HIV Plus Issue 107 July/August 2015

SPECIAL ANNUAL TREATMENT GUIDE New Medications & Side Effects BECAUSE YOU’RE MORE THAN YOUR STATUS

How to Get Away With Murder Star Conrad Ricamora Talks Hollywood and HIV

JULY / AUGUST 2015 www.hivplusmag.com

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before.

STRIBILD can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL of virus in their blood) and whose healthcare provider determines that they meet certain other requirements. STRIBILD combines 4 medicines into 1 pill to be taken once a day with food.

STRIBILD is a complete single tablet regimen and should not be used with other HIV-1 medicines.

STRIBILD does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses you must keep taking STRIBILD. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about STRIBILD? STRIBILD can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain.

• You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking STRIBILD, your hepatitis may suddenly get worse. Do not stop taking STRIBILD without first talking to your healthcare provider, as they will need to monitor your health. STRIBILD is not approved for the treatment of HBV.

Who should not take STRIBILD? Do not take STRIBILD if you: • Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herbal supplement St. John’s wort.

• For a list of brand names for these medicines, please see the Brief Summary on the following pages.

• Take any other medicines to treat HIV-1 infection, or the medicine adefovir (Hepsera®).

What are the other possible side effects of STRIBILD? Serious side effects of STRIBILD may also include: • New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 medicines.

• Changes in your immune system.

Your immune system may get stronger and begin to fight infections.

Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking STRIBILD? • All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist.

Do not start any new medicines while taking STRIBILD without first talking with your healthcare provider.

• If you take hormone-based birth control (pills, patches, rings, shots, etc).

• If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD. • If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed.

HIV-1 can be passed to the baby in breast milk. Also, some medicines in STRIBILD can pass into breast milk, and it is not known if this can harm the baby.

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 Brief Summary of full Prescribing Information with important warnings on the following pages. *STRIBILD is a combination of the medicines TRUVADA (emtricitabine and tenofovir disoproxil fumarate), TYBOST (cobicistat), and VITEKTA (elvitegravir).

STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before.

STRIBILD can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL of virus in their blood) and whose healthcare provider determines that they meet certain other requirements. STRIBILD does not cure HIV-1or AIDS.

I started my personal revolution Talk to your healthcare provider about HIV-1 treatment.

STRIBILD is a complete HIV-1 treatment in 1 pill, once a day that combines the medicines in TRUVADA + TYBOST + VITEKTA.* Ask if it’s right for you.

www.STRIBILD.com

Patient Information STRIBILD® (STRY-bild) (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/ tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information.

What is STRIBILD? • STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD can also be used to replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL of virus in their blood), and have been on the same HIV-1 medicines for at least 6 months and have never failed past HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements.

• STRIBILD is a complete HIV-1 medicine and should not be used with any other HIV-1 medicines.

• STRIBILD does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood.

What is the most important information I should know about STRIBILD? STRIBILD can cause serious side effects, including: 1. Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take STRIBILD or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: • feel very weak or tired • have unusual (not normal) muscle pain • have trouble breathing • have stomach pain with nausea or vomiting • feel cold, especially in your arms and legs • feel dizzy or lightheaded • have a fast or irregular heartbeat 2. Severe liver problems. Severe liver problems can happen in people who take STRIBILD. 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). Call your healthcare provider right away if you get any of the following symptoms of liver problems: • your skin or the white part of your eyes turns yellow (jaundice) • dark “tea-colored” urine • light-colored bowel movements (stools) • loss of appetite for several days or longer • nausea • stomach pain You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking STRIBILD for a long time.

3. Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take STRIBILD, your HBV may get worse (flare-up) if you stop taking STRIBILD. A “flare-up” is when your HBV infection suddenly returns in a worse way than before.

