about EGRIFTA® that is written for healthcare professionals.

For more information about EGRIFTA®, go to www.EGRIFTA.com or contact the AXIS Center toll-free at 1-877-714-2947.

What are the ingredients in EGRIFTA®?

Active ingredient: tesamorelin Inactive ingredients: mannitol and Sterile Water for Injection

©2011 EMD Serono, Inc. 110627-101931 7/11 All rights reserved. EGRIFTA is a registered trademark of Theratechnologies Inc.

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How should I use EGRIFTA®?

• Read the detailed “Instructions for Use” that comes with EGRIFTA® before you start using EGRIFTA®. Your healthcare provider will show you how to inject EGRIFTA®.

• Use EGRIFTA® exactly as prescribed by your healthcare provider.

• Inject EGRIFTA® under the skin (subcutaneously) of your stomach area (abdomen).

• Change (rotate) the injection site on your stomach area (abdomen) with each dose.

Do not inject EGRIFTA® into scar tissue, bruises or your navel.

• Do not share needles or syringes with other people. Sharing of needles can result in the transmission of infectious diseases, such as HIV.

• Increase in glucose (blood sugar) intolerance and diabetes. Your healthcare provider

T:10.125 in

What should I tell my healthcare provider before using EGRIFTA®?

Before using EGRIFTA®, tell your healthcare provider if you: • have or have had cancer • have diabetes • are breastfeeding or plan to breastfeed. It is not known if EGRIFTA® passes into your breast milk. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby. Talk with your healthcare provider about the best way to feed your baby if you are taking EGRIFTA® • have kidney or liver problems • have any other medical condition Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. EGRIFTA® may affect the way other medicines work, and other medicines may affect how EGRIFTA® works.

Know the medicines you take. Keep a list with you to show your healthcare provider and pharmacist when you get a new medicine.

– hives – swelling of your face or throat – shortness of breath or trouble breathing – fast heartbeat – feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome).

“

“

Imitations

of Life From An Early Frost to Precious, a time line of the 15 best HIV stories ever told ➝

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Film 1990

TV SERIES 1989–1993

TV MOVIE 1993

Longtime Companion Though taken to task by The New York Times for putting a white gay face on AIDS, Longtime Companion was embraced by many critics, including Roger Ebert, who saw the movie as groundbreaking, as it was one of the first mainstream films to take on HIV.

Life Goes On When it premiered in 1989, this family drama made headlines for featuring a main character with Down syndrome— it broke further ground two years later when Chad Lowe was cast as an HIV-positive teen who romances series star Kellie Martin.

And the Band Played On The HBO adaptation of Randy Shilts’s 600page tome on the early days of the epidemic was heralded by critics, who saw it as a respite from the TV movies of the day that often focused on tabloid sensations like Amy Fisher instead of serious issues.

this page: longtime companion courtesy mgm; opposite: rent: joan marcus

TV MOVIE 1985

An Early Frost A big-name cast including Gena Rowlands, Ben Gazzara, and Aidan Quinn brought AIDS into America’s living rooms with a realistic dramatization of a family grappling with their son’s diagnosis. The TV movie won Emmy, Peabody, and Golden Globe awards.

Imitations of Life Imitations of Life

1992 broadway

1987–1991 tv series

1986 Film

Falsettos Though not as wellremembered as shows like Rent or The Normal Heart, this musical, which featured an HIV-positive main character, received critical praise as well as Tony awards for Best Score and Best Book.

Thirtysomething The massive ABC hit took a big risk when gay character Peter contracted HIV. The Emmy-winning series received accolades for featuring not only an HIV story line but a budding relationship between two men.

Parting Glances AIDS isn’t the only story in this New York–centric independent movie, but the disease hovers over much of the action. Steve Buscemi made a big impression as an HIV-positive rock star in love with his best friend. Director-writer Bill Sherwood died of AIDS complications four years after the film’s release.

The Normal Heart, a semiautobiographical play about a gay man’s transformation into an AIDS activist, was a sensation when it premiered in New York in 1985. The drama was even more warmly received when it was revived on Broadway this year, and Tony voters honored it with three awards in June. The Normal Heart is just the latest story about AIDS to be embraced by critics—here are some of the most acclaimed depictions on TV, celluloid, and the stage:

Film 1993

Film 2009

TV movie 1998

tv series 1994–2009

Precious: Based on the Novel “Push” by Sapphire Produced by none other than Oprah Winfrey, Precious is an unflinching study of a poor and abused black teen in 1980s Harlem. Raped repeatedly by her father, Precious Jones gives birth to two children and contracts HIV. The movie manages to be uplifting in spite of its very downbeat premise, a quality that endeared it to critics and the public.

Gia This artful and sexy HBO film rocketed Angelina Jolie to stardom and won her a Golden Globe. Jolie plays Gia Carangi, a lesbian supermodel of the 1970s and ’80s who succumbed to both heroin addiction and AIDS.

er This much-loved show, which launched the careers of George Clooney and Julianna Margulies, also changed public perceptions of HIV with the character of Jeanie Boulet (played by Gloria Reuben), an African-American physician assistant living, working, and loving while HIV-positive.

Philadelphia Based on a heartbreaking true story, this Oscar-winning film stars Tom Hanks as a lawyer fired for his HIV-positive status. Director Jonathan Demme intentionally followed The Silence of the Lambs, accused of homophobia for its transgender serial killer, with the gaypositive, HIV-sensitive Philadelphia.

2002 Film

1996 broadway

1995 Film

1993 BROADWAY

The Hours This Oscar-winning film, based on a novel by Michael Cunningham, focuses on three women in three different eras. The modern-day character of Clarissa Vaughan (Meryl Streep) spends a pivotal day planning a party for Richard (Ed Harris), a past love now dying of AIDS. Richard’s struggle with the disease brings Clarissa’s story line and the entire film to a startling end.

rent Puccini’s La Bohème, the opera about struggling artists in 19th-century Paris, inspired Jonathan Larson’s Pulitzer Prize–winning musical about creative 20-somethings trying to avoid eviction in New York’s East Village.

The beloved characters are a diverse mix of ethnicities and HIV statuses.

Kids Controversial, disturbing, and lauded by many critics, Kids received an NC-17 rating when released in theaters.

The movie takes a frank look at teenagers partying their way through New York City—a major plot point concerns a promiscuous boy spreading HIV to his numerous female sex partners.

Angels in America: Millennium Approaches Tony Kushner’s sprawling AIDS epic hit theatergoers like a punch and took home a Tony Award for Best Play and the Pulitzer Prize for Drama. The production’s second half, Angels in America: Perestroika, premiered the same year and also won a Tony.

La Familia

Bonita Family is often described as the cornerstone of Latino culture. So what does that mean for Latinos with HIV?

Alfred Gescheidt

BY Michelle Garcia

28 | H I V P L U S s e p t e m b e r / o c t o b e r 2 0 1 1

mother asked her not to tell the rest of her family about her HIV status out of fear that she would be ostracized.

“It came from a good place,” Mejia says. “There was a lot of stigma back then. She said, ‘I believe you’re not going to die from this, but you must not tell anyone. If you get sick, we’ll tell them you have another disease. We’ll do the research.’ ” Mejia, her mother, and her younger brother moved to Colombia, their native country, where she lived for the following decade without medication. Instead, Mejia’s mother opened a health food store and used the products to help her daughter live the healthiest life possible. Mejia and her mother did disclose her status to an uncle, a local doctor who regularly monitored her cell counts. Mejia and her family also used their faith to ground them through the rough times.

Families in Crisis Mejia’s experience is just one example of how Latino families band together in times of crisis. And that’s how researchers are seeing HIV among Latinos: It affects not only the individual diagnosed but the whole family structure. The National Council of La Raza, a leading advocacy organization for Latino Americans, says families are the most influential part of life for Latinos. A 2006 analysis by the organization advocates getting more sex education into Hispanic homes, where addressing such topics is often avoided due to religion or conservative values.

La Raza also suggests finding ways to empower women— frequently the hub of family life—to be vocal ambassadors for educating others about

HIV in casual atmospheres and small gatherings. The key is getting family involved in HIV prevention and care.

Gerardo L. Angulo, a clinical supervisor for Latinos Unidos Contra el SIDA (Latinos United Against AIDS), part of Chicanos por la Causa in Phoenix, says his organization is already adapting to that type of family-centered counseling for those who have been newly diagnosed with HIV. Angulo says Hispanic people tend to face pressure to live up to their parents’ expectations.

“Being Latino myself, I can tell you that you grow up trying to be the perfect student, the perfect son, the perfect brother,” he says. “You just constantly seek perfection.”

That pressure makes it harder for a son or daughter to disclose that they are HIV-positive. Once they do, in Latino families, diagnosis and treatment become something the entire family faces together. Angulo recalls one patient who found out he was positive. His entire family came in to LUCES to learn more and help support him through the counseling process.

“They were all devastated—his wife, his mother, his father, siblings,” says Angulo.

