HIV Plus Magazine #89 by Pride Media

THE 2012 HIV TREATMENT GUIDE New Medications Coming Soon +

ADAP State-by-State +

Is Acupuncture Safe?

Over 100 drugs & therapie s!

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

Friends or Frenemies? One woman reconciles her complicated relationship with her meds

the voiceâ&#x20AC;&#x2122;s JAMAR RogeRs: the new FACe OF hIV In AmerICA

Celebrity Apprentice Comic Lisa Lampanelli may have lost but she won us tons of money

jULy/AUgUST 2012

www.hivplusmag.com

www.egrifta.com

Actual Actualpatient patientliving living with withHIV HIVsince since1996 2000

YOU’VE WORKED TO CONTROL YOUR HIV. NOW, TIME TO WORK ON YOUR

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 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 111122-103209 12/11

• 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).

T:7 in 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 hormone-releasing 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 have 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: – redness – bleeding – itching – rash – pain – swelling – irritation The most common side effects of EGRIFTA® include: – joint pain – nausea – pain in legs and arms – vomiting – swelling in your legs – rash – muscle soreness – itching – 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 the 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

T:9.75 in

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

S:9.375 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)

in this issue

July+August 2012

the annual treatment guide

6 Medication by the numbers An in-depth map of the FDA-approved drugs used to treat HIV or HIVrelated complications. This includes photos, dosages, interactions, and recomendations, as well as how each medication works.

22 alternative and complementary medicine From yoga to zinc, acupuncture, prayer, and bitter melon—which alternative treatments help with symptoms of HIV, and which might just be a danger to your health and your pocketbook?

23 Investigational medicine A look at the medications undergoing clincial trials, what’s been approved, and which new discoveries just might be making their way into your medicine cabinet this year.

36 How to pay for your meds Having trouble footing the pharmacy bills? A federally-mandated, statemanaged program called AIDS Drug Assistance Program (or ADAP) can help. Our state-by-state pull-out guide lists income limits for your area, as well as contact information you’ll need to apply.

you 2.0 45 Beating back the blues An ancient practice is the new natural way to stop yourself from falling back into depression.

38 Jamar Rogers,

The Voice of a Nation

45 When it’s not just anxiety

clock wise from top: courtesy nbc/universal; photos.com; courtesy subjec t

How to know when you need help.

columns 46 message in a bottle Sometimes you just want to curl up and hide, but skipping your meds isn’t the answer, says columnist River Huston. Find out how she made her regime work and you can too.

He stole our hearts (and Cee Lo’s attention) on NBC’s The Voice, but reality TV is just the start for this HIV-positive musical sensation. Rogers talks about his former addictions, how music saved him, and why helping others is as important as his career.

Celebrity Apprentice’s HIV Activist, Comic Lisa Lampinelli

Sure, she might be best known for her ribald humor and pointed barbs, but with one fell swoop she became one of Gay Men’s Health Crisis biggest celebrity donors. We chat with the comic about where that money goes, her crazy life on the road, and why she sometimes jokes about HIV.

Editor's LEttEr

EdItor In CHIEF

Diane Anderson-Minshall

MAnAgIng EdItor Neal

Broverman Scott McPherson dIgItAL EdItor Michelle Garcia CoPy EdItor Trudy Ring ContrIButIng EdItor Michael Matson CrEAtIVE dIrECtor

MAnAgEr, EdItorIAL And MArkEtIng oPErAtIonS

Charles Culbert

PuBLISHEr

Joe Valentino

IntEgr AtEd AdVErtISIng MAnAgEr

Steven O’Brien Shamila Siddiqui

AdVErtISIng And MArkEtIng MAnAgEr

Kevin Stec Robbie Imes IntEgr AtEd MArkEtIng MAnAgEr Stephanie Block SEnIor IntEgr AtEd MArkEtIng MAnAgEr

SEnIor MAnAgEr, IntEgr AtEd MArkEtIng

dIrECtor, PuBLIC rELAtIonS And

HERE MEDIA CHAIrMAn

Stephen P. Jarchow CeO Paul Colichman CFo Tony Shyngle CPO Robert Ames

Mark Umbach Robert Hébert SEnIor dIrECtor, CLIEnt SErVICES Stewart Nacht

CorPorAtE CoMMunICAtIonS IntErACtIVE Art dIrECtor

ExECutIVE VICE PrESIdEnts and General manaGers

Stephen Macias, Bernard Rook Landry AdVoCAtE grouP EdItorIAL dIrECtor Matthew Breen SEnIor VICE PrESIdEntS Christin Dennis, Alex Paul, Josh Rosenzweig VICE PrESIdEntS Eric Bui, Steven Capone, Mike Dubin, Joe Valentino LEAd WEB ArCHItECt & dE VELoPEr Peter Di Maso CrEAtI VE dIrECtor, dIgItAL MEdIA Dave Johnson dIrECtor, dIgItAL MEdIA, dE VELoPMEnt Lisa Brown SEnIor onLInE ProduCEr Christopher Harrity WEB ProduCtIon CoordInAtor Joe Okonkwo SEnIor VICE PrESIdEnt & grouP PuBLISHEr Joe

Jeff Lettiere Argus Galindo

dIrECtor oF CIrCuLAtIon FuLFILLMEnt MAnAgEr

ProduCtIon MAnAgEr

Kevin Roff

AdVErtISIng ProduCtIon MAnAgEr

Heidi Medina

advertising & subscriptions offices P.O. Box 1253, Old Chelsea Station, New York, New York 10113-1251 Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 242-8100, Ext. 19 • Subscriptions Fax (212) 242-1344 editorial offices 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email mail@HIVPlusMag.com

DISTRIBUTE HIV PLUS FOR FREE AT YOUR OFFICE OR FACILITY aIds service organizations, community-based groups, pharmacies, physicians’ offices, and other qualifying agencies can request bulk copies for Free distribution at your office or facility. log on to HIVPlusmag.com and select “organization copies” on the “subscribe” link at the top of the page to download a copy request form. There is a 10-copy minimum. FREE INDIVIDUAL SUBSCRIPTIONS HIV Plus magazine is now available Free to individual subscribers. subscribe and get a digital copy of each magazine delivered to the privacy of your computer six times per year. We require only your email address to initiate delivery. You may also share your copies with friends. To sign up, just log on to HIVPlusmag.com and select “individual subscriptions” on the “subscribe” link at the top of the page. 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.

Bitter Pill

admit it, there's something so unsexy about taking medication. the older I get the more meds I take, but in reality, I'm not all that uncommon. nearly half of all Americans take prescription medications and 70% use some form of alternative therapy. And for people with some conditions, like HIV, medication can literally be the difference between life and death. that's why our HIV Plus team is proud to release our biggest annual treatment guide, with detailed information on the 65 FdA-approved drugs for HIV and its complications. We also analyze the most common alternative therapies and look at upcoming investigational drugs. It's a heady time for HIV medicine: possible preventive use of truvada, likely approval of the oraQuick home test, the invention of Quad (the first four-drugs-in-one pill). But in the end, it all comes down to people—and how we approach the less-than-exciting task of adhering to drug regimens, managing our health care needs, and keeping ourselves happy, healthy, and safe. Come to think of it, that's kind of sexy, isn't it?

KINA WILLIAMS

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. 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 © 2012 by Here Publishing Inc. All rights reserved. Printed in the uSA.

diane Anderson-Minshall Editor in ChiEf

j u ly/a u g u s t 2 0 1 2 •

hiv plus

The most comprehensive look at medications approved by the Food and Drug Administration for treatment of HIV and the opportunistic infections that sometimes come with it.

Please note that before starting any new drug, you should tell your doctor what other medications you take, both prescription and nonprescription, as well as vitamins, nutritional supplements, and herbal products, and what other health conditions you have. Also, disclose if you smoke or otherwise consume tobacco products, drink alcoholic beverages, or use recreational drugs—these substances often interact badly with HIV meds. And tell your doctor if you are pregnant, if you or your partner plan to become pregnant, and if you are breast-feeding. Some of these medications are safe to take when pregnant or breastfeeding, but many are not. So always check with your physician. This information was culled from the National Institutes of Health’s drug database and the individual pharmaceutical companies. All dosages listed are for adults. Researched and Compiled by Diane Anderson-Minshall, Neal Broverman, Trudy Ring, Michelle Garcia, Lucas Grindley, and Joshua Hinkle 6

hiv plus

• j u ly/a u g u s t 2 0 1 2

Combination Drugs

[Help prevent replication of HIV] MEDICATION NAME Generic Name

TRADITIONAL DOSAGE

Maker

ATRIpLA efavirenz, emtricitabine, and tenofovir disoproxil fumarate Bristol-Myers Squibb

COMpLERA emtricitabine, rilpivirine, and tenofovir disoproxil fumarate Gilead

DRuG INTERACTIONS, pRECAuTIONS, & RECOMMENDATIONS

SIDE EFFECTS

One tablet, containing 600 mg of efavirenz, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate, once daily, on an empty stomach at the same time every day, preferably at bedtime

Efavirenz is a nonnucleoside reverse transcriptase inhibitor (NNRTI), the other components nucleoside reverse transcriptase inhibitors (NRTIs); the different types of drugs attack HIV at different stages in its replication process. Do not take Atripla with anti-HIV drugs Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Sustiva, Trizivir, Truvada, or Viread, which have the same or similar active ingredients. Do not take with Vascor, Propulsid, Versed, Orap, Halcion, ergot medications (such as Wigraine and Cafergot), Vfend, Hepsera, or the herbal remedy Saint-John’s-wort. Use with caution with Fortovase, Invirase, Videx, Reyataz, Kaletra, Crixivan, Selzentry, Biaxin, Noxafil, Sporanox, calcium channel blockers (such as diltiazem and verapamil, which have various brand names), immunosuppressant drugs (such as cyclosporine, tacrolimus, and sirolimus, sold under various brand names), methadone, Mycobutin, Rifadin, Rimactane, Lipitor, Pravachol, Zocor, Zoloft, or seizure meds (such as phenytoin, carbamazepine, and phenobarbital). If you have hepatitis B and stop taking Atripla, you may experience a flare-up of the disease.

Most serious: buildup of lactic acid in the blood, severe liver or kidney problems, serious psychiatric problems, thinning bones Other: dizziness, headache, insomnia, drowsiness, trouble concentrating, unusual dreams, fatigue, upset stomach, nausea, vomiting, gas, diarrhea

One tablet, containing 200 mg of emtricitabine, 25 mg of rilpivirine, and 300 mg of tenofovir disoproxil fumarate, once daily, with a meal

Rilpivirine is an NNRTI, the other components NRTIs. Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, and Trizivir), other HIV antiretroviral medications, drugs to treat seizures or tuberculosis, proton-pump inhibitors, Hespera, Saint-John’s-wort, or more than one dose of dexamethasone. Use caution when taking antacids, antifungal medications, H2-receptor antagonists, antibiotics, or methadone.

Most serious: buildup of lactic acid in the blood, severe liver problems, hepatitis B virus infection flare-ups, depression, bone thinning, and changes in the immune system Other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, and skin discoloration

j u ly/a u g u s t 2 0 1 2 •

hiv plus

COMPLERA (emtricitabine/rilpivirine/tenofovir disoproxil fumarate) is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV medicines before. COMPLERA does not cure HIV or AIDS or help prevent passing HIV to others.

The

one

for me

Patient model. Pill shown is not actual size.

INDICATION COMPLERA® (emtricitabine 200 mg/rilpivirine 25 mg/tenofovir disoproxil fumarate 300 mg) is a prescription HIV medicine that contains 3 medicines, EMTRIVA® (emtricitabine), EDURANT™ (rilpivirine), and VIREAD® (tenofovir disoproxil fumarate) combined in one pill. COMPLERA is used as a complete single-tablet regimen to treat HIV-1 infection in adults (age 18 and older) who have never taken HIV medicines before. COMPLERA does not cure HIV and has not been shown to prevent passing HIV to others. It is important to always practice safer sex, use latex or polyurethane condoms to lower the chance of sexual contact with any body fluids, and to never re-use or share needles. Do not stop taking COMPLERA 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 while taking COMPLERA: • 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 (hepatotoxicity), with liver enlargement (hepatomegaly), and fat in the liver (steatosis) • If you have HIV-1 and hepatitis B virus (HBV), your liver disease may suddenly get worse if you stop taking COMPLERA. Do not stop taking COMPLERA without ﬁrst talking to your healthcare provider. Your healthcare provider will monitor your condition COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works, and may cause serious side effects.

Do not take COMPLERA if you are taking the following medicines: • other HIV medicines (COMPLERA provides a complete treatment for HIV infection.) • the anti-seizure medicines carbamazepine (Carbatrol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®, Epitol®), oxcarbazepine (Trileptal®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®) • the anti-tuberculosis medicines rifabutin (Mycobutin), rifampin (Rifater®, Rifamate®, Rimactane®, Rifadin®) and rifapentine (Priftin®) • a proton pump inhibitor medicine for certain stomach or intestinal problems, including esomeprazole (Nexium®, Vimovo®), lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole sodium (Protonix®), rabeprazole (Aciphex®) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate • St. John’s wort (Hypericum perforatum) • other medicines that contain tenofovir (VIREAD®, TRUVADA®, ATRIPLA®) • other medicines that contain emtricitabine or lamivudine (EMTRIVA®, Combivir®, Epivir® or Epivir-HBV®, Epzicom®, Trizivir®) • rilpivirine (Edurant™) • adefovir (HEPSERA®) In addition, also tell your healthcare provider if you take: • an antacid medicine that contains aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA • a histamine-2 blocker medicine, including famotidine (Pepcid®), cimetidine (Tagamet®), nizatidine (Axid®), or ranitidine hydrochloride (Zantac®). Take these medicines at least 12 hours before or at least 4 hours after you take COMPLERA • the antibiotic medicines clarithromycin (Biaxin®), erythromycin (E-Mycin®, Eryc®, Ery-Tab®, PCE®, Pediazole®, Ilosone®), and troleandomycin (TAO®) • an antifungal medicine by mouth, including fluconazole (Diflucan®), itraconazole (Sporanox®), ketoconazole (Nizoral®), posaconazole (Noxafil®), voriconazole (Vfend®) • methadone (Dolophine®) 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.

Save up to

200

per month

COMPLERA.

You may be able to save on the co-pay for your COMPLERA prescription with a Gilead HIV Co-pay Assistance Card. Call 1-877-505-6986 for more information or visit www.COMPLERA.com.*

A complete HIV treatment in only 1 pill a day. Ask your healthcare provider if it’s the one for you.

Before taking COMPLERA, tell your healthcare provider if you: • have liver problems, including hepatitis B or C virus infection • have kidney problems • have ever had a mental health problem • have bone problems • are pregnant or plan to become pregnant. It is not known if COMPLERA can harm

your unborn child • are breastfeeding; women with HIV should not breast-feed because they can pass HIV through their milk to the baby Contact your healthcare provider right away if you experience any of the following serious or common side effects: Serious side effects associated with COMPLERA: • New or worse kidney problems can happen in some people who take COMPLERA. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA • Depression or mood changes can happen in some people who take COMPLERA. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, or if you have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones • Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long-term health effect of these conditions are not known • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine

Common side effects associated with COMPLERA: • trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression Other side effects associated with COMPLERA: • vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles),

and pain 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 COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider for medical advice about side effects. 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. Take COMPLERA exactly as your healthcare provider tells you to take it • Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to

help get the right amount of medicine in your body. A protein drink does not replace a meal • Stay under the care of your healthcare provider during treatment with COMPLERA and see your healthcare provider regularly

Please see Patient Information for COMPLERA on the following pages. *The co-pay program covers up to $200 per month for 1 year from card activation or until the card expires, up to $2400 in a calendar year. The program is subject to change or cancellation at any time.