• Do not run out of STRIBILD. Refill your prescription or talk to your healthcare provider before your STRIBILD is all gone • Do not stop taking STRIBILD without first talking to your healthcare provider • If you stop taking STRIBILD, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking STRIBILD Who should not take STRIBILD? Do not take STRIBILD if you also take a medicine that contains: • adefovir (Hepsera®) • alfuzosin hydrochloride (Uroxatral®) • cisapride (Propulsid®, Propulsid Quicksolv®) • ergot-containing medicines, including: dihydroergotamine mesylate (D.H.E. 45®, Migranal®), ergotamine tartrate (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), and methylergonovine maleate (Ergotrate®, Methergine®) • lovastatin (Advicor®, Altoprev®, Mevacor®) • midazolam, when taken by mouth • pimozide (Orap®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • sildenafil (Revatio®), when used for treating lung problems • simvastatin (Simcor®, Vytorin®, Zocor®) • triazolam (Halcion®) • the herb St. John’s wort Do not take STRIBILD if you also take any other HIV-1 medicines, including: • Other medicines that contain elvitegravir, cobicistat, emtricitabine, or tenofovir (Atripla®, Complera®, Emtriva®, Truvada®, Tybost®, Viread®, Vitekta®) • Other medicines that contain lamivudine or ritonavir (Combivir®, Epivir® or Epivir-HBV®, Epzicom®, Kaletra®, Norvir®, Triumeq®, Trizivir®) STRIBILD is not for use in people who are less than 18 years old.

What are the possible side effects of STRIBILD? STRIBILD may cause the following serious side effects: • See “What is the most important information I should know about STRIBILD?” • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking STRIBILD. Your healthcare provider may tell you to stop taking STRIBILD if you develop new or worse kidney problems.

• Bone problems can happen in some people who take STRIBILD. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones.

• Changes in body fat can happen in people who take HIV-1 medicine.

These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk).

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

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 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 right away if you start having any new symptoms after starting your HIV-1 medicine.

The most common side effects of STRIBILD include:

- disopyramide (Norpace®)

• Nausea

- estazolam

• Diarrhea

- ethosuximide (Zarontin®)

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

- flecainide (Tambocor®)

• These are not all the possible side effects of STRIBILD. For more information, ask your healthcare provider.

- fluticasone (Flovent®, Flonase®, Flovent Diskus®, Flovent HFA®, Veramyst®)

• Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

- itraconazole (Sporanox®)

What should I tell my healthcare provider before taking STRIBILD? Tell your healthcare provider about all your medical conditions, including:

- flurazepam

- ketoconazole (Nizoral®) - lidocaine (Xylocaine®) - mexiletine - oxcarbazepine (Trileptal®)

• If you have or had any kidney, bone, or liver problems, including hepatitis B infection

- perphenazine

• If you are pregnant or plan to become pregnant. It is not known if STRIBILD can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking STRIBILD.

- phenytoin (Dilantin®, Phenytek®)

- There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry.

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take STRIBILD. - You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

- Two of the medicines in STRIBILD can pass to your baby in your breast milk. It is not known if the other medicines in STRIBILD can pass into your breast milk.

- Talk with your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements: • STRIBILD may affect the way other medicines work, and other medicines may affect how STRIBILD works.

• Be sure to tell your healthcare provider if you take any of the following medicines: - Hormone-based birth control (pills, patches, rings, shots, etc) - Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or after you take STRIBILD - Medicines to treat depression, organ transplant rejection, or high blood pressure - amiodarone (Cordarone®, Pacerone®) - atorvastatin (Lipitor®, Caduet®) - bepridil hydrochloride (Vascor®, Bepadin®) - bosentan (Tracleer®) - buspirone - carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) - clarithromycin (Biaxin®, Prevpac®) - clonazepam (Klonopin®) - clorazepate (Gen-xene®, Tranxene®) - colchicine (Colcrys®) - medicines that contain dexamethasone - diazepam (Valium®) - digoxin (Lanoxin®)

- phenobarbital (Luminal®) - propafenone (Rythmol®) - quinidine (Neudexta®) - rifabutin (Mycobutin®) - rifapentine (Priftin®) - risperidone (Risperdal®, Risperdal Consta®) - salmeterol (Serevent®) or salmeterol when taken in combination with fluticasone (Advair Diskus®, Advair HFA®) - sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®, Staxyn®), for the treatment of erectile dysfunction (ED). If you get dizzy or faint (low blood pressure), have vision changes or have an erection that last longer than 4 hours, call your healthcare provider or get medical help right away.