“But they were all there, and we counseled them together on what the options were. To them, the attitude was, ‘Oh, my God, my son is dying.’ For them, it was a tragedy. They were all crying throughout the counseling sessions, but they were also like, ‘It doesn’t matter— we’re going to love him no matter what.’ ” For that family, a crisis was averted when it turned out the man was incorrectly diagnosed; he had received a false(continued on page 34)

previous spread: Comstock ; opposite page: stockby te

M

a r i a M e j i a’ s childhood in Miami was far from idyllic.

By the time she reached 14, Mejia couldn’t stand her home environment—which included a strict father and a sexually abusive uncle—so she ran away from home. Mejia says she ended up running with a gang until the age of 18, when she met her first boyfriend.

In the early 1990s, after four years away from home, Mejia decided it was time to turn her life around. She returned to her mother, who by then was separated from her father.

Part of the young woman’s plan to turn over a new leaf was joining Job Corps, a vocational education program for young people. She went to a Job Corps facility in Kentucky for medical screening and the typical 60 days of training. When the doctor tried to get her to come in to the clinic after the routine screening tests, Mejia initially ignored his requests out of fear; a smoker, Mejia was afraid she had cancer. Instead, when the doctor was finally able to sit her down, she learned that she had HIV. “I was not a drug user, and back then it was still thought of as a gay man’s disease,” Mejia says. “It’s not that I was sick or anything. I never thought it could happen to me.”

Despite being assured that she could stay at Job Corps, Mejia was so devastated that she quit the program and again returned to her mother.

“I wanted to die at home and not in Kentucky,” she says. Mejia packed up her life and headed back to Miami.

She then broke the news to her mother, who offered her full support. However, Mejia’s

INDICATION: REYATAZ® (atazanavir sulfate) is a prescription medicine used in combination with other medicines to treat people 6 years of age and older who are infected with the human immunodeficiency virus (HIV).

REYATAZ has been studied in a 48-week trial in patients who have taken anti-HIV medicines and a 96-week trial in patients who have never taken anti-HIV medicines.

REYATAZ does not cure HIV or lower your chance of passing HIV to others. People taking REYATAZ may still get opportunistic infections or other conditions that happen with HIV infection.

IMPORTANT SAFETY INFORMATION: Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

Do not take REYATAZ if you are taking the following medicines due to potential for serious, life-threatening side effects or death: Versed® (midazolam) when taken by mouth, Halcion® (triazolam), ergot medicines (dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as Cafergot®, Migranal®, D.H.E. 45®, ergotrate maleate, Methergine®, and others), Propulsid® (cisapride), or Orap® (pimozide).

Do not take REYATAZ with the following medicines due to potential for serious side effects: Camptosar® (irinotecan), Crixivan® (indinavir), Mevacor® (lovastatin), Zocor® (simvastatin), Uroxatral® (alfuzosin), or Revatio® (sildenafil).

Do not take REYATAZ with the following medicines as they may lower the amount of REYATAZ in your blood, which may lead to increased HIV viral load and resistance to REYATAZ or other anti-HIV medicines: rifampin (also known as Rimactane®, Rifadin®, Rifater®, or Rifamate®), St. John’s wort (Hypericum perforatum)containing products, or Viramune® (nevirapine).

Serevent Diskus® (salmeterol) and Advair® (salmeterol with fluticasone) are not recommended with REYATAZ. Do not take Vfend® (voriconazole) if you are taking REYATAZ and Norvir® (ritonavir).

The above lists of medicines are not complete. Taking REYATAZ with some other medicines may require your therapy to be monitored more closely or may require a change in dose or dose schedule of REYATAZ or the other medicine. Discuss with your healthcare provider all prescription and non-prescription medicines, vitamin and herbal supplements, or other health preparations you are taking or plan to take.

Tell your healthcare provider if you are pregnant or plan to become pregnant. REYATAZ use during pregnancy has not been associated with an increase in birth defects. Pregnant women have experienced serious side effects when taking REYATAZ with other HIV medicines called nucleoside analogues. After your baby is born, tell your healthcare provider if your baby’s skin or the white part of his/her eyes turns yellow.

You should not breast-feed if you are HIV-positive.

Also tell your healthcare provider if you have end-stage kidney disease managed with hemodialysis or severe liver dysfunction.

Tell your healthcare provider right away if you have any side effects, symptoms, or conditions, including the following: • Mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started, and usually goes away within 2 weeks with no change in treatment.

IMPORTANT SAFETY INFORMATION (cont’d): • Severe rash may develop with other symptoms that could be serious and potentially cause death. If you develop a rash with any of the following symptoms, stop using REYATAZ and call your healthcare provider right away: — Shortness of breath – General ill-feeling or “flu-like” symptoms – Fever – Muscle or joint aches – Conjunctivitis (red or inflamed eyes, like “pink eye”) – Blisters – Mouth sores – Swelling of your face • Yellowing of the skin and/or eyes may occur due to increases in bilirubin levels in the blood (bilirubin is made by the liver).

• A change in the way your heart beats may occur.

You may feel dizzy or lightheaded. These could be symptoms of a heart problem.

• Diabetes and high blood sugar may occur in patients taking protease inhibitor medicines like REYATAZ. Some patients may need changes in their diabetes medicine.

• If you have liver disease, including hepatitis B or C, it may get worse when you take anti-HIV medicines like REYATAZ. • Kidney stones have been reported in patients taking REYATAZ. Signs or symptoms of kidney stones include pain in your side, blood in your urine, and pain when you urinate.

• Some patients with hemophilia have increased bleeding problems with protease inhibitor medicines like REYATAZ. • Changes in body fat have been seen in some patients taking anti-HIV medicines. The cause and long-term effects are not known at this time.

• Immune reconstitution syndrome has been seen in some patients with advanced HIV infection (AIDS) and a history of opportunistic infection. Signs and symptoms of inflammation from previous infections may occur soon after starting anti-HIV treatment, including REYATAZ. • Gallbladder disorders (including gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. Other common side effects of REYATAZ taken with other anti-HIV medicines include: nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.

You should take REYATAZ once daily with food (a meal or snack). Swallow the capsules whole; do not open the capsules. You should take REYATAZ and your other anti-HIV medicines exactly as instructed by your healthcare provider.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

REYATAZ is one of several treatment options your doctor may consider.

Please see Important Patient Information about REYATAZ on the adjacent pages.

REYATAZ is a registered trademark of Bristol-Myers Squibb. All other trademarks are the property of their respective owners and not of Bristol-Myers Squibb.

© 2011 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US11AB05806 06/11

DETERMINED + UNDETECTABLE

REYATAZ CAN HELP GET YOU TO UNDETECTABLE, SO YOU CAN FIGHT HIV YOUR WAY.

ONCE-DAILY REYATAZ IN HIV COMBINATION THERAPY: • Can help lower your viral load to undetectable* and help raise your T-cell (CD4+ cell) count • Has been prescribed by physicians for more than 200,000 HIV patients since 2003 † • Can be taken by adults who are starting HIV treatment for the first time and adults who have already been on HIV treatment Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

REYATAZ does not cure HIV and has not been shown to reduce the risk of passing HIV to others.

Individual results may vary.

Ask your healthcare team how REYATAZ in combination therapy can help get you to undetectable.

Fight HIV your way.

www.REYATAZ.com * Undetectable was defined as a viral load of less than 400 copies/mL.

† Wolters Kluwer. SDI Product Brand Report.

Total Patient Tracker; November 2010.

FDA-Approved Patient Labeling Patient Information

REYATAZ® (RAY-ah-taz) (generic name = atazanavir sulfate) Capsules ALERT: Find out about medicines that should NOT be taken with REYATAZ (atazanavir sulfate). Read the section “What important information should I know about taking REYATAZ with other medicines?”

Read the Patient Information that comes with REYATAZ before you start using it and each time you get a refill. There may be new information. This leaflet provides a summary about REYATAZ and does not include everything there is to know about your medicine. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is REYATAZ? REYATAZ is a prescription medicine used with other anti-HIV medicines to treat people 6 years of age and older who are infected with the human immunodeficiency virus (HIV). HIV is the virus that causes acquired immune deficiency syndrome (AIDS). REYATAZ is a type of anti-HIV medicine called a protease inhibitor. HIV infection destroys CD4+ (T) cells, which are important to the immune system.

The immune system helps fight infection. After a large number of (T) cells are destroyed, AIDS develops. REYATAZ helps to block HIV protease, an enzyme that is needed for the HIV virus to multiply. REYATAZ may lower the amount of HIV in your blood, help your body keep its supply of CD4+ (T) cells, and reduce the risk of death and illness associated with HIV. Does REYATAZ cure HIV or AIDS? REYATAZ does not cure HIV infection or AIDS. At present there is no cure for HIV infection. People taking REYATAZ may still get opportunistic infections or other conditions that happen with HIV infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. It is very important that you see your healthcare provider regularly while taking REYATAZ. REYATAZ does not lower your chance of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom or other barrier to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles.

Who should not take REYATAZ? Do not take REYATAZ if you: • are taking certain medicines. (See “What important information should I know about taking REYATAZ with other medicines?”) Serious life-threatening side effects or death may happen. Before you take REYATAZ, tell your healthcare provider about all medicines you are taking or planning to take.

These include other prescription and nonprescription medicines, vitamins, and herbal supplements.