Learn more at www.COMPLERA.com

FDA-Approved Patient Labeling Patient Information COMPLERA® (kom-PLEH-rah) (emtricitabine, rilpivirine and tenofovir disoproxil fumarate) Tablets

COMPLERA may help: • Reduce the amount of HIV in your blood. This is called your “viral load”. • Increase the number of white blood cells called CD4+ (T) cells that help fight off other infections.

Important: Ask your doctor or pharmacist about medicines that should not be taken with COMPLERA. For more information, see the section “What should I tell my healthcare provider before taking COMPLERA?”

Reducing the amount of HIV and increasing the CD4+ (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections).

Read this Patient Information before you start taking COMPLERA and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment. What is the most important information I should know about COMPLERA?

COMPLERA does not cure HIV infections or AIDS. • Always practice safer sex. • Use latex or polyurethane condoms 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 about how to prevent passing COMPLERA can cause serious side effects, including: 1. Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in HIV to other people. some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic Who should not take COMPLERA? acidosis is a serious medical emergency that can lead to death. • Do not take COMPLERA if your HIV infection has been previously treated with Lactic acidosis can be hard to identify early, because the symptoms could seem like HIV medicines. symptoms of other health problems. Call your healthcare provider right away if you • Do not take COMPLERA if you are taking certain other medicines. For more get any of the following symptoms which could be signs of lactic acidosis: information about medicines that must not be taken with COMPLERA, see “What • feeling very weak or tired should I tell my healthcare provider before taking COMPLERA?” • have unusual (not normal) muscle pain • have trouble breathing What should I tell my healthcare provider before taking COMPLERA? • have stomach pain with Before you take COMPLERA, tell your healthcare provider if you: - nausea (feel sick to your stomach) • have liver problems, including hepatitis B or C virus infection - vomiting • have kidney problems • feel cold, especially in your arms and legs • have ever had a mental health problem • feel dizzy or lightheaded • have bone problems • have a fast or irregular heartbeat • are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child Pregnancy Registry. There is a pregnancy registry for women who take antiviral medicines during pregnancy. Its purpose is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry. Call your healthcare provider right away if you have any of the following symptoms • are breast-feeding or plan to breast-feed. The Centers for Disease Control and of liver problems: Prevention recommends that mothers with HIV not breastfeed because they can pass • your skin or the white part of your eyes turns yellow (jaundice). the HIV through their milk to the baby. It is not known if COMPLERA can pass through • dark “tea-colored” urine your breast milk and harm your baby. Talk to your healthcare provider about the best • light-colored bowel movements (stools) way to feed your baby. • loss of appetite for several days or longer Tell your healthcare provider about all the medicines you take, including prescription • nausea and nonprescription medicines, vitamins, and herbal supplements. • stomach pain 2. Severe liver problems. Severe liver problems can happen in people who take COMPLERA or similar medicines. In some cases these liver problems can lead to death. Your liver may become large (hepatomegaly) and you may develop fat in your liver (steatosis) when you take COMPLERA.

You may be more likely to get lactic acidosis or severe liver problems if you are COMPLERA may affect the way other medicines work, and other medicines may female, very overweight (obese), or have been taking COMPLERA or a similar affect how COMPLERA works, and may cause serious side effects. If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and medicine containing nucleoside analogs for a long time. it may not work to help control your HIV infection. The HIV virus in your body may become 3. Worsening of Hepatitis B infection. If you also have hepatitis B virus (HBV) infection resistant to COMPLERA or other HIV medicines that are like it. and you stop taking COMPLERA, your HBV infection may become worse (flare-up). A “flare-up” is when your HBV infection suddenly returns in a worse way than before. Do not take COMPLERA if you also take these medicines: COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV • COMPLERA provides a complete treatment for HIV infection. Do not take other HIV medicines with COMPLERA. therapy with your healthcare provider. • the anti-seizure medicines carbamazepine (CARBATROL®, EQUETRO®, TEGRETOL®, • Do not let your COMPLERA run out. Refill your prescription or talk to your healthcare TEGRETOL-XR®, TERIL®, EPITOL®), oxcarbazepine (TRILEPTAL®), phenobarbital provider before your COMPLERA is all gone. (LUMINAL®), phenytoin (DILANTIN®, DILANTIN-125®, PHENYTEK®) • Do not stop taking COMPLERA without first talking to your healthcare provider. ® ® • If you stop taking COMPLERA, your healthcare provider will need to check your health • the anti-tuberculosis medicines rifabutin (MYCOBUTIN ), rifampin (RIFATER , ® ® ® ® , RIMACTANE , RIFADIN ) and rifapentine (PRIFTIN ) RIFAMATE often and do regular blood tests to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking • a proton pump inhibitor medicine for certain stomach or intestinal problems, including esomeprazole (NEXIUM®, VIMOVO®), lansoprazole (PREVACID®), omeprazole COMPLERA. (PRILOSEC®), pantoprazole sodium (PROTONIX®), rabeprazole (ACIPHEX®) • more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium What is COMPLERA? COMPLERA is a prescription HIV (Human Immunodeficiency Virus) medicine that: phosphate • is used to treat HIV-1 in adults who have never taken HIV medicines before. HIV is the • St. John’s wort (Hypericum perforatum) virus that causes AIDS (Acquired Immunodeficiency Syndrome). If you are taking COMPLERA, you should not take: • contains 3 medicines, (rilpivirine, emtricitabine, tenofovir disoproxil fumarate) • other medicines that contain tenofovir (VIREAD®, TRUVADA®, ATRIPLA®) combined in one tablet. EMTRIVA and VIREAD are HIV-1 (human immunodeficiency • other medicines that contain emtricitabine or lamivudine (EMTRIVA®, COMBIVIR®, virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and EDURANT is an EPIVIR® or EPIVIR-HBV®, EPZICOM®, TRIZIVIR®) HIV-1 non-nucleoside analog reverse transcriptase inhibitor (NNRTI). • rilpivirine (EDURANT™) It is not known if COMPLERA is safe and effective in children under the age of 18 years. • adefovir (HEPSERA®)

Also tell your healthcare provider if you take: The most common side effects of COMPLERA include: • an antacid medicine that contains aluminum, magnesium hydroxide, or calcium • trouble sleeping (insomnia) carbonate. Take antacids at least 2 hours before or at least 4 hours after you take • abnormal dreams COMPLERA. • headache • a histamine-2 blocker medicine, including famotidine (PEPCID®), cimetidine • dizziness (TAGAMET®), nizatidine (AXID®), or ranitidine hydrochloride (ZANTAC®). Take these • diarrhea medicines at least 12 hours before or at least 4 hours after you take COMPLERA. • nausea ® ® ® • the antibiotic medicines clarithromycin (BIAXIN ), erythromycin (E-MYCIN , ERYC , • rash ERY-TAB®, PCE®, PEDIAZOLE®, ILOSONE®), and troleandomycin (TAO®) • tiredness ® • an antifungal medicine by mouth, including fluconazole (DIFLUCAN ), itraconazole ® ® ® (SPORANOX ), ketoconazole (NIZORAL ), posaconazole (NOXAFIL ), voriconazole • depression (VFEND®) Additional common side effects include: • methadone (DOLOPHINE®) • vomiting Ask your healthcare provider or pharmacist if you are not sure if your medicine is • stomach pain or discomfort one that is listed above. • skin discoloration (small spots or freckles) Know the medicines you take. Keep a list of your medicines and show it to your • pain healthcare provider and pharmacist when you get a new medicine. Your healthcare provider and your pharmacist can tell you if you can take these medicines with COMPLERA. Do not start any new medicines while you are taking COMPLERA 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 COMPLERA. How should I take COMPLERA? Stay under the care of your healthcare provider during treatment with COMPLERA. • Take COMPLERA exactly as your healthcare provider tells you to take it. • Always take COMPLERA with a meal. Taking COMPLERA with a meal is important to help get the right amount of medicine in your body. A protein drink does not replace a meal. • Do not change your dose or stop taking COMPLERA without first talking with your healthcare provider. See your healthcare provider regularly while taking COMPLERA. • If you miss a dose of COMPLERA within 12 hours of the time you usually take it, take your dose of COMPLERA with a meal as soon as possible. Then, take your next dose of COMPLERA at the regularly scheduled time. If you miss a dose of COMPLERA by more than 12 hours of the time you usually take it, wait and then take the next dose of COMPLERA at the regularly scheduled time. • Do not take more than your prescribed dose to make up for a missed dose. • When your COMPLERA supply starts to run low, get more from your healthcare provider or pharmacy. It is very important not to run out of COMPLERA. The amount of virus in your blood may increase if the medicine is stopped for even a short time. • If you take too much COMPLERA, contact your local poison control center or go to the nearest hospital emergency room right away. •

What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects, including: • See “What is the most important information I should know about COMPLERA?” • New or worse kidney problems can happen in some people who take COMPLERA. If you have had kidney problems in the past or take other medicines that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: - feeling sad or hopeless - feeling anxious or restless - have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do additional tests to check your bones. • Changes in body fat can happen in people taking HIV medicine. These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen. The cause and long term health effect of these conditions are not known. • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having new symptoms after starting your HIV medicine.

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 COMPLERA. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088). How do I store COMPLERA? • Store COMPLERA at room temperature 77 °F (25 °C). • Keep COMPLERA in its original container and keep the container tightly closed. • Do not use COMPLERA if the seal over the bottle opening is broken or missing. Keep COMPLERA and all other medicines out of reach of children. General information about COMPLERA: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use COMPLERA for a condition for which it was not prescribed. Do not give COMPLERA to other people, even if they have the same symptoms you have. It may harm them. This leaflet summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals. For more information, call (1-800-445-3235) or go to www.COMPLERA.com. What are the ingredients of COMPLERA? Active ingredients: emtricitabine, rilpivirine hydrochloride, and tenofovir disoproxil fumarate Inactive ingredients: pregelatinized starch, lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, magnesium stearate, povidone, polysorbate 20. The tablet film coating contains polyethylene glycol, hypromellose, lactose monohydrate, triacetin, titanium dioxide, iron oxide red, FD&C Blue #2 aluminum lake, FD&C Yellow #6 aluminum lake. This Patient Information has been approved by the U.S. Food and Drug Administration Manufactured and distributed by: Gilead Sciences, Inc. Foster City, CA 94404 Issued: August 2011 COMPLERA, the COMPLERA Logo, EMTRIVA, HEPSERA, TRUVADA, VIREAD, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc. or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other trademarks referenced herein are the property of their respective owners. © 2012 Gilead Sciences, Inc. All rights reserved. 202123-GS-000 02AUG2011 CON12383 4/12

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

PROTEASE INHIBITORS

[Help prevent replication of HIV] MEDICATION NAME Generic Name Maker

pREZISTA darunavir Janssen

REyATAZ atazanavir Bristol-Myers Squibb

ApTIvuS tipranavir Boehringer Ingelheim

hiv plus

TRADITIONAL DOSAGE

DRuG INTERACTIONS, pRECAuTIONS, & RECOMMENDATIONS

SIDE EFFECTS

Two 400-mg capsules with one 100-mg Norvir capsule, once daily, with food

Drugs in this class attack protease, which HIV needs to reproduce. Do not take Prezista with UroXatral, D.H.E. 45, Embolex, Migranal, Cafergot, Ergomar, methylergonovine, Propulsid, Orap, oral midazolam, Halcion, Saint-John’s-wort, Mevacor, Altoprev, Advicor, Zocor, Simcor, Vytorin, Rifadin, Rifater, Rifamate, Rimactane, Revatio when used to treat pulmonary arterial hypertension, Crixivan, Kaletra, Invirase, or Incivek. Use with caution if taking Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Colcrys, or ColProbenecid. May reduce birth control pills’ efficacy; take other precautions.

Most serious: severe liver disease, severe rash, high blood sugar or diabetes, changes in body fat or immune system Other: diarrhea, nausea, mild rash, headache, stomach pain, vomiting

300 mg, in capsule form, taken with 100 mg of Norvir, once daily, with food. For adults unable to tolerate Norvir, 400 mg of Reyataz with food is recommended

Do not take with Versed, Halcion. Cafergot, Migranal, D.H.E. 45, Methergine, other ergot medicines, or Orap, Camptosar, Crixivan, Mevacor, Zocor, UroXatral, Revatio, Rimactane, Rifadin, Rifater, Rifamate, SaintJohn’s-wort, Viramune, Diskus, or Advair. Do not take Vfend (voriconazole) if you are taking Reyataz and Norvir. If you are taking Videx, Videx EC, or antacids, take Reyataz two hours before or one hour after those medicines. Use with caution if taking drugs for indigestion, heartburn, or ulcers. Take Reyataz at the same time every day.

Most serious: severe rash, yellowing of skin or eyes, heart rhythm change, diabetes, kidney stones, changes in body fat, changes in immune system, worsening liver disease, increased bleeding problems, gallbladder disorders Other: nausea, headache, stomach pain, vomiting, diarrhea, depression, fever, dizziness, trouble sleeping, muscle pain, numbness, tingling, or burning of hands or feet

500 mg (two 250-mg capsules) with 200 mg (two 100-mg capsules/ tablets or 2.5 milliliters of solution) of Norvir), twice daily. Capsules or solution may be taken with or without meals; tablets must be taken with meals

Take with at least two other anti-HIV drugs, but do not use with other protease inhibitors. Use caution if taking certain antiseizure medications. Use with caution if you have hemophilia or other conditions that increase the chance of bleeding, or liver disorders.

Most serious: severe or fatal liver disease, severe bleeding in the brain, new or worsened diabetes Other: diarrhea, nausea, fever, vomiting, tiredness, headache, and stomach pain

• j u ly/a u g u s t 2 0 1 2

Crixivan indinavir Merck

Invirase saquinavir mesylate Hoffmann-La Roche

Kaletra lopinavir and ritonavir Abbott Laboratories

800 mg, taken every eight hours, with water or another beverage, without food (one hour before or two hours after a meal) or with a light meal

Do not take with oral Versed, Propulsid, Zocor, Mevacor, Orap, Cordarone, Hismanal, Halcion, Xanax, Revatio, UroXatral, Rifadin, Rimactane, Rifamate, Rifater, Saint-John’s-wort, Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate, Methergine, or Reyataz. Use with caution with Viagra, Cialis, Levitra, Lipitor, and Crestor. Drink plenty of fluids and do not take the drug with meals that are high in calories, fat, and protein.