- tadalafil (Adcirca®), for the treatment of pulmonary arterial hypertension - thioridazine - voriconazole (Vfend®) - warfarin (Coumadin®, Jantoven®) - zolpidem (Ambien®, Edlular®, Intermezzo®, Zolpimist®) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking STRIBILD without first talking with your healthcare provider.

Keep STRIBILD and all medicines out of reach of children.

This Brief Summary summarizes the most important information about STRIBILD. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about STRIBILD that is written for health professionals, or call 1-800-445-3235 or go to www.STRIBILD.com.

Issued: December 2014

COMPLERA, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, the STRIBILD Logo, TRUVADA, TYBOST, VIREAD, and VITEKTA are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. © 2015 Gilead Sciences, Inc. All rights reserved. STBC0180 03/15

EDITOR’S LETTER BRAG BAG! Usually we get letters about the cover star, but this last issue our best letter came from the cover star, actor Mel England. We had to share:

DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM

4|

july / august 2015

32 Things You Need to Know When You Find Out You Have HIV

BECAUSE YOU’RE MORE THAN YOUR STATUS

POW!

ACTOR MEL ENGLAND

TREATMENTS

TESTING

STIGMA

KNOCKS OUT FANS & TALKS STRAIGHT ABOUT BEING POZ THE CURE

COMORBIDITIES MAY / JUNE 2015 www.hivplusmag.com

We got other letters too, including this from San Francisco’s Jack Bossard: “Kudos to all of you who created this wonderful magazine. As an HIVpositive, 32-year-surviving, 74-year-old man, I must say, this small magazine is packed full of great and interesting info on HIV. I even learned a few things. This is the first time I’ve seen your magazine and I’m sure glad I did.

Your Top 25 Questions was my fave.”

Editor’s note: You can read our 25 Things Everyone Needs to Know About HIV online now!

SPELLING IT OUT We put out the first HIV Style Guide so reporters around the country could learn how to properly report on people with HIV without all the mistakes you usually see in the media. The guide is available at HIVLawandPolicy. org (http://bit.ly/1HcmX7W) in case you have a local reporter who keeps screwing it up. “I have to thank you so much for publishing this guide,” wrote reader Jim Vokoun. “Having been infected with HIV before 1980, you can imagine the extent of my glee as I read this! You’ve exposed so many of the things that have been driving me crazy for YEARS. But now let’s see if we can get The New York Times to stop using the antiquated “H.I.V.” I wonder what would happen if your fine style sheet should end up in their hands.”

Jim, we will send the Times a copy today!

BACK TO WORK One of the top indicators of medication adherence is whether someone stays in the workforce. Jobs keep us grounded, which is why we rolled out our series on working while poz last issue and have begun planning what we hope is a groundbreaking feature called Best Places to Work for 2016. For our series, we got some great feedback, including this praise from Mark Misrok, the president of the board of directors for the National Working Positive Coalition: “How wonderful to read these fantastic pieces you’ve published in Plus on employment…the whole suite of articles focused on HIV and employment are terrific and a tremendous contribution. There’s so much work going on now in this area, and these will be tremendously helpful. On Wednesday, I presented to the Federal AIDS Policy Partnership, to an unexpectedly interested, warm and energized reception (had they seen these?). We’ve been invited by NMAC to prepare a full-day pre-conference institute on September 9 for USCA 2015 in D.C., and next week we’re facilitating a day-long community-level cross-sector event among HIV workforce development and vocational rehabilitation providers and people living with HIV. Plus we’re about to release our recommendations for updates to the NHAS employment provisions. Timing couldn’t have been better, with a more extraordinary collection of articles. Thank you.”