• are allergic to REYATAZ or to any of its ingredients. The active ingredient is atazanavir sulfate. See the end of this leaflet for a complete list of ingredients in REYATAZ. Tell your healthcare provider if you think you have had an allergic reaction to any of these ingredients.

What should I tell my healthcare provider before I take REYATAZ? Tell your healthcare provider: • If you are pregnant or plan to become pregnant. REYATAZ use during pregnancy has not been associated with an increase in birth defects.

Pregnant women have experienced serious side effects when taking REYATAZ with other HIV medicines called nucleoside analogues. You and your healthcare provider will need to decide if REYATAZ is right for you. If you use REYATAZ while you are pregnant, talk to your healthcare provider about the Antiretroviral Pregnancy Registry.

• After your baby is born, tell your healthcare provider if your baby’s skin or the white part of his/her eyes turns yellow.

• If you are breast-feeding. You should not breast-feed if you are HIV-positive because of the chance of passing HIV to your baby. Also, it is not known if REYATAZ can pass into your breast milk and if it can harm your baby. If you are a woman who has or will have a baby, talk with your healthcare provider about the best way to feed your baby.

• If you have liver problems or are infected with the hepatitis B or C virus.

See “What are the possible side effects of REYATAZ?” • If you have end stage kidney disease managed with hemodialysis.

• If you have diabetes. See “What are the possible side effects of REYATAZ?” • If you have hemophilia. See “What are the possible side effects of REYATAZ?”

REYATAZ® (atazanavir sulfate) About all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Keep a list of your medicines with you to show your healthcare provider. For more information, see “What important information should I know about taking REYATAZ with other medicines?” and “Who should not take REYATAZ?” Some medicines can cause serious side effects if taken with REYATAZ. How should I take REYATAZ? • Take REYATAZ once every day exactly as instructed by your healthcare provider. Your healthcare provider will prescribe the amount of REYATAZ that is right for you.

• Always take REYATAZ with food (a meal or snack) to help it work better.

Swallow the capsules whole. Do not open the capsules. Take REYATAZ at the same time each day.

• If you are taking antacids or didanosine (VIDEX® or VIDEX® EC), take REYATAZ 2 hours before or 1 hour after these medicines.

• If you are taking medicines for indigestion, heartburn, or ulcers such as AXID® (nizatidine), PEPCID AC® (famotidine), TAGAMET® (cimetidine), ZANTAC® (ranitidine), AcipHex® (rabeprazole), NEXIUM® (esomeprazole), PREVACID® (lansoprazole), PRILOSEC® (omeprazole), or PROTONIX® (pantoprazole), talk to your healthcare provider.

• Do not change your dose or stop taking REYATAZ without first talking with your healthcare provider. It is important to stay under a healthcare provider’s care while taking REYATAZ. • When your supply of REYATAZ starts to run low, get more from your healthcare provider or pharmacy. It is important not to run out of REYATAZ. The amount of HIV in your blood may increase if the medicine is stopped for even a short time.

• If you miss a dose of REYATAZ, take it as soon as possible and then take your next scheduled dose at its regular time. If, however, it is within 6 hours of your next dose, do not take the missed dose. Wait and take the next dose at the regular time. Do not double the next dose. It is important that you do not miss any doses of REYATAZ or your other anti-HIV medicines.

• If you take more than the prescribed dose of REYATAZ, call your healthcare provider or poison control center right away.

What are the possible side effects of REYATAZ? The following list of side effects is not complete. Report any new or continuing symptoms to your healthcare provider. If you have questions about side effects, ask your healthcare provider. Your healthcare provider may be able to help you manage these side effects.

The following side effects have been reported with REYATAZ: • mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started. Rashes usually go away within 2 weeks with no change in treatment. Tell your healthcare provider if rash occurs.

• severe rash: Rash may develop in association with other symptoms which could be serious and potentially cause death.

If you develop a rash with any of the following symptoms stop using REYATAZ and call your healthcare provider right away: • shortness of breath • general ill feeling or “flu-like” symptoms • fever • muscle or joint aches • conjunctivitis (red or inflamed eyes, like “pink eye”) • blisters • mouth sores • swelling of your face • yellowing of the skin or eyes. These effects may be due to increases in bilirubin levels in the blood (bilirubin is made by the liver). Although these effects may not be damaging to your liver, skin, or eyes, call your healthcare provider promptly if your skin or the white part of your eyes turn yellow.

• a change in the way your heart beats (heart rhythm change). Call your healthcare provider right away if you get dizzy or lightheaded. These could be symptoms of a heart problem.

• diabetes and high blood sugar (hyperglycemia) sometimes happen in patients taking protease inhibitor medicines like REYATAZ. Some patients had diabetes before taking protease inhibitors while others did not. Some patients may need changes in their diabetes medicine.

• if you have liver disease including hepatitis B or C, your liver disease may get worse when you take anti-HIV medicines like REYATAZ. • kidney stones have been reported in patients taking REYATAZ. If you develop signs or symptoms of kidney stones (pain in your side, blood in your urine, pain when you urinate) tell your healthcare provider promptly.

•

REYATAZ® (atazanavir sulfate) some patients with hemophilia have increased bleeding problems with protease inhibitors like REYATAZ. • changes in body fat. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk.

Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known at this time.

• immune reconstitution syndrome. In some patients with advanced HIV infection (AIDS) and a history of opportunistic infection, signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment, including REYATAZ, is started.

Other common side effects of REYATAZ taken with other anti-HIV medicines include nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.

Gallbladder disorders (which may include gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. What important information should I know about taking REYATAZ with other medicines?

•

Do not take REYATAZ if you take the following medicines (not all brands may be listed; tell your healthcare provider about all the medicines you take).

REYATAZ may cause serious, life-threatening side effects or death when used with these medicines.

• Ergot medicines: dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as CAFERGOT®, MIGRANAL®, D.H.E. 45®, ergotrate maleate, METHERGINE®, and others (used for migraine headaches).

• ORAP® (pimozide, used for Tourette’s disorder).

• PROPULSID® (cisapride, used for certain stomach problems).

• Triazolam, also known as HALCION® (used for insomnia).

• Midazolam, also known as VERSED® (used for sedation), when taken by mouth.

Do not take the following medicines with REYATAZ because of possible serious side effects: • CAMPTOSAR® (irinotecan, used for cancer).

• CRIXIVAN® (indinavir, used for HIV infection). Both REYATAZ and CRIXIVAN sometimes cause increased levels of bilirubin in the blood.

• Cholesterol-lowering medicines MEVACOR® (lovastatin) or ZOCOR® (simvastatin).

• UROXATRAL® (alfuzosin, used to treat benign enlargement of the prostate).

• REVATIO® (sildenafil, used to treat pulmonary arterial hypertension).

Do not take the following medicines with REYATAZ because they may lower the amount of REYATAZ in your blood. This may lead to an increased HIV viral load. Resistance to REYATAZ or cross-resistance to other HIV medicines may develop: • Rifampin (also known as RIMACTANE®, RIFADIN®, RIFATER®, or RIFAMATE®, used for tuberculosis).

• St. John’s wort (Hypericum perforatum), an herbal product sold as a dietary supplement, or products containing St. John’s wort.

• VIRAMUNE® (nevirapine, used for HIV infection).

The following medicines are not recommended with REYATAZ: • SEREVENT DISKUS® (salmeterol) and ADVAIR® (salmeterol with fluticasone), used to treat asthma, emphysema/chronic obstructive pulmonary disease also known as COPD. Do not take the following medicine if you are taking REYATAZ and NORVIR® together: • VFEND® (voriconazole).

The following medicines may require your healthcare provider to monitor your therapy more closely (for some medicines a change in the dose or dose schedule may be needed): • CIALIS® (tadalafil), LEVITRA® (vardenafil), or VIAGRA® (sildenafil), used to treat erectile dysfunction. REYATAZ may increase the chances of serious side effects that can happen with CIALIS, LEVITRA, or VIAGRA. Do not use CIALIS, LEVITRA, or VIAGRA while you are taking REYATAZ unless your healthcare provider tells you it is okay.

• ADCIRCA® (tadalafil) or TRACLEER® (bosentan), used to treat pulmonary arterial hypertension.

• LIPITOR® (atorvastatin) or CRESTOR® (rosuvastatin). There is an increased chance of serious side effects if you take REYATAZ with this cholesterollowering medicine.

• Medicines for abnormal heart rhythm: CORDARONE® (amiodarone), lidocaine, quinidine (also known as CARDIOQUIN®, QUINIDEX®, and others).

• MYCOBUTIN® (rifabutin, an antibiotic used to treat tuberculosis).

REYATAZ® (atazanavir sulfate) •

BUPRENEX®, SUBUTEX®, SUBOXONE®, (buprenorphine or buprenorphine/ naloxone, used to treat pain and addiction to narcotic painkillers).

• VASCOR® (bepridil, used for chest pain).

• COUMADIN® (warfarin).

• Tricyclic antidepressants such as ELAVIL® (amitriptyline), NORPRAMIN® (desipramine), SINEQUAN® (doxepin), SURMONTIL® (trimipramine), TOFRANIL® (imipramine), or VIVACTIL® (protriptyline).