Most serious: Liver failure, kidney stones, changes in body fat, diabetes, anemia Other: abdominal pain, fatigue or weakness, low red blood cell count, flank pain, painful urination, feeling unwell, nausea, upset stomach, diarrhea, vomiting, acid regurgitation, increased or decreased appetite, back pain, headache, dizziness, taste changes, rash, itchy skin, yellowing of the skin and/or eyes, upper respiratory infection, dry skin, sore throat

1,000 mg (five 200-mg capsules or two 500-mg tablets), in combination with 100 mg of Norvir, twice daily, at least two hours after a meal

Do not use with UroXatral, Cordarone, Vascor, Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot medications such as Parlodel, Migranal, Ergonovine, Bellamine, Cafergot, Ergomar, Methergine, or Permax, oral Versed, Orap, Rifadin, Revatio when used to treat pulmonary hypertension, Mevacor, Advicor, Zocor, Juvisync, Simcor, Vytorin, Desyrel, Oleptro, or Halcion. Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Aptivus, Rescriptor, Viramune, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, SaintJohn’s-wort, garlic capsules, hormonal contraceptives, certain calcium channel blockers, certain antibiotics and antifungal medicines, some antipsychotics or antidepressants, proton pump inhibitors. Do not use if you have severe liver problems, low potassium or low magnesium in your blood, Congenital Long QT Syndrome, or complete atrioventricular block. Use with caution if you have other heart or liver problems, hemophilia, or diabetes.

Most serious: worsening of liver problems, increased bleeding with hemophilia, diabetes or high blood sugar, elevated cholesterol or triglycerides, changes in body fat or immune system Other: Nausea, vomiting, diarrhea, fatigue, abdominal pain

Do not take with Halcion, midazolam oral syrup, Orap, Mevacor, Zocor, Rimactane, Rifadin, Rifater, Rifamate, Revatio when used to treat pulmonary arterial hypertension, UroXatral, SaintJohn’s-wort, ergot-containing medicines, including ergotamine (Cafergot and others), dihydroergotamine (D.H.E. 45 and others), ergonovine (Ergotrate), and methylergonovine (Methergine). Use with caution with Viagra, Cialis, Levitra, Adcirca, birth control pills or contraceptive patches containing estrogen, Tasigna, Sprycel, Lipitor, Crestor, Atripla, Sustiva, Viramune, Agenerase, Lexiva, Viracept, Dilantin, Tegretol, Mycobutin, Flonase, Serevent, Advair, Colcrys, Tracleer, Duragesic, Ionsys, Fentora, and methadone.

Most serious: changes in heart rhythm, severe liver problems, pancreatitis, changes in immune system, changes in body fat, new or worsened diabetes, elevated triglyceride or cholesterol levels Other: diarrhea, nausea, stomach pain, vomiting, weakness, headache

800 mg, typically four tablets, once daily. Twice-aday options are available to some patients. Swallow tablets whole; do not chew, break, or crush. An oral solution is available but should be taken with food

Orem zzril ipsuscilla feum vent vulput dolorpero odigna consectet am velisci ncinciliqui ea faccum velissenit am nullum ip euismod ex eummy nibh estie dio odiam nibh ent am dolore dolor summy n

j u ly/a u g u s t 2 0 1 2 •

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

protease inhibitors (ContinUeD) MeDicatioN Generic Name Maker

Lexiva nelfinavir ViiV Healthcare

Norvir ritonavir Abbott Laboratories

viracept nelfinavir ViiV Healthcare

hiv plus

traDitioNaL DoSaGe

DruG iNteractioNS, precautioNS, & recoMMeNDatioNS

SiDe eFFectS

For those used to protease inhibitors, 700 mg plus a 100mg capsule of Norvir, twice daily. For those new to therapy, 1,400 mg of Lexiva twice daily, sometimes paired with Norvir, depending on the patient. Lexiva is available in tablets or oral solution; tablets can be taken with or without food, oral solution without food

Do not take with Rescriptor, UroXatral, Rifadin, Rimactane, Saint-John’s-wort, certain arrythmia medications,ergot-based medications, Propulsid, Zocor, Mevacor, Orap, Revatio when used to treat pulmonary arterial hypertension, Versed, or Halcion. If you take oral contraceptives, consider alternative birth control methods. Do not take with Viramune unless also taking Norvir. Use with caution with H2 blockers and calcium channel blockers. Do not use if you have Stevens-Johnson syndrome or if you take drugs that use the enzyme CYP3A4 to metabolize.

Most serious: severe skin reactions including Stevens-Johnson syndrome, new or worsened diabetes, redistribution of body fat, elevated cholesterol, anemia, spontaneous bleeding, kidney stones Other: diarrhea, rash, nausea, vomiting, headache

600 mg (six 100-mg tablets), twice daily, with a meal. Swallow tablets whole with water; do not chew, break, or crush. Also available in capsules or oral solution

Do not take with Xatral, Cordarone, Tambocor, Vascor, Rythmol, Fucidin, Hismanal, Seldane, Orap, Propulsid, Cafergot, Migranal, D.H.E. 45, Ergotrate, Maleate, Vfend, Mevacor, Zocor, Halcion, Versed, Advair, Serevent, Levitra, Revatio if used for pulmonary arterial hypertension, Saint-John’s-wort. Do not take with both Invirase and any version of rifampin (Rimactane, Rifadin, Rifater, or Rifamate), and use with caution with either of those drugs separately. Use with caution with Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Tracleer, Rapamune, Flonase, Agenerase, Crixivan, Viracept, Videx, Mycobutin, Aptivus, Rescriptor, Reyataz, Celsentrin, Telzir, Prezista, Tiazac, Adalat, Isoptin, Nizoral, Sporanox, Demerol, Tegretol, Dilantin, phenobarbital, Mycobutin, Biaxin, Duragesic, theophylline, Colcrys used for treatment of gout, certain anticancer medications, certain antidepressants. Use with caution if you have liver problems or diabetes.

Most serious: worsening of liver disease, pancreatitis, diabetes or high blood sugar, elevated cholesterol or triglycerides, changes in body fat, increased bleeding among hemophiliacs, severe skin reactions Other: rash, abdominal pain, diarrhea, feeling weak or tired, headache, nausea,vomiting, changes in taste, loss of appetite, dizziness, tingling feeling or numbness in hands, feet, or around the lips

1,250 mg (five 250mg tablets or two 625-mg tablets), twice daily, or 750 milligrams (three 250-mg tablets) three times daily. Each dose should be taken with a meal. An oral powder is also available

Do not take with Cordarone, Orap, Quinidine, Quinaglute, Cardioquin, Quinidex, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Methergine, Halcion, Versed, Revatio if used for pulmonary arterial hypertension, UroXatral, Prilosec, Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Mevacor, Zocor, or Serevent. Use with caution with Lipitor, Crestor, Pravachol, Lescol, Viagra, Levitra, Cialis, Adcirca, or Tracleer. If also taking Videx, take Viracept with food one hour after or more than two hours before you take Videx. May reduce effectiveness of birth control pills, so use additional or alternative form of contraception. Doses of Crixivan, Norvir, Invirase, Fortovase, Mycobutin or Dilantin may need to be adjusted. Rescriptor may lower the amount of Viracept in the blood or vice versa.

Most serious: diabetes and high blood sugar, high blood pressure, changes in body fat Other: diarrhea, nausea, rash

• j u ly/a u g u s t 2 0 1 2

entry and fusIon InhIbItors MeDICAtIon Generic Name Maker

Selzentry maraviroc ViiV Healthcare

Fuzeon enfuvirtide Roche Laboratories (brand name)

trADItIonAl DoSAGe

WHAt It DoeS

DruG InterACtIonS, preCAutIonS, & reCoMMenDAtIonS

SIDe eFFeCtS

300 mg (one or two tablets) twice daily

Helps block HIV from entering T cells. This is yet another mechanism of inhibiting viral replication. Always taken with other anti-HIV medications.

Do not take SaintJohn’s-wort, as it can lower the amount of Selzentry in the blood. Some other medications may also affect the amount of Selzentry in the blood. Tell your doctor if you have a history of hepatitis B or C, have heart or kidney problems, of if you have low blood pressure or take medication to lower it.

Most serious: heart or liver disorders, lowered blood pressure when standing up, possible increased risk of cancer and other infections, changes in the immune system Other: cough, fever, dizziness, headache, lowered blood pressure, nausea, bladder irritation

Injection of 90 mg in the upper arm, upper leg, or stomach twice daily

Helps block HIV from entering T cells. Always taken with other antiHIV medications.

Some people use the Biojector 2000, a needle-free device, to administer Fuzeon, but in some it causes nerve pain, tingling, bruising, and collections of blood under the skin.

Most serious: injection-site infections or reactions such as itching, swelling, redness, pain or tenderness, hardened skin, bumps at the site of injection; allergic reactions—also, patients taking Fuzeon may develop bacterial pneumonia more often than others, although it is unclear if the drug is the cause Other: pain and numbness in feet or legs, loss of sleep, depression, decreased appetite, sinus problems, enlarged lymph nodes, weight decrease, weakness or loss of strength, muscle pain, constipation, and pancreas problems

Trimeris (generic)

Integrase InhIbItors ISentreSS raltegravir Merck

One 400-mg tablet, twice daily

Blocks integrase, an enzyme HIV needs to reproduce itself. Always taken with other anti-HIV medications.

Tell your doctor if you take the tuberculosis medication rifampin. Also, tell your doctor if you have liver problems or phenylketonuria. If you miss a dose, skip the missed dose and go back to your regular schedule. Do not double your next dose or take more than your prescribed dose.

Most serious: severe skin reactions and allergic reactions, liver problems, changes in your immune system. Other: headache, trouble sleeping, nausea, tiredness; less common side effects include weakness, stomach pain, dizziness, depression, and suicidal thoughts and actions

j u ly/a u g u s t 2 0 1 2 •

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

nucleoside reverse transcriptase inhibitors (nrti) [Help prevent replication of HIV]

MEDICATION Generic Name

TRADITIONAL DOSAGE

DRuG INTERACTIONS, pRECAuTIONS, & RECOMMENDATIONS

One tablet, containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate, once daily

Truvada contains two NRTIs, which act on reverse transcriptase, a substance HIV needs for replication. Do not take Truvada if you take Atripla, Combivir, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, or Viread, which have the same or similar active ingredients. You may need to adjust dosage if also taking Videx, Reyataz, or Kaletra. Do not take with Hepsera. If you have had kidney problems or take other drugs that can cause kidney problems, your doctor should do regular blood tests to check your kidneys.

Most serious: buildup of lactic acid in the blood, serious liver problems, flare-ups of hepatitis B virus infection, kidney problems, thinning bones, changes in body fat, symptoms of inflammation from previous infections Other: diarrhea, dizziness, nausea, vomiting, headache, fatigue, abnormal dreams, sleeping problems, rash, depression, shortness of breath, pain, fatty liver, stomach pain, weakness, indigestion, intestinal gas, high volume of urine, excessive thirst, skin discoloration

One tablet, containing 150 mg of lamivudine and 300 mg zidovudine (both NRTIs), twice daily

Do not take with other medicines containing lamivudine, zidovudine, or emtricitabine (such as Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir, Atripla, Emtriva, and Truvada). Use caution with if taking interferon alfa, ribavirin, doxorubicin, or ganciclovir. Tell your doctor if youâ&#x20AC;&#x2122;ve previously had any kidney or liver problems (such as hepatitis or cirrhosis), pancreatitis, or low red/white blood cell counts.

Most serious: low white and red blood cell counts, serious allergic reactions, buildup of lactic acid in the blood, liver toxicity or worsening of liver disease, pancreatitis, muscle disorders and inflammation, changes in body fat, changes in the immune system Other: headache, nausea, fatigue, diarrhea, cough, stuffy nose, general feeling of discomfort

One 200-mg capsule or 240 mg of oral solution, once daily

Do not use with other drugs containing emtricitabine, such as Atripla, Complera, or Truvada.

Most serious: buildup of lactic acid in the blood, liver problems including flare-up of hepatitis B after discontinuation Other: headache, diarrhea, nausea, fatigue, dizziness, depression, insomnia, abnormal dreams, rash, abdominal pain, asthenia, increased cough, rhinitis

300 mg daily, in one or two doses, in tablets or oral solution

Do not take with Emtriva, Combivir, Epzicom, Trizivir, Atripla, Truvada, or Complera. If you have hepatitis C, there is a chance of severe liver decomposition if you are taking combination antiretroviral therapy and interferon alfa drugs for hep C.

Most serious: buildup of lactic acid in the blood, severe liver problems, changes in the immune system, changes in body fat Other: headache, nausea, malaise and fatigue, nasal signs and symptoms, diarrhea, and cough

Maker

TRuvADA emtricitabine and tenofovir disoproxil fumarate Gilead

COMbIvIR lamivudine and zidovudine ViiV Healthcare (Brand name) Teva Pharmaceuticals (Generic)

EMTRIvA emtricitabine Gilead

EpIvIR lamivudine or 3TC ViiV Healthcare

SIDE EFFECTS

Epzicom abacavir sulfate and lamivudine ViiV Healthcare

Retrovir zidovudine or AZT ViiV Healthcare; generic versions also available

Trizivir abacavir sulfate, lamivudine, and zidovudine

One tablet, containing 600 mg of abacavir sulfate and 300 mg of lamivudine (both NRTIs), once daily

Do not take if you have kidney problems or are prone to heart disease. Use with caution if you already take Atripla, Combivir, Emtriva, Epivir, Trizivir, Truvada, Ziagen, methadone, or medicines used to treat hepatitis. If you have hepatitis B, do not run out of Epzicom or stop taking it without talking to your healthcare provider. Your healthcare provider should monitor your health and do regular blood tests to check your liver if you stop taking Epzicom. Do not take if you have moderate to severe liver problems.

Most serious: severe allergic reactions, buildup of acid in the blood, liver problems Other: insomnia, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, and fever

600 mg a day, taken in divided doses, in tablets, capsule, or syrup. Can also be given as an intravenous infusion, one mg per kilogram of body weight, over one hour, five or six times daily

Do not take with other medicines that contain the same active ingredients, including Combivir and Trizivir. Use with the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere is not recommended. Use with caution if taking ganciclovir or interferon alfa.

Most serious: neutropenia and anemia (low white and red blood cell counts, myopathy and myositis (muscle disorders and inflammation), buildup of lactic acid in the blood, severe liver problems, changes in the immune system, changes in body fat Other: headache, malaise, nausea, anorexia, and vomiting

One tablet (300 mg of abacavir sulfate, 150 mg of lamivudine, and 300 mg of zidovudine, all NRTIs), twice daily

Do not take if you have certain liver problems or weigh less than 90 pounds. Take with caution if you have a particular gene variation called HLA-B*5701, hepatitis B, kidney or heart problems, low blood cell counts, high blood pressure, high cholesterol, or diabetes. Use with caution if you take Bactrim, Septra, Cytovene, DHPG, interferon-alfa, Adriamycin, Copegys, Rebetol, Virazole, bone marrow suppressive medicines or cytotoxic medicines, Atripla, Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Retrovir, Truvada, Zerit, or Ziagen.

Most serious: severe or fatal allergic reactions, heart attack, buildup of lactic acid in the blood, liver disorders, blood problems, muscle weakness, changes in body fat, changes in immune system Other: nausea, vomiting, headache, weakness or tiredness, diarrhea, fever and/or chills, depression, muscle and joint pain, skin rashes, cold symptoms, nervousness, and ear, nose, and throat infections

Depends on weight. For individuals weighing 132 pounds or more, the recommended dose is 400 mg in enteric-coated capsules, once daily. For adults weighing less than 132 pounds, the recommended dose is 250 mg, once daily. Take the drug on an empty stomach, and swallow the capsules whole; do not chew, break, crush, or dissolve. A powder form to be mixed with water is available for children

Do not take if you take Lopurin or Zyloprim, which are used to treat gout and kidney stones, or the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere. Use with caution if taking methadone or ganciclovir, or any drugs that may cause toxicity to the pancreas or nervous system. If you are also taking Viread, the dose of Videx EC should be reduced, and it should be taken on an empty stomach or with a light meal.