BYBRADFORD ROGNE (DIANE); THINKSTOCK (HAT)

People with HIV are rarities on TV (the last series to have one was Brothers & Sisters, which ended in 2011), and when they exist there’s usually a lot of stigmatizing, hand-wringing, and self-loathing around them, with singular storylines that play like a “very special episode.”

Which is why it was such a thrill when two TV series this year introduced HIV-positive characters that were fan favorites.

On HBO’s Looking—a critically acclaimed but sadly now-canceled series about gay men in San Francisco—we met Eddie, the character played by Daniel Franzese (already popular from his influential role in Mean Girls). He’s poz, proud, and big body–positive.

That there’s a poz guy on a show set in the city that was once the epicenter of the AIDS crisis and still has one of the nation’s highest percentages of HIV-positive gay and bi men wasn’t a surprise, but the deft handling of the story, including an HIV-negative man’s pursuit of Eddie and the introduction of PrEP into their relationship was. (Looking was the first scripted TV series to talk about PrEP.) An even bigger reveal happened on network TV on ABC’s breakout hit How to Get Away With Murder. Conrad Ricamora’s character Oliver, Connor’s love interest and one of the nicest, most normal gay guys to ever grace TV, finds out in the season finale that he has HIV. It’s a shocking moment for Oliver—as finding out a positive result would be for anyone—but it let viewers feel what that experience is like and showed us that HIV defies stereotypes. It was not the sexually promiscuous guy who was positive; it was the responsible, monogamous boy.

Only Conrad will be back this fall, and time will tell how his story plays out, but there are high hopes for it. Our contributing editor Daniel Reynolds was fortunate to talk to both Conrad and Daniel about their characters, playing poz, and what TV producers need to change about portraying HIV-positive people on TV. I found it fascinating. Hopefully you will too.

Meanwhile, the rest of this issue is dedicated to our annual treatment guide, which includes a look at every medication on the market to treat HIV or HIV-related complications. Plus we look at complementary therapies (what works and what definitely doesn’t), how drugs make it to the market, and how you can get help paying for these medications.

Oh, don’t forget to check HIVPlusMag.com later this summer too for our look at the 10 most important HIV drug developments in 2015.

Enjoy!

“I’ve been meaning to send this for a week—but I’ve been absolutely blown away the last week since the magazine came out. I’ve been getting messages from people all over, and it’s been transforming and actually emotional—people telling me how their dad/brother/lover died years ago and how inspiring this is, people telling me their own journey of survival. An old friend contacted me and told me she’s been running a shelter for homeless youth with HIV and would love to have me come there sometime. It’s been amazing. I can’t thank you enough. What a privilege and honor for me. Mel”

JULY | AUGUST 2015

IN EVERY ISSUE

FEATURE

48 Ask & Tell: Ted Allen

50 Cover: Is Hollywood Ready to Get HIV Right?

The Chopped host dishes up activism.

62 Daily Dose

Looking star Daniel Franzese and Conrad Ricamora of How to Get Away With Murder talk to Daniel Reynolds about playing HIV-positive characters on television and why viewers are ready to see them.

Discovering love again after diagnosis.

63 Barbershop Diaries

Young, poz, and finding himself.

SPECIAL SECTION: 2015 ANNUAL TREATMENT GUIDE

7 A look at every medication used to treat HIV or HIV-related infections Plus: Which complementary therapies work and which don’t; how to pay for your meds; and how a drug goes from research idea to your local pharmacy.