• Medicines to prevent organ transplant rejection: SANDIMMUNE® or NEORAL® (cyclosporin), RAPAMUNE® (sirolimus), or PROGRAF® (tacrolimus).

• The antidepressant trazodone (DESYREL® and others).

• Fluticasone propionate (FLONASE®, FLOVENT®), given by nose or inhaled to treat allergic symptoms or asthma. Your doctor may choose not to keep you on fluticasone, especially if you are also taking NORVIR®.

• Colchicine (COLCRYS®), used to prevent or treat gout or treat familial Mediterranean fever.

The following medicines may require a change in the dose or dose schedule of either REYATAZ or the other medicine: • INVIRASE® (saquinavir).

• NORVIR® (ritonavir).

• SUSTIVA® (efavirenz).

• Antacids or buffered medicines.

• VIDEX® (didanosine).

• VIREAD® (tenofovir disoproxil fumarate).

• MYCOBUTIN® (rifabutin).

• Calcium channel blockers such as CARDIZEM® or TIAZAC® (diltiazem), COVERA-HS® or ISOPTIN SR® (verapamil) and others.

• BIAXIN® (clarithromycin).

• Medicines for indigestion, heartburn, or ulcers such as AXID® (nizatidine), PEPCID AC® (famotidine), TAGAMET® (cimetidine), or ZANTAC® (ranitidine).

Talk to your healthcare provider about choosing an effective method of contraception. REYATAZ may affect the safety and effectiveness of hormonal contraceptives such as birth control pills or the contraceptive patch. Hormonal contraceptives do not prevent the spread of HIV to others.

Remember: 1. Know all the medicines you take.

2. Tell your healthcare provider about all the medicines you take.

3. Do not start a new medicine without talking to your healthcare provider.

How should I store REYATAZ? • Store REYATAZ Capsules at room temperature, 59° to 86° F (15° to 30° C).

Do not store this medicine in a damp place such as a bathroom medicine cabinet or near the kitchen sink.

• Keep your medicine in a tightly closed container.

• Keep all medicines out of the reach of children and pets at all times. Do not keep medicine that is out of date or that you no longer need. Dispose of unused medicines through community take-back disposal programs when available or place REYATAZ in an unrecognizable, closed container in the household trash.

General information about REYATAZ This medicine was prescribed for your particular condition. Do not use REYATAZ for another condition. Do not give REYATAZ to other people, even if they have the same symptoms you have. It may harm them. Keep REYATAZ and all medicines out of the reach of children and pets.

This summary does not include everything there is to know about REYATAZ. Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Remember no written summary can replace careful discussion with your healthcare provider. If you would like more information, talk with your healthcare provider or you can call 1-800-321-1335.

What are the ingredients in REYATAZ? Active Ingredient: atazanavir sulfate Inactive Ingredients: Crospovidone, lactose monohydrate (milk sugar), magnesium stearate, gelatin, FD&C Blue #2, and titanium dioxide.

VIDEX® and REYATAZ® are registered trademarks of Bristol-Myers Squibb Company.

COUMADIN® and SUSTIVA® are registered trademarks of Bristol-Myers Squibb Pharma Company. DESYREL® is a registered trademark of Mead Johnson and Company. Other brands listed are the trademarks of their respective owners and are not trademarks of Bristol-Myers Squibb Company.

Princeton, NJ 08543 USA 1246226A9

F1-B0001B-02-11

Rev February 2011

“Being Latino myself, I can tell you that you grow up trying to be the perfect student, the perfect son, the perfect brother. You just constantly seek perfection.”

positive test result. The trauma for this family, though, was all too real. Angulo says the incident demonstrates the close bonds within Latino families but adds that it could have turned out differently in another family, due to the minimal amount of education on HIV that has been directed at Latinos in the United States and elsewhere.

“There are still issues with ignorance around contracting the virus,” he says. “Sometimes people still avoid drinking from the same glass as [an HIV] positive person. They say, ‘I don’t want you around my children.’

Unfortunately, when there’s a lack of education within the Latino family unit, they don’t understand they can deal with the issue [together].”

La Doctora Is In Isabel Gómez-Bassols, Ed.D., has been making it her mission to educate Latino parents and families on being more accept-

ing of both gay family members and those with HIV. Through her Miami-based radio show for Univision, Bassols doles out advice on a range of topics like relationships, communication, and self-esteem to her millions of Spanish-speaking listeners across the country. Each day 8,000 people attempt to call in to her two-hour show, which airs in the top 15 Hispanic markets across the country, reaching about 80% of Hispanic households. But as her relationship with her gay, HIV-positive son, Eric Vasallo, has matured, she has begun educating parents who have just learned that their son or daughter is HIVpositive.

Nine years ago, Bassols decided it was time to share her family’s story at an event for Latino youth where she was speaking.

“I told them, ‘I have a gay son who is HIV-positive,’ ” Bassols says. “Even now you hear my

34 | H I V P L U S s e p t e m b e r / o c t o b e r 2 0 1 1

voice shaking. [Learning that he is positive was] the hardest thing I’ve gone though, but I love him, and he believes in himself because of the love my family gives him.”

After the speech, Bassols says, she was greeted by throngs of attendees who embraced her, many in tears.

“They told me, ‘I wish I had a mother like you,’ ” she says. “I told them to tell their mothers.

Or in some cases, if it’s going to be difficult, I advise them to have a sister or brother help them tell their family members one by one.”

Coming Out Mejia, the woman who lived with HIV in secrecy for a decade, has similar advice for those who are ready to tell their family about their status.

“Come out slowly,” she says.

“Don’t get the whole family together and tell them in one place.” Mejia followed her own advice when she was ready to end years of hiding. As time progressed, her condition eventually worsened, so she left Colombia to get medical care in the U.S. It was at this point that Mejia says she felt compelled to tell a few more family members about her HIV status, at first gauging what their reactions would be.

Her volunteer work as an HIV counselor came in handy as she slowly started informally educating her cousins, aunts, uncles, and grandparents about the basics of HIV. Then she told a

small handful of close relatives that she was HIV-positive. She says they were all supportive of her, but she quickly learned to be ready to comfort shocked family members.

“They always start crying!” she says. “I tell them I’ve been dealing with this for a long time and that it’s OK, but it’s always still a shock.”

In 2010, when an in-law died of a brain tumor, Mejia decided it was time to stop hiding her HIV status from the rest of her family.

“I thought to myself, Why can people say they have family members with other illnesses, but I can’t say I have HIV? I was fed up, and that’s when I [decided] 2011 was when I would tell my family completely.

If they’re going to discriminate against me, that’s their loss.”

In her 38 years, Mejia has educated many young people about HIV and has endured decades with the virus. She’s faced violence and pain. She’s fought for success as a business owner. As with a lot of Latino folks, her mother has been in her corner guiding the way through it all.

“She’s very strong and educated about it now,” she says.

“At first she was scared for me, because she didn’t want anyone to hurt me or my feelings. But she knows now that my mission is to save lives, and no one is going to stop me. And she’s dealt with it as best as she can.

She’s been my rock.” ✜

angulo: sean kapera; opposite page: Jupiterimages

­ Gerardo Angulo, a clinical supervisor for — Centro de la Familia-LUCES (pictured, left)

Power of the People Having HIV as a Latino presents its own singular challenges, but some are working to ease the struggle of being a double minority

being hiv-positive is hard, but being HIV-positive and Latino is doubly difficult, says Patricia*, a 30-year-old transgender woman living in Phoenix.

Patricia hasn’t told her family about her HIV status, which she’s known for two years. And because they live in Mexico, even if they were supportive—which she doubts—her family couldn’t offer tangible help. Patricia’s parents didn’t talk about sex when she was growing up, so she had to learn and make mistakes on her own. Patricia’s English skills are limited, and since one of her former doctors didn’t speak Spanish, she was forced to bring a translator to appointments.

Stories like Patricia’s play out thousands of times every year across this country. In addition to the difficulties any HIV-positive person faces in the United States, many Latinos face additional cultural shame and guilt over their disease.

It’s likely that cultural stigma plays a role in HIV and AIDS transmission.

Latinos, the fastest-growing minority in the nation, are certainly contracting HIV at alarming rates. Hispanic men are getting HIV at twice the rate of nonHispanic white men, while infections of Latinas are nearly four times that of non-Hispanic white women, according to the latest numbers from the Centers for Disease Control. In 2008, Latinos accounted for more than 19% of the over 42,000 new cases of HIV in the 37 states with infection reporting, though they make up 16% of the U.S. population. Perhaps the most frightening statistic is that Latinos progress more quickly to AIDS than both blacks and non-Hispanic whites.

36 | H I V P L U S s e p t e m b e r / o c t o b e r 2 0 1 1

The CDC acknowledges that certain characteristics of Latino culture complicate proper HIV care. According to the agency, a traditional “macho” attitude adds to the stigma regarding homosexuality and discourages proactive prevention, testing, and treatment, which Patricia says affects both men and women.

“Many women don’t feel the freedom to get tested because their boyfriends or husbands feel that is an insult to their relationship,” Patricia tells HIV Plus, adding that many heterosexual Latinos still believe AIDS is a gay disease. And protection is a hurdle as well. Patricia says, “Many men would rather not use condoms during sex because it does not feel the same or they feel it is the woman’s responsibility to take care of herself if she does not want to get pregnant.”