Most serious: pancreatitis, buildup of lactic acid in the blood, liver disorders, vision problems, changes in immune system, changes in body fat, peripheral neuropathy Other: diarrhea, nausea, vomiting, headache, stomach pain, skin rash

ViiV Healthcare

Videx EC didanosine Bristol-Myers Squibb

j u ly/a u g u s t 2 0 1 2 â&#x20AC;˘

hiv plus

=T 8H C CE K2I081M2< CH )I V ' ( )T R E A T M E N T

GUIDE

=i\eZ_ HlXik\i# _fd\ f] Jflk_\ie ;\ZX[\eZ\

Complementary and Alternative Medicine

The use of what’s called complementary and alternative medicine (CAM) is popular in the U.S., where yoga and massage have become mainstream activities. In fact, according to a study published in the journal AIDS Care, 60% of HIV-positive people have tried some form of CAM, most in addition to their antiretrovirals. While some have demonstrated benefits, others may be dangerous or unproven. Here’s the lowdown on some popular ones. TREATMENT

ACUPUNCTURE

WORTH IT?

Yes

WHY?

Studies have shown it reduces symptoms of HIV and side effects of medications, including fatigue, pain, headache, forgetfulness, and nausea.

TAKE IT EASY

New Orleans is ready for Southern found Decadence, are youResearchers ready for it? two proteins Chinese butMaybe

THINKSTOCK

in bitter melon that inhibit HIV bitter melon tests.Y\Xlo But no one (0k_$Z\eklip Èk_\ Y`^ \Xjp#É k_\ e`Zb$ Zfd # inX laboratory for sure if there’s XiZ_`k\ZkliXc a\n\c any eXd\ f]k\e Y\jkfn\[ fe Xikj knows clinical Yp usefulness. k_\ i\mfcmè^ E\n Fic\Xej# jl^^\jkj X Zifne\[ :Xiflj\c 9Xi# `ddfikXc`q\[ jcfn$gXZ\[# \Xjp^fè^ c`]\$ The FDA doesn’t consider it to be No Colloidal ni`kè^j jkpc\% =fi jò silver [Xpj Y\^èeè^ è k_\ safe. Amongf] its?\dè^$ many side effects Dfek\c\fe\Ëj j`j$ bluish 8l^ljk )0 k_\ jflk_\ie Z`kp nXp% isK_\ argyria, an irreversible k_\ of9`\em`cc\ n`cc Y\ îXZ`flj p\k Xepk_è^ k\i i\j`[\eZ\# discoloration the skin. Ylk ^\ek\\c% K_XkËj n_\e Xe ?flj\ 9`\em`cc\?flj\%Zfd # Scientists have discovered Xggfèk\[ Yflk`hl\ that \jk`dXk\[ )''#''' ^Xp d\e No X i`Z_cp Manganese increasing manganese in cells fZZlg`\j knf i\ef$ Xe[# jli\# jfd\ X[m\ekliflj gifg\ikp# decrease HIV’snXi\$ ability to c\jY`Xej n`cc [\jZ\e[ fe k_\ mXk\[ can(/k_$Z\eklip replicate, but there’s no evidence d\kifgfc`j kf [\]p k_\ fggi\j$ _flj\ Yl`c[è^j Xe[ gifm`[\j that dietary manganese has any j`m\ _ld`[`kp Xe[ i\m\c è k_\ X dfi\ X]]fi[XYc\ Xck\ieXk`m\% 8ck_fl^_ k_\ HlXik\iËj effect on HIV. efejkfg fejcXl^_k f] Yffqp Z\c\YiXk`fej befne Xj Jflk_$ 9fliYfe Jki\\k gifm`[\j X Studies show it reduces anxiety Yes jè]lc jì\e ZXcc kf jki`g ZclYj \ie ;\ZX[\eZ\ Jflk_\ie$ Massage pain, lowers blood pressure, fk_\i iXlZflj XZk`m`$ ;\ZX[\eZ\%e\k % ;liè^ k_\ Xe[ and releases endorphins, improves k`\j# C>9K m`j`kfij nflc[ cfe^ CXYfi ;Xp n\\b\e[ k_\ bloodkf circulation, andk_\ boosts efk kXb\ è hlXèk jkfi\]ifekj Xe[ Yi`Zb$ Y\ i\d`jj mXjk ZlckliXc _\i`kX^\% cè\[ jki\\kj f] E\n Fic\XejËj Z`kpËj immunity. ]XYc\[ =i\eZ_ HlXik\i n`cc Y\ 8 jki\\kZXi kfli f] k_\ e\XiYp One;`jki`Zk study found that Yes >Xi[\e VItamins \dg_Xj`q\j kiXej]fid\[ èkf X j\X f] YXi\ multivitamins reduced HIVi`Z_ XiZ_`k\ZkliXc _`jkfip jbè# ]\Xk_\ij# Xe[ ^c`kk\i% women’s risk of AIDS \ogcfiè^ k_\ Y\^l`c$ Dfi\ k_Xe Y\`ê\kj Xe[ n_`c\ positive and death by 30%. YfliYfe Xi\ i\hlì\[ kf è^ i\j`[\ek`Xc e\`^_Yfi_ff[# jkfgj Xek\Y\ccld ]l\c X cfe^ e`^_kËj aflie\p n`k_ If you Xk arek_\ a believer, there’s Maybe PrayEr ]fid\i _fd\ f] Y\cfm\[ efm$ k_ifl^_ k_\ ]\jk`mXcËj eld\i$ ample evidence that prayer flj ZìZl`k gXik`\j% @e X Z`kp \c`jk 8ee\ I`Z\ Xj n\cc Xj k_\ offers a positive interpersonal XYfm\$îfle[ nfic[$]Xdflj ]fi ]è\ Zl`jè\ e\XiYp coping mechanism Z\d$ and may be è dXep f] _\i k_\i\Ëj Xe XYle[XeZ\ f] kilcp \k\i`\j as efk\[ beneficial in helping you cope c\^\e[Xip i\jkXliXekj% Knf Y\jk$j\ccè^ efm\cj% with, if not eliminate, symptoms. Dfm`\ Yl]]j n`cc ef [flYk dljkj1 YileZ_ Xk 9i\eeXeËj Y\ kf inm`j`k ?fldXj 9i\eeXejE\nFic\Xej%Zfd # A study Thailand found that Maybe cli\[ Reflexology ?fldXj?flj\%Zfd _fd\ f] k_\ YiXe[p d`cb ?flj\ foot reflexology reduced# pain gcXekXk`fe n`k_ AIDS gleZ_ Xe[ ]cXdè^ YXeXeXj Xe \c\^Xek and fatigue in hospitalized ^Xi[\ej Xe[ cXb\j# =fjk\i# Xe[ [èe\i Xk >XcX$ m\i[Xek patients. kfì\Ëj >XcXkfì\j%Zfd # k_\ cfZXk\[ XYflk Xe _fliËj [i`m\ Numerous studies show it Yes Yoga ZlcèXip ]ifd k_\ Z`kp% K_\ \jkXk\ gif$ HlXik\iËj X^\c\jj helps alleviate symptoms of HIV. îXe[\ [Xd\% K_\ Z`kpËj Ylj$ m`[\[ k_\ ]`cdè^ cfZXk`fe ]fi ;Xm`j Z_`cc\i kcè^ jki\\kj Xi\ ]`cc\[ n`k_ Zinc 9\kk\ deficiency occurs in over Yes k_\ (0-+ zinc Jn\\k :_Xicfkk\ jkXk\cp Ylk n\cZfdè^ _fk\cj% ?lj_¿?lj_# 50% of HIV+ adults; studies show Xcjf _fd\ kf immunological X nfic[$ Kfn\iè^ Xdfe^ k_\d `j k_\ Xe[ `j that zinc delays _`jkfi`Z# dXa\jk`Z ?fk\c Dfe$ ZcXjj i\jkXliXek# CXk`cËj CXe[$ failure and decreases diarrhea. k\c\fe\ ?fk\cDfek\c\fe\% è^% ÇA\i\dp Bèj\i never take these supplements without doctor’s approval: sutherlandia, saint-john’s-wort, grapefruit, african potato, vitamin c, and garlic.

InvestIgatIonal MedIcatIons the medications used to treat HIV and all its attendant complications went through extensive investigations and clinical trials before they were approved for general use. scientists are trying out still more meds now. science translational Medicine just detailed a study in which 43 HIV-positive volunteers had their infection-fighting t cells genetically modified, most of them over a decade ago—and they’re still healthy. It laid the groundwork for more experimental therapies with genes. But there are even more promising advances MEDICATION TRADITIONAL NAMEcoming from medical, DOSAGEuniversity, and pharmaceutical organizations doing research. some of these new medications, which are not yet approved for use outside clinical trials, may soon be coming to a pharmacy near you. Generic Name NAME/MAKER

QUAD Gilead Sciences

ng aki Bre news!

Maker

WHAT IT DOES

Quad combines the already-available drug Truvada, which contains the nucleoside reverse transcriptase inhibitors emtricitabine and tenofovir disoproxil fumarate, with the experimental integrase inhibitor elvitegravir and the experimental boosting agent cobicistat. The ingredients interfere with the work of various cell components HIV needs to reproduce. The FDA’s Antiviral Drugs Advisory Committee voted in May to recommend that the FDA approve Quad’s use for adults who have not taken antiretroviral treatment previously. The FDA usually goes along with committee recommendations, and it is expected to act on Quad by August.

AMD070 Genzyme

A type of medicine called a CXCR4 inhibitor, which works by blocking the entry of HIV into cells, therefore interfering with its replication. It is being studied to determine its efficacy, safety, and tolerability, including whether it should be taken with food.

PRO 140 Progenics Pharmaceuticals

Also a CXCR4 inhibitor, PRO 140 is injected intravenously or subcutaneously to treat HIV. Various doses have been studied.

TNX-355 Tanox

Also a CXCR4 inhibitor, TNX-355 is injected intravenously to treat HIV. Various doses, based on body weight, have been studied.

ELvITEGRAvIR

A type of medicine that blocks integrase, a protein that HIV needs to insert its viral genetic material into the genetic material of an infected cell, elvitegravir is taken orally to fight HIV, in combination with other antiretroviral medicines. Studies are looking at elvitegravir boosted with ritonavir (brand name Norvir) as part of a multidrug regimen. Elvitegravir is also a component of the Quad combination pill.

Gilead Sciences

BMS-378806 Bristol-Myers Squibb

A microbicide is a substance that protects against microorganisms (bacteria, viruses, fungi), either by destroying the microbes or preventing them from establishing an infection. In HIV research, microbicide usually refers to a topical gel used against the virus. BMS-378806 (also known as BMS-806) is an HIV entry inhibitor that has been studied both in an oral form to treat HIV and as a component of a vaginal microbicide gel to reduce HIV transmission.

CARRAGUARD Population Council & FMC BioPolymer

Carrageenan is a chemical found in certain types of seaweed, which scientists have discovered can protect cells from becoming infected with many viruses, including HIV, in laboratory environments. It was tested as the microbicidal component of the Population Council’s vaginal gel (brand name Carraguard) to reduce HIV transmission. It did not prove effective in a clinical trial a few years ago, but other carrageenan gels are being developed. The substance is also known as carragaen, carrageenan gum, carrageenin, Irish moss extract, PC-515, and PC515.

CyANOvIRIN-N Osel Inc.

Cyanovirin-N, a fusion inhibitor, is being used in a vaginal microbicide gel under study to see if it can help prevent HIV transmission. Also known as CV-N and CV-N Protein.

UC-781 CONRAD

UC-781 is a nonnucleoside reverse transcriptase inhibitor, an agent that interferes with HIV’s replication, that is being studied in the form of vaginal and rectal microbicide gels to see if it can help prevent HIV transmission.

j u ly/a u g u s t 2 0 1 2 •

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

InvestIgatIonal MedIcatIons NAME/MAKER

WHAT IT DOES

This also falls into the microbicide category (see previous page). Hydroxyethyl cellulose, being developed under the brand name Cellulosize, is a gel-like substance often used as the placebo, or control, in studies of anti-HIV microbicides. It is also sometimes used as the vehicle to carry the drug in microbicides under study. Research MEDICATION TRADITIONAL has indicated that hydroxyethyl cellulose is not active against HIV and is therefore safe to use as a placebo in any NAME DOSAGE microbicide study. Further study to determine side effects has been recommended. Also known as HEC. Generic Name

CELLuLOSIzE Union Carbide

Maker

VIVAGEL Starpharma

TENOfOVIR Gilead Sciences

Tenofovir, a nucleoside reverse transcriptase inhibitor, is already available as an anti-HIV pill under the brand name Viread and as a component of several combination drugs. It has been tested as the active ingredient in a vaginal microbicide gel (see previous page) to reduce HIV transmission. Last fall a major study was halted after the tenofovir gel demonstrated no more effect than a placebo. A different formulation of tenofovir gel was recently found safe for rectal use, and there are plans to study its effectiveness among gay and bisexual men and transgender women.

ApRICITAbINE Avexa Ltd.

Apricitabine is a new nucleoside reverse transcriptase inhibitor that may work for people with HIV strains that are resistant to other NRTIs. Other names for it include ATC, AVX754, and SPD754.

ELVuCITAbINE Achillion Pharmaceuticals

Another NRTI, elvucitabine (or ACH-126443) is similar to the FDA-approved anti-HIV drug lamivudine (Epivir). Elvucitabine may be effective in treating individuals infected with HIV strains resistant to lamivudine. It is also being studied for the treatment of hepatitis B virus infection.

fOSALVuDINE Heidelberg Pharma Kp-1461 Koronis Pharmaceuticals RACIVIR Pharmasset

CObICISTAT (GS-9350) Gilead Sciences

VivaGel is a vaginal microbicide gel that is being studied for the prevention of HIV and other STIs, including herpes simplex virus-2. In tests, it has been given either once or twice daily, for up to two weeks. Its active ingredient is SPL 7013, an HIV inhibitor. Other names for the product are SPL-7013 and SPL7013 gel.

Fosalvudine, in various doses, is an NRTI being studied for the treatment of HIV infection, both in people who have been treated previously and those who have not. Also known as HDP 99.0003.

KP-1461 introduces mutations into HIV that eventually kill the virus, making it different from other NRTIs. The process is called viral decay acceleration. Also known as KP-1212 (metabolized drug), KP-1212/1461, SN1212 (metabolized drug), and SN14. Racivir is an NRTI tablet taken once a day in combination with approved antiretroviral medications. It is under investigation to see if it can help stop HIV from reproducing in the body. Also called (+)/(-)FTC and RCV.

Cobicistat is a pharmaco-enhancer or “boosting agent” that raises the blood levels of other drugs that are broken down by the same protein. Cobicistat itself does not have any antiviral activity. It is being tested as being part of the Quad combination tablet. It’s also being tested for its capabilities in boosting available protease inhibitors.

AMpLIGEN Hemispherx Biopharma

Ampligen is a type of antiviral drug that appears to restart human immune defenses against viruses and tumors. It is being studied to see how well it works alone or in combination with other anti-HIV medicines during interruption of standard anti-HIV treatment. Also known as Poly(I)-Poly(C12U).