50

RICAMORA,C ATALINA KULCZAR PHOTOGRAPHY; FRANZESE, JOSHUA SPENCER

editor in chief DIANE ANDERSON-MINSHALL SVP, group publisher JOE VALENTINO art director BONNIE BARRETT copy chief TRUDY RING contributing editors NEAL BROVERMAN, KATIE PEOPLES, MARK S. KING, SUNNIVIE BRYDUM, JACOB ANDERSON-MINSHALL, DAWN ENNIS assistant editor RAFFY ERMAC wellness editor SAM PAGE mental health editor GARY MCCLAIN creative director, digital media DAVE JOHNSON director, digital media SCOTT RAGAN interactive art director CHRISTOPHER HARRITY online photo and graphics producers YANNICK DELVA, MICHAEL LUONG manager, application development ALEX LIM program manager VINCENT CARTE front end developer MAYRA URRUTIA drupal developer KEN MERRIMAN traffic manager KEVIN BISSADA

VP, integrated marketing AMANDA JOHNSON managers, integrated marketing LAUREN THOMAS, JOHN MCCOURT integrated sales/marketing and ad production manager PAIGE POPDAN art director, integrated marketing CHARLIE PFLAUMER junior designer COURTNEY RHODES senior director, media strategy STEWART NACHT programmatic & yield manager ADRIAN GRAHAM integrated ad sales & marketing coordinator MICHAEL TORRE sr. director, audience development & consumer marketing ROBERT HEBERT director of social media LEVI CHAMBERS associate social media editor DANIEL REYNOLDS circulation director JEFF LETTIERE fulfillment manager ANGUS GALINDO operations director KIRK PACHECO los angeles office manager HEIDI MEDINA production services GVM MEDIA SOLUTIONS, LLC

HERE MEDIA chairman STEPHEN P. JARCHOW ceo PAUL COLICHMAN cfo/coo TONY SHYNGLE executive vice presidents BERNARD ROOK, JOE LANDRY VP, editorial director LUCAS GRINDLEY senior vice presidents CHRISTIN DENNIS, JOHN MONGIARDO, JOE VALENTINO vice presidents GREG BROSSIA, ERIC BUI, STEVEN CAPONE, JUSTIN GARRETT, LUCAS GRINDLEY, AMANDA JOHNSON ADVERTISING & SUBSCRIPTIONS OFFICES

120 West 45th Street, Suite 3800, New York, New York 10036-4041 Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 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

HIV/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 “digital edition” 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.

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 © 2015 by Here Publishing Inc. All rights reserved. Printed in the USA. WHAT’S YOUR STORY?

We want to hear from you: Email us at editor@HIVPlusMag.com or write us at HIV Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024.

FOLLOW US ON FACEBOOK AND TWITTER

Facebook.com/ HIVPlusMag

6|

july / august 2015

Twitter.com/ HIVPlusMag

2015 COMPLETE HIV TREATMENT GUIDE

THINKSTOCK

Everyone needs to know about the meds we take, so Plus offers our most comprehensive look ever at the medications approved by the Food and Drug Administration for the treatment of HIV and opportunistic infections as well as a state-by-state map of drug assistance programs plus info on complementary therapies and drug trials. Remember, before you take anything you should talk with your doctor about what meds you’re on, any drug allergies, whether you smoke, drink, or take other supplements or recreational drugs, if you breast-feed, or are pregnant or want to be. This info was culled from the National Institutes of Health’s drug database, the FDA, and the individual pharmaceutical companies.

hivplusmag.com

|7

PROTEASE INHIBITORS

Help prevent replication of HIV; drugs in this class block activation of protease, an enzyme HIV needs to reproduce.