For some HIV-positive Latinos, finding treatment is complicated by immigration status, inadequate health insurance, and limited access to quality health care, according to the CDC. Through the Latinos Unidos Contra el SIDA (Latinos United Against AIDS) program at the Phoenix-based Latino advocacy organization Chicanos por la Causa, Patricia found a service provider that fit. LUCES has a bilingual staff that offers case management, including access to medication, mental health services, and healthy meals. While some HIV service providers ask for documentation or Social Security numbers to obtain services, enrollment in LUCES requires only proof of residence or proof of income.

“Even some Latinos who are documented just feel it’s a better fit culturally to come to our program because here

they don’t run into a language barrier and [our staffers] connect well with the culture,” says Gerardo L. Angulo, a clinical supervisor at LUCES. Ensuring that Latinos have places where they are comfortable seeking treatment is imperative, notes Melissa Ramirez, director of National Latino AIDS Awareness Day for the Latino Commission on AIDS. Latinos progress from HIV to AIDS faster than any other ethnic group, she says, possibly because there is so much shame attached to testing that many don’t realize their status until they have symptoms. To counter this, the commission encourages service providers to offer confidential HIV testing—where identification isn’t required—and is setting up outreach to churches so that faith leaders can stress the importance of self-knowledge.

“Ninety-five percent of Hispanics and Latinos in this country are related to some community of faith, so it’s important to have the gatekeepers of these religious communities involved and engaged, bringing forth this education to their community,” Ramirez says.

It’s not just pastors and preachers that Ramirez hopes to recruit in her effort to reduce stigma. NLAAD is working on a public service announcement aimed at young people that will feature Latino celebrities and air on Tr3s, the Latinoflavored MTV channel.

“The youth is our future,” Ramirez says. “If they’re educated and getting themselves tested, we can finally see a world without AIDS.” ✜ *Name has been changed.

Jack Hollingsworth

By Neal Broverman

J U LY/A U G U S T 2 0 1 1 H I V P L U S

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37

• EPZICOM, in combination with other antiretroviral agents, is indicated for the treatment of HIV-1 infection in adults.

• EPZICOM is one of 3 medicines containing abacavir.

Before starting EPZICOM, your healthcare provider will review your medical history in order to avoid the use of abacavir if you have experienced an allergic reaction to abacavir in the past.

• In one study, more patients had a severe hypersensitivity reaction in the abacavir once-daily group than in the abacavir twice-daily group.

• EPZICOM should not be used as part of a triple-nucleoside regimen.

• EPZICOM does not cure HIV infection/AIDS or prevent passing HIV to others.

Important Safety Information EPZICOM contains abacavir, which is also contained in ZIAGEN® (abacavir sulfate) and TRIZIVIR® (abacavir sulfate, lamivudine, and zidovudine). Patients taking abacavir may have a serious allergic reaction (hypersensitivity reaction) that can cause death. Your risk of this allergic reaction is much higher if you have a gene variation called HLA-B*5701 than if you do not.

Your healthcare provider can determine with a blood test if you have this gene variation. If you get a symptom from 2 or more of the following groups while taking EPZICOM, call your doctor right away to determine if you should stop taking this medicine.

1. Fever 2. Rash 3. Nausea, vomiting, diarrhea, or abdominal (stomach area) pain 4. Generally ill feeling, extreme tiredness, or achiness 5. Shortness of breath, cough, or sore throat Carefully read the Warning Card that your pharmacist gives you and carry it with you at all times.

If you stop EPZICOM because of an allergic reaction, NEVER take EPZICOM or any other abacavir-containing medicine (ZIAGEN, TRIZIVIR) again. If you take EPZICOM or any other abacavir-containing medicine again after you have had an allergic reaction, WITHIN HOURS you may get life-threatening symptoms that may include very low blood pressure or death.

I’ve got the fight in me.

If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your healthcare provider before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If your healthcare provider tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a healthcare provider if you need one.

A buildup of lactic acid in the blood and an enlarged liver, including fatal cases, have been reported.

Do not take EPZICOM if your liver does not function normally.

Some patients infected with both hepatitis B virus (HBV) and HIV have worsening of hepatitis after stopping lamivudine (a component of EPZICOM). Discuss any change in treatment with your healthcare provider. If you have both HBV and HIV and stop treatment with EPZICOM, you should be closely monitored by your healthcare provider for at least several months.

Worsening of liver disease (sometimes resulting in death) has occurred in patients infected with both HIV and hepatitis C virus who are taking anti-HIV medicines and are also being treated for hepatitis C with interferon with or without ribavirin. If you are taking EPZICOM as well as interferon with or without ribavirin and you experience side effects, be sure to tell your healthcare provider.

When you start taking HIV medicines, your immune system may get stronger and could begin to fight infections that have been hidden in your body, such as pneumonia, herpes virus, or tuberculosis. If you have new symptoms after starting your HIV medicines, be sure to tell your healthcare provider.

Changes in body fat may occur in some patients taking antiretroviral therapy. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the trunk. Loss of fat from the legs, arms, and face may also occur. The cause and long-term health effects of these conditions are not known at this time.

Some HIV medicines, including those containing abacavir (ZIAGEN, EPZICOM, and TRIZIVIR), may increase your risk of heart attack. If you have heart problems, smoke, or suffer from diseases that increase your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes, tell your healthcare provider.

The most common side effects seen with the drugs in EPZICOM dosed once daily were allergic reaction, trouble sleeping, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever, stomach pain, abnormal dreams, and anxiety. Most of the side effects do not cause people to stop taking EPZICOM. By prescription only.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see additional important information about EPZICOM, including boxed warnings, on the adjacent pages.

Save on your medication!

Ask your doctor about the Patient Savings Card or visit www.mysupportcard.com to learn how to save on your out-of-pocket expenses. Subject to eligibility. Restrictions apply.

“

even with hiv,

I AM UndefeAted.” “ When I was diagnosed with HIV, I was worried that the disease would take over my life. But over time, I realized I could fight back. By working on my body, my mind, and my spirit, I became stronger than I ever imagined.

My meds are a big help. Last year, I started taking ePZiCOM as part of my combination therapy. My doctor told me that, when used with other medications, it’s been shown to help keep HIV from making more copies of itself and infecting healthy cells. 68% of patients taking a regimen with ePZiCOM had their viral load become undetectable in less than one year. In addition, patients saw a 93% increase in their T-cell counts.* Looks like ePZiCOM is working well. My viral load is undetectable. And me? I just keep fighting on.” †

†

Not an actual patient testimonial. Based on collection of real patient experiences. Individual results may vary.

* HEAT study of 688 patients defines undetectable as a viral load less than 50 copies/mL. Baseline median T-cell count for patients receiving EPZICOM was 214 cells/mm3 and at 48 weeks, patients saw a median increase of 201 cells/mm3 in their T-cell count.

Ask your healthcare provider if epzicom is right for you.

Learn more at www.epzicomForYou.com

EPZICOM® (abacavir sulfate and lamivudine) Tablets MEdICaTIOn GuIdE EPZICOM® (ep′ zih com) Tablets Generic name: abacavir (uH-BACK-ah-veer) sulfate and lamivudine (la-MIV-yoo-deen) Read the Medication Guide that comes with EPZICOM before you start taking it and each time you get a refill because there may be new information. This information does not take the place of talking to your doctor about your medical condition or your treatment. Be sure to carry your EPZICOM Warning Card with you at all times.

What is the most important information I should know about EPZICOM? • Serious Allergic Reaction to Abacavir. EPZICOM contains abacavir (also contained in ZIAGEN® and TRIZIVIR®). Patients taking EPZICOM may have a serious allergic reaction (hypersensitivity reaction) that can cause death. Your risk of this allergic reaction is much higher if you have a gene variation called HLA-B*5701 than if you do not. Your doctor can determine with a blood test if you have this gene variation. If you get a symptom from 2 or more of the following groups while taking EPZICOM, call your doctor right away to determine if you should stop taking this medicine.

Group 1 Group 2 Group 3 Group 4 Group 5

Symptom(s) Fever Rash Nausea, vomiting, diarrhea, abdominal (stomach area) pain Generally ill feeling, extreme tiredness, or achiness Shortness of breath, cough, sore throat

A list of these symptoms is on the Warning Card your pharmacist gives you. Carry this Warning Card with you.

If you stop EPZICOM because of an allergic reaction, NEVER take EPZICOM (abacavir sulfate and lamivudine) or any other abacavir-containing medicine (ZIAGEN and TRIZIVIR) again. If you take EPZICOM or any other abacavir-containing medicine again after you have had an allergic reaction, WITHIN HOURS you may get life-threatening symptoms that may include very low blood pressure or death.

If you stop EPZICOM for any other reason, even for a few days, and you are not allergic to EPZICOM, talk with your doctor before taking it again. Taking EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If your doctor tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a doctor if you need one.

• Lactic Acidosis. Some human immunodeficiency virus (HIV) medicines, including EPZICOM, can cause a rare but serious condition called lactic acidosis with liver enlargement (hepatomegaly).