DEpAKENE Abbott Laboratories

Valproic acid, which Abbott markets under the brand name Depakene, is typically used to treat seizures and other nervous system problems. The acid also works against HIV by releasing the virus from resting cells so other antiHIV medicines can attack it, and studies have been undertaken to determine its effectiveness in this application. Also known as Depakote, Divalproex sodium, VPA, and Valproate.

hiv plus

• j u ly/a u g u s t 2 0 1 2

NRTI (CONTINUED) MEDICATION Generic Name

TRADITIONAL DOSAGE

Drug interactions, precautions, & recommendations

One 300mg tablet, once daily. Adults who are unable to swallow tablets whole may take 7Â˝ scoops of Viread oral powder. Patients with liver problems may be prescribed a lower dose

Do not take Viread if you are taking other medicines that contain tenofovir (Atripla, Complera, Truvada) or adefovir (Hepsera). Dosages may need to be changed if you are taking Videx EC, Reyataz, or Kaletra.

For patients weighing 132 pounds or more, 40 mg, in capsules or oral solution, twice daily; for patients weighing less than 132 pounds, 30 mg twice daily

Do not take with Retrovir (zidovudine) or any zidovudine-containing products, such as Combivir or Trizivir. Do not take with hydroxyurea, which is marketed under brand names Droxia and Hydrea. Use with caution with Videx EC, Adriamycin, Rubex, Copegus, Rebetol, Ribasphere, Virazole, Roferon-A, and Intron-A. Use with caution if you have liver, pancreas, or kidney problems, peripheral neuropathy, or gallstones. For patients with renal impairment or undergoing hemodialysis, dosing adjustments may be needed. Do not drink alcohol while on the drug.

Most serious: buildup of an acid in the blood, serious liver problems, pancreatitis, changes in body fat, changes in immune system, peripheral neuropathy Other: headache, diarrhea, rash, nausea, vomiting

600 mg in tablets daily, administered as either 300 mg twice daily or 600 mg once daily. Also available as an oral solution

Do not take if also taking Epzicom or Trizivir. Do not take if you have moderate to severe liver impairment. Do not breast-feed while taking the drug. Risk of allergic reaction is higher if you have a gene variation called HLA-B*5701.

Most serious: severe allergic reaction, buildup of lactic acid in the blood with liver enlargement, changes in body fat, changes in immune system, increased risk of heart attack, especially if you have other risk factors such as smoking, history of heart trouble, diabetes, high blood pressure, or high cholesterol Other: nausea, vomiting, tiredness, headache, diarrhea, trouble sleeping, fever and chills, and loss of appetite

Maker

Viread tenofovir disoproxil fumarate Gilead

Zerit stavudine or d4T Bristol-Myers Squibb

Ziagen abacavir GlaxoSmithKline

Viread is also used to treat hepatitis B.

SIDE EFFECTS

Most serious: buildup of lactic acid in the blood, severe liver problems, changes in body fat, changes in the immune system, bone pain, softening, or thinning Other: nausea, rash, diarrhea, headache, pain, depression, weakness

j u ly/a u g u s t 2 0 1 2 â&#x20AC;˘

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

NoNNucleoside reverse traNscriptase iNhibitors (NNrti) [Help prevent replication of HIV]

MEDICATION Generic Name

TRADITIONAL DOSAGE

Maker

EDuRANT rilpivirine Tibotec

INTELENCE etravirine Janssen

RESCRIpTOR delavirdine ViiV Healthcare

SuSTIvA efavirenz Bristol-Myers Squibb

vIRAMuNE nevirapine Boehringer Ingelheim

hiv plus

DRuG INTERACTIONS, pRECAuTIONS, & RECOMMENDATIONS

SIDE EFFECTS

One 25-mg tablet, once daily, with a meal

NNRTIs attack the same enzyme NRTIs do, in a different way. Do not take Edurant with antiseizure drugs like Tegretol, Trileptal, and Dilantin; antibacterials Mycobutin, Rifadin, Rimactane, or Priftin; proton pump inhibitors such as Nexium, Vimovo, Prevacid, Prilosec, Protonix, and Aciphex; more than one dose of dexamethasone; or SaintJohn’s-wort. Use with caution with antifungals taken orally, antibiotics like Biaxin and erythromycin, and methadone. Take antacids or H2 blockers at least 12 hours before or four hours after Edurant.

Most serious: depression or mood changes, including suicidal thoughts; changes in body fat; changes in immune system Other: insomnia, headache, rash

200 mg (one 200-mg tablet or two 100-mg tablets), twice daily

Do not take with the anti-HIV drugs Activus, Lexiva, Reyataz, fulldose Norvir, Viramune, Sustiva, or Rescriptor; epilepsy and seizure medicines Tegretol, Carbatrol, Luminal, Dilantin, or Phenytek; herbal products containing Saint-John’s-wort; or the antibacterial drugs Mycobutin, Rifadin, Rifater, Rifamate, or Priftin. Always take after a meal and swallow the pill with a full glass of water; do not chew.

Most serious: severe skin rash or allergic reaction Other: changes in body shape or body fat, changes in immune system, tingling or pain in the hands or feet, numbness

400 mg (two or four tablets) three times daily

When taking Rescriptor, do not take Versed, Halcion, Xanax, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Orap, Propulsid, Hismanal, Seldane, rifampin, phenobarbital, Dilantin, Tegretrol, Saint-John’s-wort, Mevacor, or Zocor. Talk to your doctor before taking Viagra, Lipitor, Baycol, or Lescol. If taking Videx or antacids, take an hour before or an hour after taking Rescriptor. Doses of protease inhibitors Agenerase, Crixivan, Invirase, Fortovase, Kaletra, Norvir, and Viracept may need to be adjusted. Talk with your doctor if you have liver or kidney disease.

Most serious: severe skin rash accompanied by blisters, fever, joint or muscle pain, redness or swelling of the eyes, or sores in the mouth Other: headache, nausea, diarrhea, and tiredness

600 mg (three capsules at once or one tablet), taken daily

Do not take Vascor, Propulsid, Versed, Orap, Halcion, or ergot medications (such as Wigraine and Cafergot). The following medicines may need to be replaced with another when you are taking Sustiva: Fortovase, Invirase, Biaxin, Carbatrol, Tegretol, Noxafil, Sporanox, and Reyataz (if this is not the first time you have been treated for HIV). The following drugs may require a change in the dose of either Sustiva or the other medicine: Cardizem, Tiazac, Covera HS, Isoptin SR, Lipitor, Pravachol, Zocor, Crixivan, Kaletra, methadone, Mycobutin, Reyataz, Rifadin, Rifamate, Rifater, Selzentry, Vfend, Gengraf, Neoral, Sandimmune, Prograf, Rapamune, Wellbutrin, Zoloft, and Zyvan. If you are taking Sustiva and Reyataz, you should also be taking Norvir. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures. Take Sustiva on an empty stomach, preferably at bedtime, with water.

Severe: serious liver problems, rashes, and skin reactions Other: changes in the immune system and changes in body fat

One 200-mg or 400-mg tablet, once daily, depending on if the patient has had antiretroviral treatment previously

Do not take Saint-John’s-wort, Sustiva, Atripla, Kaletra, Lexiva, Reyataz, Nizoral, Sporanox, Rifadin, Rifamate, Rifater, or birth control pills. Tell doctor if taking Biaxin, Diflucan, Crixivan, methadone, Viracept, Mycobutin, Coumadin, Jantoven, or Invirase.

• j u ly/a u g u s t 2 0 1 2

Most serious: severe psychiatric problems, including suicidal thoughts; liver disorders Other: dizziness, nausea, vomiting, diarrhea, rash, sleep disturbances, drowsiness, trouble concentrating, or unusual dreams

OPPORTUNISTIC INFECTION AND OTHER DRUGS MEDICATION Generic Name

WHAT IT DOES

DRuG INTERACTIONS, pRECAuTIONS, & RECOMMENDATIONS

Two mg injected subcutaneously (just below the skin), once daily

Helps reduce HIVrelated excess belly fat by encouraging the body to produce natural growth hormones that reduce fat

Do not take if you have or had issues involving your pituitary gland, or if you have newly diagnosed or recurrent cancer

Most serious: severe allergic reaction or fluid retention, injection site reactions, or increase in glucose intolerance/diabetes Other: Pain, swelling, muscle soreness, tingling, numbness, and pricking, nausea, vomiting, rash, itching

400 mg (two or four tablets) three times daily

One or two tablets, twice daily. Some versions are available as oral solutions or infusion forms

Take at the same time every day. Try not to miss a dose

Most serious: skin rash, joint or muscle aches, sore throat or fever, unusual bleeding or bruising. Other: dizziness, nausea, vomiting, diarrhea, loss of appetite, fatigue, headache

One 600-mg tablet, every 72 hours, or 200 mg of oral solution, once daily

One or two tablets, twice daily. Some versions are available as oral solutions or infusion forms

Do not take Pegasys. If using oral solution, close bottle and clean dosing cup immediately after dosing, keep cup dry between uses, do not use for anything else

Most serious: buildup of lactic acid in body, severe liver problems, muscle pain or weakness, nerve problems, flare-up of hepatitis B after discontinuation Other: diarrhea, abdominal pain or swelling, cough, headache, dizziness, sore throat, fever

Two 450 mg tablets, twice daily, for 21 days, then two tablets once daily

Treats the eye infection cytomegalovirus retinitis

Use with caution if also taking Retrovir, Benemid, CellCept, Myfortic, or Videx. Since Valcyte can cause seizures, do not drive until you know how the medication affects you

Most serious: anemia, fertility impairment, fetal abnormalities, kidney failure Other: diarrhea, vomiting, fever, tremors, and seizures

100 units per kilogram of body weight, three times a week, given intravenously

Treats anemia that results as a side effect of Retrovir

Don’t take if you have uncontrolled high blood pressure. Iron supplements may be needed for patients who undergo blood transfusions. Talk to your doctor if you have cancer

Most serious: high blood pressure, seizures, development of antibodies against the drug, severe allergic reactions Other: joint, muscle, or bone pain, fever, cough, rash, nausea, vomiting, soreness of mouth, itching, headache, pain at injection site

625 mg (one teaspoon), once daily

Treats appetite loss, severe malnutrition, or unexplained, significant weight loss.

May decrease effectiveness of Crixivan. If you have a history of blood clots, check with your doctor before taking

Most serious: Cushing’s syndrome, development or worsening of diabetes Other: decreased sexual desire or performance, flatulence, rash, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding

Traditional dosage: 0.1 mg per kilogram of body weight daily (up to 6 mg), injected subcutaneously at bedtime

Treats wasting (HIV-related weight loss)

Do not use if you have acute critical illness following open heart or abdominal surgery, multiple accidental trauma, or acute respiratory failure. Do not use if you have neoplasia

Most serious: Glucose intolerance, which may require adjustment of diabetes medications for patients with this disorder; musculoskeletal discomfort; carpal tunnel syndrome; swelling of the hands and feet

TRADITIONAL DOSAGE

Maker

EGRIFTA tesamorelin EMD Serono

BACTRIM, SEpTRA, SuLFATRIM sulfamethoxazole/ trimethoprim Various (see HIVPlusmag.com)

TyzEkA telbivudine Idenix/Novartis

VALCyTE valganciclovir Genentech

EpOGEN, pROCRIT epoetin alfa Amgen (Epogen); Janssen (Procrit)

MEGACE ES megestrol acetate Strativa

SEROSTIM somatropin EMD Serono

SIDE EFFECTS

j u ly/a u g u s t 2 0 1 2 •

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E MEDICATION

MegAce oRAl SuSpenSion

DOSAGE

Bristol-Myers Squibb (name brand); Teva Parenteral Medicines (generic)

peginTRon peginterferon alfa-2b

No significant interactions discovered to date. If you have a history of blood clots, check with your doctor before taking

Most serious: Cushing’s syndrome, diabetes Other: decreased libido, flatulence, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding

135 mg per square meter of body surface, intravenously over three hours every three weeks, or 100 mg per square meter of body surface, intravenously over three hours every two weeks

Provides second-line treatment for Kaposi’s sarcoma

Use caution when taking with Versed, Buspar, Vansar, Plendil, Altocor, Altoprev, Mevacor, Zocor, Relpax, Revatio, Viagra, Halcion, Reyataz, Biaxin, Crixivan, Sporanox, Feoris, Nizoral, Serzone, Viracept, Norvir, and several other drugs. See HIVPlusMag.com for others.

Most serious: bone marrow disorders Other: tiredness, weakness, shortness of breath, nausea, vomiting, diarrhea, unusual bleeding or bruising, joint pain or numbness, hair loss

1.5 micrograms per kilogram of body weight, once weekly, by subcutaneous injection

Treats chronic hepatitis C, alone or in combination with other drugs

180 micrograms, once weekly, by subcutaneous injection

Treats chronic hepatitis C or B, alone or in combination with other drugs

Merck

pegASyS peginterferon alfa-2a Genentech

bARAclude entecavir Bristol-Myers Squibb

nebupenT pentamidine isethionate

0.5 or 1.0 mg, once daily, in tablet form or oral solution. Should be taken without food, on an empty stomach at least two hours after a meal and two hours before the next meal

300 mg every four weeks, via oral inhalation

APP Pharmaceuticals

hiv plus

SIDE EFFECTS

Treats severe malnutrition, appetite loss, or significant weight loss

Bristol-Myers Squibb

paclitaxel

WHAT TO KNOW

800 mg, once daily

megestrol acetate

TAxol

WHAT IT DOES

• j u ly/a u g u s t 2 0 1 2

Treats chronic hepatitis B. May also help inhibit HIV replication, although this use has not been studied.

Helps prevent pneumocystis pneumonia in patients with a history of the disease or low T-cell counts

Use with caution with drugs metabolized by CYP2C8/9 or CYP2D6. Monitor for toxicities when used with NRTIs. Do not take if you have autoimmune hepatitis or certain other liver problems.

Most serious: severe eye, blood, liver, nerve, thyroid, or lung problems, pancreatitis, colitis, high blood sugar or diabetes, allergic reaction Other: flu-like symptoms, tiredness, appetite problems, skin reactions, hair thinning

Do not take if you have autoimmune hepatitis or liver problems. Do not take with Copegus if you are pregnant, if you or your partner plan to become pregnant, or if you take Videx. Use with caution if taking Tyzeka, Theo-24, Elixophyllin, Uniphyl, Theolair, methadone, Azasan, or Imuran.

People with HIV should be receiving antiretroviral treatment for that as well. May affect concentration of drugs that reduce kidney function or vice versa. Those with decreased kidney function may need to reduce dosage.

Use with caution with aminoglycosides (a class of antibiotics), amphotericin B (an antifungal drug marketed under various brand names), Platinol, Foscavir, or Vancocin. If breast-feeding, take only if doctor determines benefits outweigh risks.