MEDICATION Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

APTIVUS

500 mg (two 250-mg capsules or 5

For treatment-experienced patients only. Take with at least two other anti-HIV

Most serious: severe or fatal liver disease,

Generic name

milliliters of oral solution) with 200 mg

drugs, but do not use with other protease inhibitors. Do not take with Rifadin,

severe bleeding in the brain, new or

(two 100-mg capsules/tablets or 2.5

ergot derivatives, Saint-John’s-wort, certain antiarrhythmic drugs, Revatio,

worsened diabetes Other: diarrhea, nausea,

milliliters of solution) of Norvir, twice

Uroxatral, Altoprev, Mevacor, Orap, Zocor, or Halcion. If taking birth control pills,

fever, vomiting, tiredness, headache, and

Maker

daily. If taken with Norvir capsules or

switch to another method of contraception. Use with caution with Flonase,

stomach pain

Boehringer Ingelheim

solution, may be taken with or without

Viagra, Cialis, Levitra, or Seroquel, or if taking certain antiseizure medications.

meals; if taking Norvir tablets, must be

Use with caution if you have hemophilia or other conditions that increase the

taken with meals

chance of bleeding, or liver disorders.

CRIXIVAN

800 mg, taken every eight hours, with

Do not take with oral Versed, Propulsid, Zocor, Mevacor, Orap, Cordarone,

Most serious: liver failure, kidney stones,

Generic name

water or another beverage, without food

Hismanal, Halcion, Xanax, Revatio, Uroxatral, Rifadin, Rimactane, Rifamate,

changes in body fat, diabetes, anemia,

(one hour before or two hours after a

Rifater, Saint-John’s-wort, Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate,

severe pain, muscle weakness Other:

meal) or with a light meal

Methergine, or Reyataz. Use with caution with Viagra, Cialis, Levitra, Lipitor,

abdominal pain, fatigue or weakness,

Maker

Seroquel, and Crestor. Drink plenty of fluids and do not take the drug with meals

low red blood cell count, flank pain,

Merck

that are high in calories, fat, and protein.

painful urination, feeling unwell, nausea,

Maker

tipranavir

indinavir

upset stomach, diarrhea, vomiting, acid regurgitation, increased or decreased appetite, back or shoulder pain, headache, dizziness, taste changes, rash, itchy skin, yellowing of the skin and/or eyes, upper respiratory infection, dry skin, sore throat

INVIRASE

1,000 mg (five 200-mg capsules or two

Do not use with Aptivus-Norvir combination, Uroxatral, Cordarone, Vascor,

Most serious: worsening of liver problems,

Generic name

500-mg tablets), in combination with

Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot

increased bleeding with hemophilia,

100 mg of Norvir, twice daily, at least two

medications such as Parlodel, Migranal, Ergonovine, Bellamine, Cafergot, Ergomar,

diabetes or high blood sugar, elevated

hours after a meal

Methergine, or Permax, oral Versed, Orap, Rifadin, Revatio when used to treat

cholesterol or triglycerides, changes in

Maker

pulmonary hypertension, Mevacor, Advicor, Zocor, Juvisync, Simcor, Vytorin,

body fat, immune system, or heart rhythm

Hoffmann-La Roche

Desyrel, Oleptro, Halcion, Saint-John’s-wort, garlic capsules, or fusidic acid

Other: Nausea, vomiting, diarrhea, fatigue,

products. Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Rescriptor,

abdominal pain

saquinavir mesylate

Viramune, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Seroquel, hormonal contraceptives, certain calcium channel blockers, certain antibiotics and antifungals, some antipsychotics or antidepressants, and 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.

KALETRA

800 mg, typically four tablets, once

Do not take with Halcion, midazolam oral syrup, certain steroids, Incivek, Orap,

Most serious: changes in heart rhythm,

Generic name

daily, or 400 mg, typically two tablets,

Mevacor, Zocor, Rimactane, Rifadin, Rifater, Rifamate, Revatio when used to

severe liver problems, pancreatitis,

twice daily. Swallow tablets whole;

treat pulmonary arterial hypertension, Stendra, Uroxatral, Victrelis, Xarelto,

changes in immune system, changes in

do not chew, break, or crush. An oral

Saint-John’s-wort, ergot-containing medicines, including ergotamine (Cafergot

body fat, new or worsened diabetes,

Maker

solution is available but should be taken

and others), dihydroergotamine (D.H.E. 45 and others), ergonovine (Ergotrate),

elevated triglyceride or cholesterol levels

AbbVie

with food

and methylergonovine (Methergine). Use with caution with Viagra, Cialis, Levitra,