Nausea and tiredness that don’t get better may be symptoms of lactic acidosis. In some cases this condition can cause death. Women, overweight people, and people who have taken HIV medicines like EPZICOM for a long time have a higher chance of getting lactic acidosis and liver enlargement. Lactic acidosis is a medical emergency and must be treated in the hospital.

• Worsening of hepatitis B virus (HBV) infection. Patients with HBV infection, who take EPZICOM and then stop it, may get “flare-ups” of their hepatitis. “Flare-up” is when the disease suddenly returns in a worse way than before. If you have HBV infection, your doctor should closely monitor your liver function for several months after stopping EPZICOM. You may need to take anti-HBV medicines.

• Use with interferon- and ribavirin-based regimens. Worsening of liver disease (sometimes resulting in death) has occurred in patients infected with both HIV and hepatitis C virus who are taking anti-HIV medicines and are also being treated for hepatitis C with interferon with or without ribavirin. If you are taking EPZICOM as well as interferon with or without ribavirin and you experience side effects, be sure to tell your doctor.

EPZICOM can have other serious side effects. Be sure to read the section below entitled “What are the possible side effects of EPZICOM?”

What is EPZICOM? EPZICOM is a prescription medicine used to treat HIV infection. EPZICOM includes 2 medicines: abacavir (ZIAGEN) and lamivudine or 3TC (EPIVIR®). See the end of this Medication Guide for a complete list of ingredients in EPZICOM. Both of these medicines are called nucleoside analogue reverse transcriptase inhibitors (NRTIs). When used together, they help lower the amount of HIV in your blood. This helps to keep your immune system as healthy as possible so that it can help fight infection.

Different combinations of medicines are used to treat HIV infection. You and your doctor should discuss which combination of medicines is best for you.

• EPZICOM does not cure HIV infection or AIDS. We do not know if EPZICOM will help you live longer or have fewer of the medical problems that people get with HIV or AIDS. It is very important that you see your doctor regularly while you are taking EPZICOM. • EPZICOM does not lower the risk of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safe sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles.

Who should not take EPZICOM? Do not take EPZICOM if you: • have ever had a serious allergic reaction (a hypersensitivity reaction) to EPZICOM or any other medicine that has abacavir as one of its ingredients (TRIZIVIR and ZIAGEN). See the end of this Medication Guide for a complete list of ingredients in EPZICOM. • have a liver that does not function properly.

• are less than 18 years of age.

Before starting EPZICOM tell your doctor about all of your medical conditions, including if you: • have been tested and know whether or not you have a particular gene variation called HLA-B*5701.

• are pregnant or planning to become pregnant. We do not know if EPZICOM will harm your unborn child.

You and your doctor will need to decide if EPZICOM is right for you. If you use EPZICOM while you are pregnant, talk to your doctor about how you can be on the Antiviral Pregnancy Registry for EPZICOM. • are breastfeeding. Some of the ingredients in EPZICOM can be passed to your baby in your breast milk. It is not known if they could harm your baby. Also, mothers with HIV should not breastfeed because HIV can be passed to the baby in the breast milk.

• have liver problems including hepatitis B virus infection.

• have kidney problems.

• have heart problems, smoke, or suffer from diseases that increase your risk of heart disease such as high blood pressure, high cholesterol, or diabetes.

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take any of the following medicines*: • methadone • HIVID® (zalcitabine, ddC) • EPIVIR or EPIVIR-HBV® (lamivudine, 3TC), ZIAGEN (abacavir sulfate), COMBIVIR® (lamivudine and zidovudine), or TRIZIVIR (abacavir sulfate, lamivudine, and zidovudine).

How should I take EPZICOM? • Take EPZICOM by mouth exactly as your doctor prescribes it. The usual dose is 1 tablet once a day. Do not skip doses.

• You can take EPZICOM with or without food.

• If you miss a dose of EPZICOM, take the missed dose right away. Then, take the next dose at the usual time.

• Do not let your EPZICOM run out.

• Starting EPZICOM again can cause a serious allergic or life-threatening reaction, even if you never had an allergic reaction to it before. If you run out of EPZICOM even for a few days, you must ask your doctor if you can start EPZICOM again. If your doctor tells you that you can take EPZICOM again, start taking it when you are around medical help or people who can call a doctor if you need one.

• If you stop your anti-HIV drugs, even for a short time, the amount of virus in your blood may increase and the virus may become harder to treat.

• If you take too much EPZICOM, call your doctor or poison control center right away.

What should I avoid while taking EPZICOM? • Do not take EPIVIR (lamivudine, 3TC), COMBIVIR (lamivudine and zidovudine), ZIAGEN (abacavir sulfate), or TRIZIVIR (abacavir sulfate, lamivudine, and zidovudine) while taking EPZICOM. Some of these medicines are already in EPZICOM. • Do not take zalcitabine (HIVID, ddC) while taking EPZICOM. Avoid doing things that can spread HIV infection, as EPZICOM does not stop you from passing the HIV infection to others.

• Do not share needles or other injection equipment.

• Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades.

• Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with semen, vaginal secretions, or blood.

• Do not breastfeed. EPZICOM can be passed to babies in breast milk and could harm the baby. Also, mothers with HIV should not breastfeed because HIV can be passed to the baby in the breast milk.

What are the possible side effects of EPZICOM? EPZICOM can cause the following serious side effects: • Serious allergic reaction that can cause death. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.)

• Lactic acidosis with liver enlargement (hepatomegaly) that can cause death. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.)

• Worsening of HBV infection. (See “What is the most important information I should know about EPZICOM?” at the beginning of this Medication Guide.)

• Changes in immune system. When you start taking HIV medicines, your immune system may get stronger and could begin to fight infections that have been hidden in your body, such as pneumonia, herpes virus, or tuberculosis. If you have new symptoms after starting your HIV medicines, be sure to tell your doctor.

• Changes in body fat. These changes have happened in patients taking antiretroviral medicines like EPZICOM. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known.

Some HIV medicines including EPZICOM may increase your risk of heart attack. If you have heart problems, smoke, or suffer from diseases that increase your risk of heart disease such as high blood pressure, high cholesterol, or diabetes, tell your doctor.

The most common side effects with EPZICOM are trouble sleeping, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever, stomach pain, abnormal dreams, and anxiety. Most of these side effects did not cause people to stop taking EPZICOM. This list of side effects is not complete. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store EPZICOM? • Store EPZICOM at room temperature between 59º to 86ºF (15º to 30ºC).

• Keep EPZICOM and all medicines out of the reach of children.

General information for safe and effective use of EPZICOM Medicines are sometimes prescribed for conditions that are not mentioned in Medication Guides. Do not use EPZICOM for a condition for which it was not prescribed. Do not give EPZICOM to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about EPZICOM. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for the information that is written for healthcare professionals or call 1-888-825-5249.

What are the ingredients in EPZICOM? Active ingredients: abacavir sulfate and lamivudine Inactive ingredients: Each film-coated EPZICOM Tablet contains the inactive ingredients magnesium stearate, microcrystalline cellulose, and sodium starch glycolate. The tablets are coated with a film (OPADRY® orange YS-1-13065-A) that is made of FD&C Yellow No. 6, hypromellose, polyethylene glycol 400, polysorbate 80, and titanium dioxide.

COMBIVIR, EPIVIR, EPZICOM, TRIZIVIR, and ZIAGEN are registered trademarks of GlaxoSmithKline. *The brands listed are trademarks of their respective owners and are not trademarks of GlaxoSmithKline. The makers of these brands are not affiliated with and do not endorse GlaxoSmithKline or its products.

This Medication Guide has been approved by the US Food and Drug Administration.

Lamivudine is manufactured under agreement from Shire Pharmaceuticals Group plc, Basingstoke, UK ©2009, GlaxoSmithKline. All rights reserved.

March 2009 EPZ:2MG ©2010 ViiV Healthcare Group of Companies All rights reserved.

Printed in USA.

ECM520R0

June 2010

HAART BEATS

Turning Results Into Reality

Siri Stafford

After two studies show the effectiveness of the drug Truvada in preventing HIV among high-risk heterosexuals, experts seek to turn that good news into action over 4,700 kenyan and ugandan heterosexual serodiscordant couples—in which one partner is HIV-positive and the other is negative—took part in a recent trial studying the effectiveness of pre-exposure prophylaxis, a.k.a. PrEP, the use of HIV medication by those who are not HIV-positive as a prevention measure.

One third of uninfected partners were given a placebo, another third the drug tenofovir (Viread), and the final third took Truvada, a pill that contains tenofovir and the drug emtricitabine. The results, released in July, were staggering: Compared to those

on the placebo, those taking tenofovir had a 62% lower transmission rate, and the Truvada users had 73% fewer transmissions.

Researchers behind the study, sponsored by the University of Washington, stopped the trial, declared the PrEP therapy an unequivocal benefit, and distributed the drugs to all participants. Another recent study, sponsored by the U.S. Centers for Disease Control and Prevention, distributed Truvada to certain high-risk heterosexual HIV-negative individuals in Botswana. Although that study had a smaller group of participants at 1,200, the numbers were still extremely

encouraging, with 62% fewer new HIV cases among those receiving the drug than those given a placebo.