Most serious: worsening of hepatitis B after discontinuation of treatment, other liver problems, buildup of lactic acid in the blood Other: headache, fatigue, dizziness, nausea

Most serious: acute pancreatitis Other: night sweats, anemia, bronchitis, nonspecific herpes, herpes zoster, nonspecific influenza, oral Candida, pharyngitis, sinusitis, headache, chest pain, cough, wheezing

Intron A interferon alfa-2b Schering

roferon-A interferon alfa-2 Roche

tubIzId isoniazid Selleck Chemicals

SporAnox itraconazole Janssen

GAmImune n, GAmunex, GAmmAGArd immune globulin Bayer Biological Talecris Biotherapeutics, Baxter Healthcare

doxIl doxorubicin, liposomal Janssen

30 million int. units per square meter of body surface, subcutaneously or intramuscularly, three times a week for Kaposi’s sarcoma; 3 million IUs three times a week for chronic hepatitis C

Treats AIDSrelated Kaposi’s sarcoma and hepatitis infection, especially hepatitis C

Use caution if taken with Retrovir, theophylline, or Tyzeka. Do not take if you have autoimmune hepatitis, decompensated liver disease, thalassemia major, sickle-cell anemia, or problems with creatine clearance. Use with caution if you have history of cardiovascular or cerebrovascular diseases.

Most serious: Depression, suicidal thoughts, severe flu-like symptoms Other: difficulty sleeping, nervousness, muscle pain or numbness, blood in urine or stools, painful or difficult urination, chest pain, fever, chills, unusual bleeding or bruising

3 million international units per square meter of body surface, subcutaneously or intramuscularly, three times a week

Treats chronic hepatitis C

Use caution if taken with Retrovir and similar anti-HIV drugs; or theophylline, marketed under various names to treat breathing problems; or Tyzeka

Most serious: depression, suicidal behavior, pain, breathing and vision problems, fever, bleeding or bruising Other: flu-like symptoms, sleep disturbances, headache, thyroid problems, fatigue, and more

five mg per kg of body weight, daily for 9 months (for latent TB) or two weeks, then 15 mg/kg twice weekly for 18 weeks (for active TB) in combination with Rifadin, Rimactate, pyrazinamide, or Myambutol

Treats tuberculosis

Use with caution if taking acetaminophen, antacids, Tegretol, Antabuse, Nizoral, Dilantin, Theobid, Theo-Dur, Depakene, Depakote, and vitamins. Avoid alcoholic beverages. Tell your doctor if you have or have ever had liver disease or a history of alcoholism or injection drug use.

Most serious: severe/ fatal liver damage, eye pain, numbness or tingling in extremities, rash, fever, swollen glands, sore throat, bleeding or bruising, stomach pains Other: diarrhea, vision problems

200 mg daily, in oral solution, for one to two weeks for oral candidiasis; 200 mg daily in capsule form, for other fungal infections, such as histoplasmosis and blastomycosis

Treats fungal infections such as oral candidiasis, also known as thrush

Do not take if taking D.H.E. 45, Migranal, Germinal, Hydergine, Ergotrate, Bellergal-S, Cafergot, Ergomar, Wigraine, Methergine, Sansert, Altocor, Altoprev, Mevacor, Zocor, or Halcion. Use caution if you have heart, lung, or kidney disease or take protease inhibitors. Do not take capsules if you have heart failure.

Most serious: liver failure, neuropathy, hearing loss Other: nausea, diarrhea, vomiting, fever, respiratory disorders, rash, headache

May interfere with immune response to live-virus vaccines for measles, mumps, or rubella

Most serious: depression, suicidal behavior, severe pain, difficulty breathing, vision problems, high fever, bleeding or bruising Other: headache, nausea, diarrhea, chills, fatigue

300 to 600 mg per kg of body weight, every three to four weeks, administered intravenously

For AIDS-related Kaposi’s sarcoma, 20 mg per square meter of body surface, every three weeks by intravenous infusion

Helps fight bacterial infections in children with HIV

Treats Kaposi’s sarcoma in patients who cannot tolerate other medicines or whose disease is advanced

Dose may need to be adjusted if you have liver problems

Most serious: congestive heart failure, decrease in blood cells Other: tingling or burning, swelling, blisters, mouth sores, fever, nerve damage and more (see HIVPlusMag.com)

j u ly/a u g u s t 2 0 1 2 •

hiv plus

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

Sculptra injectable poly-L-lactic acid

Amount and frequency varies by patient; delivered by subcutaneous injection

Helps restore or correct signs of facial fat loss (lipoatrophy)

If you have an active skin infection or inflammation in or near the treatment area, do not use until this condition is under control. Minimize exposure to sunlight or sun lamps

Most serious: bruising, edema, hematoma, injection site reactions

800 to 1,200 mg daily, depending on the type of virus and the patientâ&#x20AC;&#x2122;s weight, taken orally in two divided doses for 24 to 48 weeks

In combination with Pegasys, treats chronic hepatitis C infection

Do not use if you take Videx or Videx EC. Do not take if you have certain blood disorders, such as thalassemia major or sicklecell anemia, or certain types of hepatitis. Do not take if you are pregnant or if you or your partner plan to become pregnant

Most serious: severe eye, blood, lung, or liver problems, pancreatitis, depression or suicidal thoughts, high blood sugar or diabetes, fetal abnormalities Other: flu-like symptoms, tiredness and weakness, nausea and vomiting, loss of appetite, skin reactions, hair thinning, trouble sleeping

Dermik Laboratories

copeguS ribivarin Genentech

rebetol ribivarin

800-1,400 mg daily, by capsule or oral solution, taken with food

In combination with Intron-A or PegIntron, treats chronic hepatitis C infection

Do not use if you take Videx or Videx EC. Do note take if you have autoimmune hepatitis, certain blood disorders, or severe kidney disease. Do not take if you are pregnant or if you or your partner plan to become pregnant.

Most serious: severe eye, lung, or blood problems, pancreatitis, severe depression or suicidal thoughts, dental problems caused by dry mouth Other: less serious mood changes, flulike symptoms

300 mg in capsules, once daily. If prone to nausea

Helps prevent disseminated Mycobacterium avium complex (MAC) disease

Do not use with Rescriptor or Norvir. May reduce effectiveness of Sporanox, Biaxin, Fortovase, and Invirase as well as oral contraceptives. Cut dose in half if also taking Crixivan or Viracept. Do not take if you have active tuberculosis

Most serious: neutropenia Other: rash, gastrointestinal disorders, flu-like symptoms

Schering

Mycobutin rifabutin Pfizer

rifadin, rifadin iV rifampin Sanoifi-Aventis

aMbiSoMe, aMphotec, abelcet, aMphocin, fungizone

or vomiting, split into two doses daily, with food

10 mg per kg of body weight, once daily, orally in capsule form (Rifadin) or intravenously (Rifadin IV). Daily dosage should not exceed 600 milligrams. Oral dosage should be one hour before or two hours after a meal with water.

Helps prevent or treat infections caused by a certain type of bacterium, including the one that causes tuberculosis

Do not take if taking Reyataz, Prezista, Lexiva, Fortovase, Invirase, or Aptivus. Dosage of anticoagulant other drugs need to be adjusted. Use with caution if you have diabetes. Switch to nonhormonal contraceptives.

Gastrointestinal distress, changes in liver function, headache, drowsiness, dizziness, menstrual irregularities

No more than 1.5 mg per kg of body weight, administered intravenously, once daily

Treats fungal infections, including cryptococcal meningitis, which are more common in people with HIV

Individuals who cannot normally take traditional amphotericin B because it causes damage to their kidneys may be able to take the formulations in AmBisome, Abelcet, or Amphotec

Most serious: allergic reaction, kidney problems, rash, irregular heartbeat, muscle cramps or pain, weakness, bleeding, hearing loss blurred vision Other: fever, shaking, chills, and more. See HIVPlusMag.com for list

amphotericin B

Astellas, Alkopharma, Sigma-Tau, Pfizer, Bristol-Myers Squibb

hiv plus

â&#x20AC;˘ j u ly/a u g u s t 2 0 1 2

MEDICATION

Cytovene-Iv, vItrasert ganciclovir

Roche Laboratories (Cytovene-IV), Auritec (Vitrasert)

DIfluCan fluconazole Pfizer

DOSAGE

WHAT IT DOES

WHAT TO KNOW

Vitrasert, surgically implanted in the eye, consists of a 4.5-mg pellet of ganciclovir coated with polymers. For Cytovene-IV, dosages vary. See HIVPlusMag.com for details.

Treats the eye infection cytomegalovirus retinitis in transplant recipients people with weakened immune systems, such as those with HIV

Do not take with blood dyscrasia-causing medications, bone marrow depressants, radiation therapy, nephrotoxic medications and Retrovir. Dosage may need to be adjusted if you have kidney problems or take Videx or Videx EC.

Doses vary. Available as tablets, a powder to be mixed with water and taken orally, or an injection formula.

Treats many types of fungal infections, including AIDSrelated oral, esophageal, or vaginal yeast infections

Do not take with Quinaglute, Quinidex, Hismanal, Propulsid, Orap, or erythromycin. Use with caution with antidiabetic agents, anticonvulsants, blood pressure medications, immunosuppressive drugs, protease inhibitors, blood thinners, vitamin A nutritional supplement, and others

SIDE EFFECTS

Most serious: blood disorders, black or tarry stools, cough, sore throat, fever or chills, pain, painful urination, seeing flashes or sparks of light, floating spots, or a partial veil across vision, unusual bleeding, and unusual tiredness or weakness Other: abdominal pain, changes in behavior, diarrhea, fever, headache, increased sweating, loss of appetite, vomiting, weight loss.

A52 92.16;4 @<B?02 3<? 94/A ;2D@ .;1 2;A2?A.6;:2;A is at your fingertips

Get The Advocate News App Now READ Up-to-the-minute reporting from Advocate.com

WATCH Your favorite Advocate original video

ENJOY Every page from the current issue of The Advocate magazine

FREE! Download The Advocate News App free from the iTunesTM store and the AndroidTM Market.

The world’s leading LGBT news source since 1967, The Advocate covers everything you need to know about LGBT news, politics, entertainment, health, travel, culture and more. Get The Advocate’s award-winning reports and video directly on your iPhone.

iPHONE PHOTO COURTESY OF APPLE INC. ITUNES IS A TRADEMARK OF APPLE INC. ANDROID IS A TRADEMARK OF GOOGLE INC.

WHERE�TO�EAT��DRINK��SHOP�� AND�STAY�IF�IT’S�IN��IT’S�OUT� OUT�MAGAZINE�CITY�GUIDES

AMSTERDAM • ANTWERP • BERLIN • BOSTON • BUENOS AIRES • CHICAGO • COPENHAGEN LONDON • LOS ANGELES • MIAMI • MONTREAL • NEW YORK • PARIS SAN FRANCISCO • SANTA FE • SHANGHAI • STOCKHOLM • TORONTO • ZURICH NEW CITIES EVERY MONTH AVAILABLE FREE ON YOUR iPHONE AND iPAD AT OUT.COM/iPHONE.

having trouble making ends meet? While your HIV medication isn’t an optional expense, the federally created, state-managed AIDS Drug Assistance Program—commonly called ADAP—provides prescription medication to uninsured or underinsured people with HIV or AIDS. The requirements to qualify for ADAP vary by state, and generally include being HIV-positive and a resident, being uninsured, or having insurance that doesn’t cover your medication. You must also make under an annual income limit, which also varies. Below you’ll find a state-by-state guide to ADAP income limits, whether there is a waiting list to get signed up and how many people are on it (numbers accurate as of May), and each state’s contact information. Unless otherwise noted, the income limits are for a single individual. ALABAMA Website: adph.org/aids Telephone: (334) 206-5364 Maximum qualifying income (MQI): $27,925; Waiting List: Yes, 27

IDAHO safesex.idaho.gov (208) 334-6527 MQI: $21,780; Waiting List: Yes, 14

ALASKA alaskanaids.org/2011/resources/adap/adap.html (907) 263-2050 MQI: $41,910; Waiting List: No

ILLINOIS idph.state.il.us/health/aids/adap.htm (217) 524-5983 MQI: $22,340; Waiting List: No

ARIZONA azdhs.gov/phs/hvstdhpc/adap.htm (800) 334-1540 MQI: $33,510; Waiting List: No

INDIANA in.gov/isdh/17740.htm (866) 588-4948 MQI: $33,510; Waiting List: No

ARKANSAS healthy.arkansas.gov/programsServices/infectiousDisease/ hivStdHepatitisC/Pages/HIVServices.aspx (501) 661-2862 MQI: $22,340; Waiting List: Yes

IOWA idph.state.ia.us/HivStdHep/HIV-AIDS.aspx?prog=HIV&pg=HivHome (515) 281-4775 MQI: $22,340; Waiting List: No longer accepting new enrollees

CALIFORNIA cdph.ca.gov/programs/aids/Pages/tOAADAP.aspx (916) 449-5900 MQI: $44,680; Waiting List: No

KANSAS kdheks.gov/hiv/ryan_white_care.html (785) 368-8218 MQI: $33,510; Waiting List: No

COLORADO cdphe.state.co.us/dc/HIVandSTD/RyanWhite/adap.html (303) 692-2716 MQI: $43,669; Waiting List: No

KENTUCKY chfs.ky.gov/dph/epi/HIVAIDS/services.htm (866) 510-0005 MQI: $33,510; Waiting List: No

CONNECTICUT ct.gov/dss/lib/dss/PDFs/CADAPapp03.pdf (800) 233-2503 MQI: $44,680; Waiting List: No

LOUISIANA hiv.dhh.louisiana.gov (504) 568-7474 MQI: $33,510; Waiting List: Yes, 294

DELAWARE dhss.delaware.gov/dph/dpc/hivtreatment.html (302) 744-1050 MQI: $55,850; Waiting List: No

MAINE positiveme.org/Resources/ADAP.php (800) 245-4444 MQI: $55,850; Waiting List: No

DISTRICT OF COLUMBIA dchealth.dc.gov (202) 671-4900 MQI: $54,150; Waiting List: No

MARYLAND ideha.dhmh.md.gov/OIDPCS/CHCS/SitePages/medicare.aspx (800) 205-6308 MQI: $55,850; Waiting List: No

FLORIDA floridaADAP.org (800) 245-4444 MQI: $44,680; Waiting List: Yes, 503 people

MASSACHUSETTS massresources.org/hiv-drug-assistance-program.html (800) 228-2714 MQI: $55,850; Waiting List: No

GEORGIA health.state.ga.us/programs/stdhiv/adap.asp (404) 657-3100 MQI: $33,510; Waiting List: Yes, 957

MICHIGAN michigan.gov/dap (888) 826-6565 MQI: $50,625; Waiting List: No

HAWAII hawaii.gov/health/healthy-lifestyles/std-aids/aboutus/ prg-medical-management/index.html (808) 733-9360 MQI: $51,440; Waiting List: No

hiv plus

• j u ly/a u g u s t 2 0 1 2

MINNESOTA dhs.state.mn.us/hivaids (800) 657-3761 MQI: $33,510; Waiting List: No

T H E 2 0 1 2 H I V T R E AT M E N T G U I D E

MISSISSIPPI msdh.ms.gov/msdhsite/_static/14,0,150.html (601) 362-4356 MQI: $44,680; Waiting List: No

OREGON oregon.gov/OHA/pharmacy/care assist (800) 805-2313 MQI: $33,510; Waiting List: No

MISSOURI health.mo.gov/living/healthcondiseases/communicable/hivaids (573) 751-6439 MQI: $33,510; Waiting List: No

PENNSYLVANIA dpw.state.pa.us/provider/healthcaremedicalassistance/ specialpharmaceuticalbenefitsprogram/index.htm (800) 922-9384 MQI: $37,643 ; Waiting List: No

MONTANA dphhs.mt.gov/publichealth/hivstd/ (406) 444-4744 MQI: $36,861; Waiting List: No