Other: diarrhea, nausea, stomach pain,

Adcirca, birth control pills or contraceptive patches containing estrogen, Tasigna,

vomiting, weakness, headache

lopinavir and ritonavir

Sprycel, Lipitor, Crestor, Atripla, Crixivan, Sustiva, Viramune, Lexiva, Viracept, Viramune, Viread, Videx, Selzentry, Dilantin, Tegretol, Mycobutin, Flonase, Serevent, Advair, Colcrys, Tracleer, Duragesic, Ionsys, Fentora, Deltasone, Depakote, Lamictal, Seroquel, drugs containing budesonide, and methadone.

8|

july / august 2015

MEDICATION Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

LEXIVA

For those used to protease inhibitors,

Do not take with Incivek, Victrelis, Rescriptor, Uroxatral, Rifadin, Rimactane,

Most serious: severe skin reactions

Generic name

700 mg plus a 100-mg capsule of

Saint-John’s-wort, certain arrhythmia medications, ergot-based medications,

including Stevens-Johnson syndrome,

Norvir, twice daily. For those new to

Propulsid, Zocor, Mevacor, Orap, Revatio when used to treat pulmonary arterial

new or worsened diabetes, redistribution

therapy, 1,400 mg of Lexiva twice daily,

hypertension, Versed, or Halcion. If you take oral contraceptives, consider

of body fat, elevated cholesterol, anemia,

Maker

sometimes paired with Norvir, depending

alternative birth control methods. Do not take with Viramune unless also

spontaneous bleeding, kidney stones

ViiV Healthcare

on the patient. Lexiva is available in

taking Norvir. Use with caution with Seroquel, H2 blockers and calcium channel

Other: diarrhea, rash, nausea, vomiting,

tablets or oral solution; tablets can

blockers. Do not use if you have Stevens-Johnson syndrome or if you take drugs

headache

be taken with or without food, oral

that use the enzyme CYP3A4 to metabolize.

Maker

fosamprenavir

solution without food. Reduced dosage recommended for patients with liver impairment

NORVIR

600 mg (six 100-mg tablets), twice daily,

Do not take with Xatral, Cordarone, Tambocor, Vascor, Rythmol, Fucidin,

Most serious: worsening of liver disease,

Generic name

with a meal. Swallow tablets whole with

Hismanal, Seldane, Orap, Propulsid, Cafergot, Migranal, D.H.E. 45, Ergotrate,

pancreatitis, diabetes or high blood sugar,

water; do not chew, break, or crush. Also

Maleate, Vfend, Mevacor, Zocor, Halcion, Versed, Advair, Serevent, Levitra,

elevated cholesterol or triglycerides,

available in capsules or oral solution.

Revatio if used for pulmonary arterial hypertension, Saint-John’s-wort. Do

changes in body fat, increased bleeding

Maker

Reduced dosage recommended for

not take with both Invirase and any version of rifampin (Rimactane, Rifadin,

among hemophiliacs, severe skin reactions

AbbVie

people taking other protease inhibitors

Rifater, or Rifamate), and use with caution with either of those drugs separately.

Other: rash, abdominal pain, diarrhea,

Use with caution with Seroquel, Olysio, Lipitor, Crestor, Viagra, Levitra, Cialis,

feeling weak or tired, headache, nausea,

Adcirca, Tracleer, Rapamune, Flonase, Crixivan, Viracept, Videx, Mycobutin,

vomiting, changes in taste, loss of appetite,

Aptivus, Rescriptor, Reyataz, Celsentrin, Telzir, Prezista, Tiazac, Adalat, Isoptin,

dizziness, tingling feeling or numbness in

Nizoral, Sporanox, Demerol, Tegretol, Dilantin, phenobarbital, Mycobutin, Biaxin,

hands, in feet, or around the lips

ritonavir

Duragesic, theophylline, Colcrys used for treatment of gout, certain anticancer medications, certain antidepressants. Use with caution if you have other liver problems or diabetes.