Back in America, many hope the results will eventually lead to Truvada distribution to all serodiscordant couples and other highrisk individuals. Recent studies have already shown that the PrEP therapy is effective in transgender women and men who have sex with men. But Mitchell Warren, executive director of the New York–based AIDS Vaccine Advocacy Coalition, says widespread distribution of Truvada will likely not happen overnight.

There are two reasons for restraint, according to Warren. First, the two successful studies follow a trial that was stopped for the opposite reason that the recent couples’ trial was halted—the drug didn’t seem to work with high-risk heterosexual African women. Second, budgets are an issue. As AIDS Drug Assistance Programs are cut across the country, it’s hard to conceive of states having the money to distribute Truvada widely.

“There’s a kind of champagne celebration on one hand and a hangover on the other, because there’s a tremendous burden on our system on how to implement this,” Warren says.

The issue of cost is one that’s already being addressed, according to a report from Project Inform, a San Francisco-based HIV organization. Following the successful trials of PrEP for gay men, the CDC began initiating discussions with insurers, some of which demonstrated “a willingness to reimburse PrEP in the limited circumstances described by the CDC’s interim guidance,” while Gilead, the maker of Truvada, has shown interest in implementing a patient assistance program akin to ADAPs, which are currently used by tens of thousands of people.

Lisa Sterman, a San Francisco–based physician and board member for the San Francisco AIDS Foundation, is convinced of Truvada’s benefit and already prescribes it to high-risk patients. While she’s careful to ask potential users about diabetes history and kidney problems—conditions she says can be exacerbated by Truvada—Sterman believes the drug is an obvious choice for those regularly exposed to HIV and that the results of the unsuccessful PrEP trial were likely due to spotty adherence. “[PrEP] works if people comply with it,” she says. “I think it works 99% of the time if used properly.” ✜

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41

HAART BEATS

Bridging the Gap When it comes to HIV and violence, educated pros are few and far between

Age Acceleration

The antiretroviral drugs you take to stay healthy may hasten the natural aging process antiretroviral medications have allowed HIVers to live longer and manage their viral load, but the drugs also sometimes have harmful, toxic side effects. A recent example comes from new research by the Institute of Genetic Medicine at the U.K.’s Newcastle University, which indicates that the older antiretrovirals are primary culprits in premature aging.

Aging is simply a process of naturally occurring errors on a microscopic level, says Newcastle University professor Patrick Chinnery, MD. As we age, our DNA’s mitochondria—the “batteries” that power our cells—get copied repeatedly, leading to so-called natural errors. Essentially, that’s the process of aging, which leads to frailty, dementia, cardiovascular disease, and other age-related afflictions. Research from Chinnery’s team shows that older antiretroviral drugs, like zidovudine (AZT), accelerate the rate at which the errors accumulate.

“So over the space of, say, 10 years, a person’s mitochondrial DNA may have accumulated the same amount of errors as

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a person who has naturally aged 20 or 30 years,” Chinnery said. “What is surprising, though, is that patients who came off the medication many years ago may still be vulnerable to these changes.”

These older drugs are less commonly used in the United States and Europe due to concerns about toxicity. But because these drugs are less expensive than when they were introduced, people in low-income countries have become their primary consumers.

Brendan Payne, MD, a British HIV specialist and coauthor of the study, said that these drugs, even with their side effects, still have been able to help countless lowincome people manage their HIV. “These drugs may not be perfect, but we must remember that when they were introduced they gave people an extra 10 or 20 years when they would otherwise have died,” he said. “In Africa, where the HIV epidemic has hit hardest and where more expensive medications are not an option, they are an absolute necessity.”

from top: Stockby te, Photodisc; opposite page (from top): Brand X Pic tures, Dynamic Graphics

Every year for the past six years, University of Maryland law professor Barbara Olshansky has taken law and social work students to Africa to teach them how to effectively care for HIVpositive victims of domestic violence and sexual assault. Olshansky’s goal is to teach people early in their careers that violence aimed at women with HIV is an issue that has gone unaddressed far too long, especially in regions where rape is common as a political weapon.

While definitive data on such violence and its relation to HIV is rare, existing research does show that violence can limit a woman’s ability to follow infection prevention measures, including something as simple as making regular visits to a doctor.

“The very, very first step is to make sure the woman has received medical treatment,“ says Olshansky, “because frequently they are terrified and might not have even seen a doctor.”

Additionally, women in violent environments have a higher chance of engaging in risky behavior; they may be fearful of refusing sex with their partners and may not insist on using condoms.

Olshansky’s work, which includes educating caregivers from doctors and lawyers to social workers and shock trauma specialists, was recently put to further use in providing information for a symposium at the university about the effects of domestic violence among HIV-positive women.

Held June 29, “Secret Killer in HIV: Gender Violence” helped the university begin work on a treatment model that participants hope will allow care workers to better manage cases of partner violence involving those affected

by HIV. Jody Olsen, a professor at the university’s School of Social Work, believes the model “will better put words into actions to reduce fears. This is about family and community and a whole set of fractured disciplines trying to make an action whole.”

All Aboard

Antiretroviral drugs are becoming more available around the world, but not all are being administered correctly in 2010 an estimated 5 million people were taking antiretroviral medication to manage their HIV. In the U.S., those who are diagnosed early and start drug therapy upon diagnosis carry a near-zero chance of passing the virus on to a sexual partner. And while much more of the global population has access to medication than ever before, the level of care varies widely. With that disparity comes varied levels of concern for the safety of HIVers on antiretroviral therapy.

A study published in July and funded by the Bill and Melinda Gates Foundation found that more oversight is crucial on matters such as inappropriate use, drug interactions, toxicity, and substandard drugs, given the broadening pool of antiretroviral medication recipients.

The Forum for Collaborative HIV Research—which studies topics including drug side effects, new clinical trial designs, and how to make HIV testing universally available—had the task of advising drugmakers, government agencies, and others how best to assure

Stop Diabetes Before It Starts HIVers using certain treatment regimens should also watch their insulin levels

people with hiv who are currently on older antiretroviral therapy may want to also keep tabs on the possibility of becoming diabetic or talk to their doctor about updating their treatments.

A new study by St. Luke’s-Roosevelt Hospital Center and Columbia University in New York City recommends that people with HIV be screened for diabetes routinely when starting antiretroviral therapy, with a follow-up three to six months later, and then annually. The study authors, who reviewed previous research on HIV and diabetes, made this recommendation because the rate of diabetes among HIVers on protease inhibitors is between 7% and 13%, compared to around 3% for previously untreated

people with HIV, according to The AIDS Beacon.

Not all treatments had the same correlation with diabetes. Among protease inhibitors, Crixivan was linked to a higher risk of diabetes, while Reyataz appeared to have no link. For Kaletra, some research showed it to be associated with a higher risk of insulin resistance, one of the indicators of diabetes, while other studies showed no effect.

Other classes of drugs, particularly older nucleoside reverse transcriptase inhibitors like Zerit, Retrovir, and Videx, may also increase the chances of becoming diabetic. Some research found that the risk of high insulin levels increased 8% annually with NRTI use.

However, the newer NRTI Viread, which is also a component of Atripla and Truvada, has not been tied to heightened risk of diabetes.

The International AIDS Society has specific advice for HIVers trying

safety and proper use of antiretrovirals.

“Loss of confidence in the safety of [antiretrovirals] could lead to poor adherence and the emergence of drug resistance, reduced demand for therapy, or inappropriate switching to more toxic or expensive medicines,” researchers noted in the report. In other words, if HIVers can’t be certain their meds are safe, they’re less likely to take them in the most effective manner.

The forum’s message is clear: Health officials, regardless of nation, need to be heard on how to properly maintain antiretroviral effectiveness.

“Many stakeholders with substantial interests are still not routinely at the table. Most prominently, the pharmaceutical industry, both innovator and generic, are not included,” researchers noted. Given their multibillion-dollar investment in the war on HIV, drug companies need to play a greater role in ensuring that medications are taken safely and properly. Such vigilance is “inextricably intertwined” with HIV research on a global scale, they wrote.

to avoid diabetes; among them, it encourages doctors to monitor a patient’s glucose and lipid levels before and during antiretroviral treatment. It also recommends that patients with a family history of diabetes be tested and, if they have the disease, manage it with a healthy diet and regular exercise (and medication, if needed).

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Vision/Krasnig

MIND + MOOD

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Gary McClain, Ph.D.

Open Your Eyes

Stress and sadness can make the first part of your day the hardest— here’s how to get up and get moving “the alarm goes off and I just can’t drag myself out of bed.”

I hear this a lot. Clients I’ll call Nate, Jen, and Carlos have told me this recently. Nate received his HIV diagnosis a couple of months ago and is still adjusting to it emotionally. Jen is in the process of rebuilding her life after breaking up with her partner. Carlos has been living with HIV for 20 years but is now on disability benefits and doesn’t know what to do with his time.

What about you? How often do you have trouble getting motivated in the morning? For better or worse, the day doesn’t really get under way until you are out of bed. So if you are stuck there, chances are you’re going to lose an important chunk of your day and spend what’s left of it in catch-up mode.