RHODE ISLAND health.ri.gov/programs/ryanwhitehivcare/ (401) 222-2320 MQI: $44,680; Waiting List: No

NEBRASKA dhhs.ne.gov/publichealth/Pages/dpc_ryan_white.aspx (402) 559-4673 MQI: $22,340; Waiting List: Yes, 230

SOUTH CAROLINA scdhec.gov/adap (803) 831-7806 MQI: $33,510; Waiting List: No

NEVADA health.nv.gov/CD_HIV_Programs.htm (775) 684-3499 MQI: $44,680; Waiting List: No

SOUTH DAKOTA doh.sd.gov/RyanWhite/default.aspx (605) 773-3737 MQI: $33,510; Waiting List: No

NEW HAMPSHIRE dhhs.nh.gov/dphs/bchs/std/care.htm (603) 271-4502 MQI: $33,510; Waiting List: No

TENNESSEE health.state.tn.us/STD/ryanwhite.shtml (615) 532-2392 MQI: $33,510; Waiting List: No

NEW JERSEY state.nj.us/health/aids/freemeds.shtml (877) 613-4533 MQI: $55,850; Waiting List: No

TEXAS dshs.state.tx.us/hivstd/meds/default.shtm (800) 255-1090 MQI: $22,340; Waiting List: No

NEW MEXICO nmhealth.org/IDB/HIV_services.shtml (505) 827-2433 MQI: $44,680; Waiting List: No

UTAH health.utah.gov/cdc/hiv_treatment.htm (801) 538-6197 MQI: $27,925; Waiting List: No

NEW YORK health.state.ny.us/diseases/aids/resources/ adap/index.htm (800) 542-2437 MQI: $48,590; Waiting List: No

VERMONT healthvermont.gov/prevent/aids/aids_index.aspx (802) 951-4005 MQI: $22,340; Waiting List: No

NORTH CAROLINA epi.state.nc.us/epi/hiv/adap2.html (877) 466-2232 MQI: $13,963; Waiting List: Yes, 185

VIRGINIA vdh.virginia.gov/epidemiology/DiseasePrevention/ Programs/ADAP (866) 392-1309 MQI: $44,680; Waiting List: Yes, 689

NORTH DAKOTA ndhealth.gov/HIV (701) 328-1059 MQI: $33,510; Waiting List: No

WASHINGTON doh.wa.gov/cfh/hiv/care/default.htm (360) 236-3426 MQI: $33,510/$41,329 (Early Intervention); Waiting List: No

OHIO odh.ohio.gov/odhPrograms/hastp ac/hivcare/drugasst/drgasst1. aspx (866) 777-4775 MQI: $33,510 ; Waiting List: No

WEST VIRGINIA dhhr.wv.gov/oeps/std-hiv-hep/HIV_AIDS/caresupport/Pages/ADAP. aspx (304) 232-6822 MQI: $36,303; Waiting List: No

OKLAHOMA ok.gov/health/Disease,_Prevention,_Preparedness/HIV_STD_ Service/Ryan_White_Programs/index.html (405) 271-4636 MQI: $22,340; Waiting List: No

WISCONSIN dhs.wisconsin.gov/aids-hiv (800) 991-5532 MQI: $33,510; Waiting List: No WYOMING health.wyo.gov/phsd/aids/ryan.html (307) 777-5856 MQI: $38,300-$45,500 Waiting List: No

j u ly/a u g u s t 2 0 1 2 â&#x20AC;˘

hiv plus

DayDDream Day Believer 38

hiv plus

â&#x20AC;˘ m ay/J U N E 2 0 1 2

Out Of the darkness, The Voice’s hIV-pOsItIVe breakOut star, Jamar rOgers, shInes a brIght lIght

photo credit tk

by MICHELLE GARCIA

usic has been a constant in Jamar Rogers’s life, even when he was battling an addiction to crystal meth. “When I was using meth, I would have such down days,” says the 29-year-old Rogers. “I mean suicidal, not-good thoughts. I would sit in the shower and sing. That was my therapy. I’d sing to get things off my chest and then I would do some more drugs.” It’s hard to imagine the bright, spirited, happy guy who sang his way into our hearts (and to the top eight) on NBC’s The Voice harbored such dark thoughts or that he was addicted to crystal meth seven years ago. But that’s who he was, and that addiction, he says, eventually led him to contract HIV. Once Rogers was diagnosed with HIV, also about seven years ago, he

nearly abandoned any dreams of a singing career. With so much pressure to be a sex symbol in the music industry, Rogers thought, Who was going to take me? How am I going to be a sex symbol? When people see me, all they’re going to see is a disease. But Rogers realized his love of music transcended those fears. It also helped that along the way he found a role model, musical artist and Voice judge Cee Lo Green, whom Rogers calls an exception to the rules of pop music. “He doesn’t look like the typical pop star,” says Rogers. “Cee Lo gave us the permission a long time ago that it’s all right to be a black guy that explores all kinds of genres of music and that I don’t have to be pigeonholed into R&B or hip-hop. He gave me permission, without ever even meeting me, to just be myself.” With Cee Lo’s music as the soundtrack of his life, Rogers picked up and left Atlanta with his mother, j u ly/a u g u s t 2 0 1 2 •

hiv plus

“If you feel ugly or you feel unwanted, there’s somethIng about goIng out and makIng a stranger’s day that makes you feel so IncredIbly good about yourself.” sister, and (now ex) wife, and found refuge at a church in Milwaukee, where he began treatment to ditch his meth addiction. Rogers was welcomed into the choir, with a little nudging from his mother, and soon his inner light shone through. He realized that singing and songwriting were not only his innate talents but also his form of therapy. “I haven’t even thought about doing meth in almost seven years now,” he says. “I’ve written so many songs about struggling with addiction. Without music and my relationship with God, I don’t know where I would be right now.” And through his relationship with God, he gained a new best friend, American Idol contestant Danny Gokey. The pair auditioned for the 2009 season of Idol together, and Rogers even made it to the famed Hollywood Week but eventually was sent packing. Soon after, home became the Bronx, N.Y., where he now lives and volunteers with God’s Love We Deliver, a nonprofit with an army of volunteers who deliver food to people too sick to shop or cook for themselves. Through the organization, Rogers began delivering meals to people with HIV, cancer, Alzheimer’s disease, and multiple sclerosis. “I was like, These people can’t even leave their homes. I can at least walk up my four flights of stairs in my apartment. What am I complaining about? My life isn’t really that bad.” Rogers says he learned about the power of giving to others through the experience. “I know it doesn’t make any sense,” he says, “but if you’re lacking love, the best way to get love is to give love. If you feel ugly or you feel unwanted, there’s something about going out and making a stranger’s day that makes you feel so incredibly good about yourself.” It was there that Rogers’s life changed

hiv plus

• j u ly/a u g u s t 2 0 1 2

one August afternoon. Sure, there was a camera crew following him around that day because The Voice was interested in him as a contestant. But he had no idea that the show’s host, Carson Daly, would ambush him with an invitation as he loaded a van with bags full of meals. “That was not planned,” Rogers says, laughing. “A lot of people were like, ‘Oh, you had to have known that he was coming,’ and I knew the camera crew wanted to follow me around for a day, but I had no idea Carson was going to show up. It was genuine surprise on my face.” The next goal for Rogers was to get his idol, Cee Lo Green, to spin his chair around for him during the blind auditions. In his mind, there were no other judges, only Cee Lo. Performing the White Stripes’ “Seven Nation Army,” Rogers started to get nervous as he approached the second verse, and none of the judges had spun their chairs around yet. “I started to sweat a little bit, I’m not going to lie,” he says. “But then I saw the pearly whites. It was Cee Lo. I could have just finished right there.” From then on he was Cee Lo’s “minime,” and Cee Lo was his big brother. Mentor Cee Lo’s musical background lent itself perfectly to Rogers’s talents. He took on rock ballads, including “I Want to Know What Love Is” by Foreigner, and high-octane songs such as “Are You Gonna Go My Way” by Lenny Kravitz. Though he started as a front-runner, Rogers was eventually ousted by teammate and soulful indie rocker Juliet Simms, who herself lost to The Voice’s season 2 winner, Jermaine Paul. But Rogers is far from discouraged. After all of the adversity that he’s overcome, earning tens of thousands of new adoring fans and kick-starting his professional music career seems like a good

consolation prize. And there’s no doubt that Rogers will follow his own advice for the road ahead. “Don’t give up, ever,” Rogers says to others with HIV. “Just because we might have had something detrimental happen to us, it doesn’t mean that we stopped fulfilling our purpose or our destiny. If I could just get one message out there, it would be that HIV shouldn’t be a stop sign. If anything it was an accelerator for me. It made me want to live, it made me want to pursue my passion, and that’s the biggest message I could get out.” ✜

Scenes from The Voice (clockwise from top): Rogers belts one out; waiting for results with Carson Daly and fellow contestant Juliet Simms; Team Cee Lo

pre vious spread and this page: courtesy nbc /universal (4)

t j u ly/a u g u s t 2 0 1 2 â&#x20AC;˘

hiv plus

Model

INDICATIONS ISENTRESS (raltegravir) is a prescription HIV-1 medicine used with other HIV medicines to treat adults with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). The use of other medicines active against HIV-1 in combination with ISENTRESS may increase your ability to fight HIV. ISENTRESS does not cure HIV Infections or AIDS. Patients must stay on continuous HIV therapy to control infection and decrease HIV-related illnesses.

IMPORTANT RISK INFORMATION Severe, potentially life-threatening, and fatal skin reactions and allergic reactions have been reported in some patients taking ISENTRESS. If you develop a rash with any of the following symptoms, stop using ISENTRESS and contact your doctor right away: fever, generally ill feeling, extreme tiredness, muscle or joint aches, blisters or sores in mouth, blisters or peeling of skin, redness or swelling of the eyes, swelling of the mouth or face, problems breathing. Sometimes allergic reactions can affect body organs, like the liver. Contact your doctor right away if you have any of the following signs or symptoms of liver problems: yellowing of the skin or whites of the eyes, dark or tea-colored urine, pale-colored stools/bowel movements, nausea/vomiting, loss of appetite, pain, aching or tenderness on the right side below the ribs. Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your doctor right away if you start having new symptoms after starting your HIV medicine. People taking ISENTRESS may still develop infections or other conditions associated with HIV infections. The most common side effects of ISENTRESS include: headache, trouble sleeping, nausea, and tiredness. Less common side effects include: weakness, stomach pain, dizziness, depression, and suicidal thoughts and actions.

I am a social butterfly. I am passionate. I am a mom. I am HIV positive. You are special, unique, and different from anyone else. And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle. In a clinical study lasting 156 weeks, patients being treated with HIV medication for the first time who took ISENTRESS (raltegravir) plus Truvada: Had a low rate of side effects — The most common side effects of moderate to severe intensity (that interfered with or kept patients from performing daily activities) were insomnia (4%), headache (4%), nausea (3%), and tiredness (2%) At week 144, cholesterol was measured and patients who took ISENTRESS plus Truvada experienced less effect on LDL cholesterol (“bad” cholesterol): — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 22 mg/dL with Sustiva plus Truvada — When they began the study, the average LDL cholesterol of patients on ISENTRESS plus Truvada was 97 mg/dL versus 92 mg/dL for those on Sustiva plus Truvada

Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This may be a sign of a rare but serious muscle problem that can lead to kidney problems. Rash occurred more often in patients taking ISENTRESS and darunavir/ritonavir (Prezista) together, than with either drug separately, but was generally mild. Tell your doctor about all your medical conditions, including if you are pregnant or plan to become pregnant. It is not known if ISENTRESS can harm your unborn baby. Also tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. Tell your doctor about all the medicines you take, including prescription medicines like rifampin (a medicine used to treat infections such as tuberculosis), non-prescription medicines, vitamins, and herbal supplements. 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 read the Patient Information on the adjacent page for more detailed information.

Need help paying for ISENTRESS? Call 1-866-350-9232 Copyright © 2012 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1038367-0000 05/12 Sustiva is a registered trademark of Bristol-Myers Squibb Brands mentioned are the trademarks of their respective owners.

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Film-Coated Tablets ISENTRESS ® (eye sen tris) (raltegravir) Chewable Tablets Read this Patient Information before you start taking ISENTRESS and each time you get a refill. There may be new information. This information does not take the place of talking with your doctor about your medical condition or your treatment. What is ISENTRESS? ISENTRESS is a prescription HIV medicine used with other HIV medicines to treat adults and children 2 years of age and older with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). When used with other HIV medicines, ISENTRESS may reduce the amount of HIV in your blood (called “viral load”). ISENTRESS may also help to increase the number of CD4 (T) cells in your blood which help fight off other infections. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system. This may reduce your risk of death or infections that can happen when your immune system is weak (opportunistic infections). It is not known if ISENTRESS is safe and effective in children under 2 years of age. ISENTRESS does not cure HIV infection or AIDS. People taking ISENTRESS may still develop infections or other conditions associated with HIV infection. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. Patients must stay on continuous HIV therapy to control infection and decrease HIV-related illnesses. Avoid doing things that can spread HIV-1 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 to lower the chance of sexual contact with semen, vaginal secretions, or blood. Ask your doctor if you have any questions on how to prevent passing HIV to other people. What should I tell my doctor before taking ISENTRESS? Before taking ISENTRESS, tell your doctor if you: • have liver problems. • have phenylketonuria (PKU). ISENTRESS Chewable Tablets contain phenylalanine as part of the artificial sweetener, aspartame. The artificial sweetener may be harmful to people with PKU. • have any other medical conditions. • are pregnant or plan to become pregnant. It is not known if ISENTRESS can harm your unborn baby. Pregnancy Registry: You and your doctor will need to decide if taking ISENTRESS is right for you. If you take ISENTRESS while you are pregnant, talk to your doctor about how you can be included in the Antiretroviral Pregnancy Registry. The purpose of the registry is to follow the health of you and your baby. • are breastfeeding or plan to breastfeed. - Do not breastfeed if you are taking ISENTRESS. You should not breastfeed if you have HIV because of the risk of passing HIV to your baby. - Talk with your doctor about the best way to feed your baby. Tell your doctor about all the medicines you take, including: prescription and nonprescription medicines, vitamins, and herbal supplements. Taking ISENTRESS and certain other medicines may affect each other causing serious side effects. ISENTRESS may affect the way other medicines work and other medicines may affect how ISENTRESS works. Especially tell your doctor if you take: • rifampin (Rifadin, Rifamate, Rifater, Rimactane), a medicine commonly used to treat tuberculosis. Ask your doctor or pharmacist if you are not sure whether any of your medicines are included in the list above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine. Do not start any new medicines while you are taking ISENTRESS without first talking with your doctor. How should I take ISENTRESS? • Take ISENTRESS exactly as prescribed by your doctor. • You should stay under the care of your doctor while taking ISENTRESS. • Do not change your dose of ISENTRESS, switch between the film-coated tablet and the chewable tablet or stop your treatment without talking with your doctor first. • Take ISENTRESS by mouth, with or without food. • If your child is taking ISENTRESS, your child’s doctor will decide the right dose based on your child’s age and weight. • ISENTRESS Chewable Tablets may be chewed or swallowed whole. • ISENTRESS Film-Coated Tablets must be swallowed whole. • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not double your next dose or take more than your prescribed dose. • If you take too much ISENTRESS, call your doctor or go to the nearest emergency room right away. • Do not run out of ISENTRESS. Get your ISENTRESS refilled from your doctor or pharmacy before you run out. What are the possible side effects of ISENTRESS? ISENTRESS can cause serious side effects including: • Serious skin reactions and allergic reactions. Severe, potentially life-threatening and fatal skin reactions and allergic reactions have been reported in some patients taking ISENTRESS. If you develop a rash with any of the following symptoms, stop using ISENTRESS and contact your doctor right away: ° fever ° muscle or joint aches ° redness or swelling of the eyes ° generally ill feeling ° blisters or sores in mouth ° swelling of the mouth or face extreme tiredness blisters or peeling of the skin ° ° ° problems breathing

Sometimes allergic reactions can affect body organs, like the liver. Contact your doctor right away if you have any of the following signs or symptoms of liver problems: ° yellowing of the skin or whites of the eyes ° dark or tea colored urine ° pale colored stools/bowel movements ° nausea/vomiting ° loss of appetite ° pain, aching or tenderness on the right side below the ribs • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your doctor right away if you start having new symptoms after starting your HIV medicine. • Phenylketonuria (PKU). ISENTRESS Chewable Tablets contain phenylalanine as part of the artificial sweetener, aspartame. The artificial sweetener may be harmful to people with PKU. The most common side effects of ISENTRESS include: • headache • nausea • trouble sleeping • tiredness Less common side effects include: • weakness • depression • stomach pain • suicidal thoughts and actions • dizziness Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This may be a sign of a rare but serious muscle problem that can lead to kidney problems. Rash occurred more often in patients taking ISENTRESS and darunavir/ritonavir together than with either drug separately, but was generally mild. Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of ISENTRESS. For more information, ask your doctor or pharmacist. 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 ISENTRESS? Film-Coated Tablets: • Store ISENTRESS Film-Coated Tablets at room temperature between 68°F to 77°F (20°C to 25°C). Chewable Tablets: • Store ISENTRESS Chewable Tablets at room temperature between 68°F to 77°F (20°C to 25°C). • Store ISENTRESS Chewable Tablets in the original package with the bottle tightly closed. • Keep the drying agent (desiccant) in the bottle to protect from moisture. Keep ISENTRESS and all medicines out of the reach of children. General information about ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in Patient Information Leaflets. Do not use ISENTRESS for a condition for which it was not prescribed. Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them. This leaflet gives you the most important information about ISENTRESS. If you would like to know more, talk with your doctor. You can ask your doctor or pharmacist for information about ISENTRESS that is written for health professionals. For more information go to www.ISENTRESS.com or call 1-800-622-4477. What are the ingredients in ISENTRESS? ISENTRESS Film-Coated Tablets: Active ingredient: raltegravir Inactive ingredients: microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. The film coating contains: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide. ISENTRESS Chewable Tablets: Active ingredient: raltegravir Inactive ingredients: hydroxypropyl cellulose, sucralose, saccharin sodium, sodium citrate dihydrate, mannitol, red iron oxide (100 mg tablet only), yellow iron oxide, monoammonium glycyrrhizinate, sorbitol, fructose, natural and artificial flavors (orange, banana, and masking that contains aspartame), crospovidone, magnesium stearate, sodium stearyl fumarate, ethylcellulose 20 cP, ammonium hydroxide, medium chain triglycerides, oleic acid, hypromellose 2910/6cP, PEG 400. This Patient Information has been approved by the U.S. Food and Drug Administration. Distributed by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Whitehouse Station, NJ 08889, USA Revised April 2012 USPPI-T-05181204R018 Copyright © 2007, 2009, 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1038367-0000 05/12 U.S. Patent Nos. US 7,169,780

(c o n t i n u e d) T H E 2 0 1 2 H I V T R E A T M E N T G U I D E

Etopophos, toposar, VEpEsid etoposide

Dosages vary for small cell lung cancer and testicular cancer. See HIVPlusMag.com for details

Treats various types of cancer; being tested to see if it stops non-Hodgkin’s lymphoma and Kaposi’s sarcoma

High-dose cyclosporine and drugs such as levamisole hydrochlor can cause interactions. Use of a live virus vaccine could be complicated by weakened immune mechanisms. Do not deliver by bolus intravenous injection

Most serious: severe allergic reaction, shingles, black stools, blood in urine or stools, chills or fever, cough or hoarseness, lower back or side pain, painful or difficult urination, red pinpoint skin rash, unusual bleeding or bruising, and unusual tiredness or weakness Other: Numerous, see HIVPlusmag.com for full list

Available in capsules, tablets, oral solution, intravenous injection form, cream, or ointment. Dosage varies according to type of infection. See HIVPlusMag.com for examples

Treats and controls herpesvirus infections.

Use with caution with Retrovir, antifungal agents, Benemid, interferon, intrathecal methotrexate, and drugs that can cause kidney toxicity. Drink plenty of fluids while taking the drug

Most serious, with oral form: severe blood abnormalities and clotting; kidney failure Other: nausea, diarrhea, headache, lightheadedness, confusion, seizures, tremors, bleeding, bruising, chills, fever. With ointment, pain, swelling, or rash

Bristol-Myers Squibb, Pfizer

ZoVirax acyclovir GlaxoSmithKline

hEpsEra

One 10-mg tablet daily

adefovir dipivoxil Gilead

marinol dronabinoll Abbott Laboratories

Zithromax azithromycin Pfizer (Zithromax); various others (generic)

radiEssE calcium hydroxylapatite Merz Aesthetics

Biaxin clarithromycin Abbott Laboratories

Helps prevent disseminated Mycobacterium avium complex (MAC) disease

Do not take with Viread, Atripla, Truvada, or Complera. Use caution when taking with drugs that affect kidney function or are eliminated by the kidneys, or with other NRTIs Can interact dangerously with alcohol, Valium, Librium, Seconal, Xanax, or Nembutal. Do not smoke marijuana, as this can cause an overdose. Can become habit forming.

Most serious: worsening of hepatitis B, kidney malfunction, buildup of lactic acid in the blood Other: weakness, headache, abdominal pain, nausea, diarrhea, indigestion, gas

Most serious: amnesia, confusion, delusions, mood changes, feelings of unreality, hallucinations, depression, nervousness, anxiety, and rapid heartbeat Other: clumsiness or unsteadiness, dizziness, drowsiness, euphoria, trouble thinking, nausea, and vomiting

Varies, but usually starts with one 2.5-mg capsule taken twice daily, before lunch and dinner. Also available in five-mg or 10-mg capsules. Take the capsules whole; do not crush or chew.

Helps stimulate the appetite of HIV patients

Depends on the infection. Available in several forms, such as intravenous infusion, capsule, oral suspension, and tablets of 250, 500, or 600 mg.

Treats bacterial infections

Not recommended for patients with cystic fibrosis or impaired liver function. Antacids can lessen the drug’s efficacy if taken too close together.

Mild redness, swelling, and bruising at the injection site.

Varies; the drug is available in single-use vials with 0.3, 1, or 1.3 milliliters of calcium hydroxylapatite suspended in a gel. It is injected under the skin, and effects can last several months

Treats facial fat loss (lipoatrophy), a complication of HIV

Users of blood thinners or aspirin may have bleeding or bruising at the injection site. For 24 hours after treatment, avoid significant movement, massage, sun exposure, or makeup use

Most serious: worsening of hepatitis B, kidney malfunction, buildup of lactic acid in the blood Other: weakness, headache, abdominal pain, nausea, diarrhea, indigestion, gas

500 mg, 2 or 3 times daily, depending on the infection. Available in immediate release tablets, extended release tablets, and granules to be mixed with water.

Fights bacterial infections, especially MAC or Mycobacterium avium complex

There have been lifethreatening interactions with Colcrys and serious interactions with Altacor, Altoprev, Mevacor, Zocor, Lipitor, blood pressure drugs

Most serious: abdominal pain, fever, nausea, vomiting, bleeding or bruising, diarrhea, colitis, liver failure, hepatitis Other: milder diarrhea, headache, nausea and vomiting, change in taste j u ly/a u g u s t 2 0 1 2 •

hiv plus

STATUS SYMBOLS message in a bottle

hiv plus

â&#x20AC;˘ j u ly/a u g u s t 2 0 1 2

River Huston

Pharmaceutical Frenemies Everyone has their own story about making peace with their meds

photos.com

t’s 10 p.m., which is late for me. I am just crawling into bed with my new sunflower sheets, ready to snuggle down and go to sleep. I close my eyes and I remember, Damn! I forgot to take my pills. Then I have the all-too-common mini-debate with myself: One day won’t kill you. The responsible part of my brain responds, Just go do it. It will only take a second. The part curled around my feather pillow wonders, What would happen if I just stopped? Honestly, I’ve had a love-hate relationship with my medication from the beginning. I was able to forgo treatment for most of the 27 years I’d been infected because I also had an acute autoimmune disease, idiopathic thrombocytopenic purpura (ITP), which was killing everything that entered my body, both good and bad. But when my immune system finally slowed down due to unknown forces, HIV was able to get a foothold and went viral. I had to take the meds or die, or so I was told. On the positive side, when HIV started destroying my immune system it allowed me to stop treatment for the ITP. That treatment was awful. There was no choice or time for debates about it. If I didn’t do it, I would bleed to death. But it was a painful experience. Within 15 minutes of the IV running into my veins, I felt like an ice pick was going through the center of my head. I got nauseated and faint. The morning after the treatment I felt like someone beat me, put me in the trunk of a car, and then did some amateur drag

racing. The following day would be a little better; I only felt like I had slept in the trunk of the car and had been pummeled in the gym by some sadistic personal trainer. Several days later I would finally feel good again, and then it would be time for the next treatment. I did that for 13 years. With HIV active, my compromised immune system could no longer destroy platelets, and I was set free from the IV that had tethered me to weekly treatments for over a decade. (Yay, HIV?) Treatments for HIV had always scared me, especially after witnessing some of the more extreme side effects, like lipodystrophy and wasting. After I was diagnosed I tried alternative treatments, from bitter melon enemas to having my chakras vacuumed, in order to stave off conventional treatments. But when my T cells hit 150 I knew I had to take Western medication. At first it was a horror show. Two years dragged by, filled with every side effect possible. When I read the inserts for the meds, they listed things like, “headache, nausea, fatigue, metallic taste in your mouth, kidney failure, liver damage, death. If any if these things happen, please contact your doctor immediately.” (I guess I’d have to use a Ouija board to tell my doc about that last “side effect,” or I would just have to haunt the infectious disease clinic.) Finally, I found a drug combination that didn’t kill me. Now it’s a handful of pills at night that I can take in one gulp. I have no discernible side effects. What I do know is that when I feel depressed, like I have outlived my expiration date, I

fantasize about not taking the pills. These moments are very rare since I have found contentment and peace living in the islands, painting my heart out. But having battled depression most my life, I admit that on occasion it sneaks in to say hello. Sometimes I want to stop the treatment because I am just tired of taking it. It is also a daily reminder that I have this disease. Really, it is the only reminder (except, of course, when I meet someone I might want to date or have sex with). And yes, sometimes I want to skip the meds because it is just inconvenient—like when it’s 10 p.m. and the lovely arms of slumber are embracing me. But it comes down to acceptance. I know there are things on the horizon that might make it possible for me to stop the pills, but for now I need to get up, face what might be lurking in the dark—and in the Caribbean that can be a lizard or a big black spider—and swallow my pills. Once I do this I am usually hit with a sense of mini-accomplishment. It’s also a small reminder that I care, that I am blessed to have access to these drugs, that I no longer have to battle ITP, and that I want to live as long as I can and I will do what it takes to get there. River Huston is the codirector of sevenminuseven, 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 ancient, small dog Buddy and several strays. You can keep up with her at RiverHuston.com.

j u ly/a u g u s t 2 0 1 2 •

hiv plus

STATUS SYMBOLS ask+tell

management, HIV testing, and prevention education. The money also supports the meals program, where I have volunteered, which annually provides 90,000 nutritious meals to people living with HIV/AIDS. Either that, or it’ll be used for one big tea dance. You were a journalist for magazines like Rolling Stone in the 1980s. How aware were you of AIDS back then? I wasn’t aware of anything back then. I was a self-absorbed 20-something-yearold whose only concern was meeting bands. And back then, it wasn’t even good bands—it was heavy-metal crap like Dokken, Cinderella, and Slaughter. It wasn’t until my 40s that I started being aware of things other than myself.

nothing is sacred to lisa lampanelli, the raunchy, loudmouthed comedian who makes us cringe and guffaw, especially during Comedy Central roasts. After a tumultuous season on The Celebrity Apprentice, full of emotion and expletive-flinging, Lampanelli put Donald Trump’s money where her mouth is by raising oodles of cash for the Gay Men’s Health Crisis, the New York City-based HIV organization. Lampanelli recently revealed to us what The Donald’s hair looks like in person, what her money will buy, and why she tells jokes about HIV. —Neal Broverman You made $100,000 for the Gay Men’s Health Crisis on The Celebrity Apprentice. Actually, I made $130,000 for GMHC. I sweated for every penny. I earned $20,000 during the puppet challenge, $10,000 was given to me out of the goodness of Mr. Trump’s heart, and the big $100,000 win was during the CHI hair dryer task. That’s $130,000, so once I take my 10% fee from GMHC, that’ll be a lot for them. [Laughs] Tell us how you first got involved with the organization. Was it when you went to battle with the Westboro Baptist Church? You’re absolutely right that I did first get involved with the GMHC when I had my scuffle with

hiv plus

• J U LY/A U G U S T 2 0 1 2

the inbreds in the Westboro Baptist Church. The WBC is like a 15-year-old on Twitter—10 followers and desperate for attention. So after I donated $1,000 to GMHC for each WBC hillbilly who protested my show in Topeka, Kan.—a total of $50,000—I started serving meals at GMHC. I’ve been a supporter ever since. What will the money be used for at GMHC? The money I raised benefits the wide range of services for thousands of men, women, and families living with and affected by HIV/AIDS. These services include health and nutrition education, legal, housing, and mental health support, vocational training and case

How do you deal with people who don’t get your humor? I don’t. I don’t read negative fan mail, I don’t read negative tweets or Facebook messages anymore, and I don’t engage people in conversations who don’t get it. I just tell them that there are plenty of other entertainers they can go see. And there are. As long as the theaters I’m playing are full, I’m happy. You have a grueling schedule. How do you stay sane on the road? I don’t. What about me or my appearance on Celebrity Apprentice would indicate I’m sane? The schedule really does suck, but I fly in to where I play, try to keep everything low-key, and fly back home as soon as possible. Knowing I’m going home soon is the best way to not go completely off the rails. What does Trump’s hair look like in person? I think Penn Jillette said it best: “Pee-colored cotton candy.” Actually, if truth be told, it looks a lot better in person. I know—I was shocked too. ✜

courtesy subjec t

Tough Love

You’re an equal-opportunity offender when it comes to race and sexual orientation. Do you ever lob a few good-natured jokes toward the HIVpositive community? Absolutely. My philosophy about comedy is that no one is better than anyone else, no one is less than anyone else, so all people are included. The biggest insult to someone is being left out, so no one escapes unscathed in my comedy.

a message from your immune sysTem

Talk with your doctor about ways to help protect your immune system. 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†, along with other factors. 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. ©2012 Gilead Sciences, Inc. All rights reserved. UN12174 02/12