Here are a few techniques to help yourself make that first big move:

Andersen Ross

First, take a look at your selftalk. Each day can be a celebration of life. It starts with deciding to focus on what’s working in your life instead of what’s not working; being open to exploring what’s possible; embracing the people who matter the most and keeping them close; and giving yourself credit for doing the best you can in spite of life’s challenges. Toss all of this into your mental blender and give yourself a motivational boost before boosting yourself out of bed.

Create an incentive for getting up. Purchase a coffeepot with a timer so that you can set it like an alarm clock each night. If you

aren’t into java, find something else to look forward to, even a favorite TV or radio show that might make the morning a little easier to face. Or what about that nice hot shower? Some quiet time to think and get yourself centered? Toast with strawberry jam?

Reframe “I have to” as “I chose to.” If you have a family or a job (or both), then I suspect that you have responsibilities that ultimately force you out from under the covers. But ask yourself, Is there a labor of love somewhere in the middle of all of those obligations—a greater choice that I made? Consider the quality time in the morning with your partner.

The joy of getting the kids ready for the day. Taking your dog for a walk. Greeting a coworker you enjoy being with. Knowing that the job you are going to, even if you don’t love it, is financially providing what you need in life.

Focus less on the tasks and more on the purpose that drives you to get them done. Also, consider adding more purpose to your life.

Maybe it’s time to do some volunteering that requires you to be there early.

Enlist a support team. Is there someone you can make a deal with to call you in the morning?

Maybe a sponsor or a relative?

There’s nothing like a few words of encouragement or some tough love to help start the day.

Plan ahead. Before you go to bed at night, make a list of what you want to accomplish the next day.

One of the advantages of making

a list is to be able to decide what you want to get done and what you can postpone. Keep it simple.

Don’t forget to add something you enjoy to the list.

Fake it till you make it. Sometimes getting up in the morning is a rational decision, something that you choose to do because you have to. If you wait until you feel like getting up, you might just decide you don’t feel like it. Using a little tough love with yourself might help. And keep in mind that positive actions can create positive energy, so look at your getting-up routine as an opportunity to build some forward momentum into your life.

Get help if you’re still not feeling it. If you are suffering from anxiety or depression, getting up in the morning isn’t a matter of willpower. Not being able to get out of bed in the morning can literally be impossible due to a combination of emotional, cognitive, and physical symptoms that leave you feeling like you’re glued to the mattress. If this describes you, then it’s time to reach out to your health care team—let them know what’s going on.

This is your wake-up call.

Don’t miss out on the opportunities that each day brings by hiding under the covers.

McClain is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

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MESSAGE IN A BOTTLE

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River Huston

Paradise Found

Steve Mason

River Huston traveled to the Virgin Islands two decades ago for what she thought was her last vacation. Now she’s back in the Caribbean, still HIV-positive, and still looking for answers i live in paradise, the place people dream of, spend thousands of dollars to visit, and about which they often say, “I could stay here forever.”

I came to the Virgin Islands 20 years ago when I first found out I was HIV-positive.

Living in New York City, there were always posters of the white sand beaches, turquoise oceans, and palm trees—so I took my savings and planned a trip. Visiting a Caribbean island pictured on one of those posters was on my list of things to do before I left the planet. At that time, there was no effective treatment for HIV and you were simply expected to die.

Twenty years ago in the islands, I sat in meditation and had no outside distractions.

I saw that I could be cruel and unforgiving, relentless in my critical thinking about myself. I felt those personality traits slough off, go out with the tide, and be replaced with forgiveness, kindness, and the ability to be in the moment.

Back in New York, I accomplished much in two decades: I wrote books of poetry and a book on women and HIV. I also wrote a onewoman show, performed around the world, became an international speaker and columnist. And I married an amazing man.

I worked seven days a week, 12 to 14 hours every day. I was living like I was going to die soon and needed to finish all these tasks.

I loved what I was doing but seldom deviated from my objectives. My critical nature had resurfaced without the tides to wash it away. I forgot to stay in the moment, trying to keep momentum before it was all over. I was watching my body swiftly deteriorate and was in need of weekly IVs and strong medications.

A couple of years ago, the life my husband and I had built in New York fell apart.

My husband tried running his own business, but when it failed it took our savings, our credit, and our credibility. He was crushed, I was depressed, and we were broke. I started to dread my work. I felt like a hypocrite talking about joy and happiness while inside I

was dying. It was ironic, because at this point my body had begun to stabilize. We went through bankruptcy and foreclosure. Do we work to get it all back? Is that what life is about—owning things? I had to do something drastic to find my purpose again. With my husband’s reluctant support, I took some of the money we had left and returned to paradise in the Virgin Islands.

I’ve confronted my demons again in the eight months I’ve been here. While I had learned to forgive myself in the first trip, I had not always forgiven others. I was kind and gentle with myself but rigid about others’ failures. Sometimes I lie awake at night listening to the waves, wondering how this could be.

Each day I walk to the beach, then come back up to my small apartment in the west end of St. Thomas. I swim and I meditate. The same answers come to me every day. They are about being of service and writing. I bring my laptop to the deck, search through the memories of my life, and try to put them on paper.

I speak to my husband two or three times a day and now see how much I love him. I want him to come down here, but he found his own dream and is pursuing that. I see him every month when I go to work in the States. It is an unconventional relationship, but it works.

I wonder why I’m here, why any of us are.

I think of my friend Mike, who had HIV as long as I did, 26 years, and how he recently dropped dead of a heart attack the night before his one-man show was to open. Sometimes life makes no sense. So I meditate more and find gratitude in having lived so long when others have passed. I work to find a place for myself in this world, learning to think less about myself and more of myself.

River Huston is the codirector of Sevenminusseven, an alternative arts alliance in St. Thomas. When she’s not traveling around the U.S. doing performances and presentations, she spends her days on the island, painting, writing, and walking her small, ancient dog, Buddy. Read more about Huston at RiverHuston.com.

september /october 2011 HIV PLUS

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47

STATUS ASK + SYMBOLS TELL

to take anyone’s inspiration—I’m an artist and a designer that loves collaboration. All I know for sure is there will be lots of color and the mural will be encouraging and uplifting but also very direct.

You’re working on Color Splash as well as the new show HGTV’d, and you’re also a mentor on Design Star.

Where do you get the energy to do so much and still manage to give back to the community? I don’t know where the energy comes from. [Laughs] It’s probably just the result of such great things happening all around. Because there are so many amazing things in my life, I felt the need to reach out and do this. It’s an important subject that affects every single person out there. And I’m happy to be able to bring more awareness to it.

Is the “Know Yourself” initiative aimed primarily at gay men? It is, but only because I’m gay and I know gay men better than any [other group]. But it’s really meant to bring awareness to everybody about the importance of getting tested.

david bromstad, the host of HGTV’s Color Splash, wants everyone to know their HIV status. To elevate public awareness about the importance of regular testing, the celebrity designer is teaming up with Janssen Therapeutics to promote the “Know Yourself: Get HIV Tested” initiative.

Drawing upon his art skills, the Miami-based Bromstad will create a mural to be unveiled at an event in September in New York City in recognition of National Gay Men’s HIV/AIDS Awareness Day. —Winston Gieseke How did you get involved with “Know Yourself: Get HIV Tested?” I had the honor of appearing in an HIV educational video with Janssen Therapeutics, and that’s where we linked up. It was a nice transition from doing the video and talking about something I was very passionate about to doing something I’m very passionate about.

What’s great about this is that I’ll be able to help get the word out in the way I know best—through creative means.

What are your hopes for the program?

I want people to be encouraged and know that getting tested is just something they

need to do to maintain their health. It’s like brushing your teeth—not doing it shouldn’t be an option. I want people to get out there, get tested, and be healthy. Because if they know their status and they’re healthy, the people they have sex with will be healthy as well. It doesn’t look like HIV will be going away anytime soon, but ignoring it is definitely not the right choice.

You’re creating a mural for the New York event? Yes. And I am looking to my fans to give me some advice on how they think it should look via my Facebook artist page or Twitter.com/bromco. I’ll be glad

48 | H I V P L U S s e p t e m b e r / o c t o b e r 2 0 1 1

When were you first personally impacted by HIV/AIDS? My second boyfriend and I were together five years.

His best friend had HIV, and I watched him struggle with his medicines. At the time, the medicine was really hard on the body. But he’s doing great now. He’s living a healthy lifestyle, and over the years I’ve seen him go from a handful of pills down to one pill, which is really amazing.

What do you see as the biggest hurdle in the epidemic? I think people are lazy, honestly. I think they’re like, Well, it’s a manageable disease—therefore I don’t have to protect myself. If worst comes to worst, all I have to do is pop that pill. And that is just not the way to live. No one wants to live with a condition that requires daily medication. It’s hurtful to the body. [The medicines do] great things when you have HIV, but do you really want to have that as an option when you can just slap a condom on? ✜

photo courtesy subjec t

Designing for Life

When did you first get involved in the fight against AIDS? I think the fight begins when you get tested the first time. It’s a very scary thing to do, especially when you’re young. I remember back in the day it took two weeks to get your results, and those were the worst two weeks ever. For me, the fight’s been going on ever since.