PREZISTA

One 800-mg tablet with one 100-mg

Do not take Prezista with Uroxatral, Victrelis, D.H.E. 45, Embolex, Migranal,

Generic name

Norvir capsule, once daily, with food, or

Cafergot, Ergomar, methylergonovine, Propulsid, Orap, oral midazolam, Halcion,

one 600-mg tablet for patients without

Saint-John’s-wort, Mevacor, Altoprev, Advicor, Zocor, Simcor, Vytorin, Rifadin,

drug resistance

Rifater, Rifamate, Rimactane, Revatio when used to treat pulmonary arterial

darunavir

Maker

hypertension, Crixivan, Kaletra, Invirase, or Incivek. Use with caution if taking

Janssen

Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol,

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

Seroquel, Colcrys, or Col-Probenecid, Coartem, or Riamet. May reduce birth control pills’ efficacy; take other precautions.

REYATAZ

300 mg, in capsule form, taken with 100

Do not take with Versed, Halcion, Cafergot, Migranal, D.H.E. 45, Methergine,

Most serious: severe rash, yellowing

Generic name

mg of Norvir, once daily, with food. For

other ergot medicines, or Orap, Camptosar, Crixivan, Mevacor, Zocor, Uroxatral,

of skin or eyes, heart rhythm change,

adults unable to tolerate Norvir, 400 mg

Revatio, Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Viramune,

diabetes, kidney stones, changes in

of Reyataz with food is recommended.

Diskus, or Advair. Do not take Vfend or Victrelis if you are taking Reyataz and

body fat, changes in immune system,

Take at the same time every day

Norvir, and do not take Tegretol, Dilantin, or drugs containing phenobarbital with

worsening liver disease, increased bleeding

Reyataz alone. If you are taking Videx, Videx EC, or antacids, take Reyataz two

problems, gallbladder disorders Other:

hours before or one hour after those medicines. Use with caution if taking drugs

nausea, headache, stomach pain, vomiting,

for indigestion, heartburn, or ulcers; depression; allergies or asthma; abnormal

diarrhea, depression, fever, dizziness,

heart rhythm; blood clots; cholesterol; erectile dysfunction; gout; and certain

trouble sleeping, muscle pain, numbness,

other conditions. If taking Reyataz with Norvir and also taking Lamictal, dosage

tingling, or burning of hands or feet

atazanavir

Maker Bristol-Myers Squibb

of the latter may need to be adjusted.

VIRACEPT

1,250 mg (five 250-mg tablets or two

Do not take with Cordarone, Orap, Quinidine, Quinaglute, Cardioquin, Quinidex,

Most serious: diabetes and high blood

Generic name

625-mg tablets), twice daily, or 750

D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Methergine, Halcion,

sugar, high blood pressure, changes in

milligrams (three 250-mg tablets) three

Versed, Revatio if used for pulmonary arterial hypertension, Uroxatral, Prilosec,

body fat, changes in immune system

times daily. Each dose should be taken

Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Mevacor, Zocor, or

Other: diarrhea, nausea, rash

Maker

with a meal. An oral powder is also

Serevent. Use with caution with Seroquel, Lipitor, Crestor, Pravachol, Lescol,

ViiV Healthcare

available

Viagra, Levitra, Cialis, Adcirca, or Tracleer. If also taking Videx, take Viracept

nelfinavir

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

THINKSTOCK

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. Do not take if you have moderate to severe liver impairment.

hivplusmag.com

|9

How an HIV Med Makes It to Market

By Dawn Ennis

The process of getting a drug to your local pharmacy’s pickup shelf can be something akin to the fantasy world of The Matrix. But it’s not nearly as simple as choosing between a red or blue pill. Every drug takes a unique path, but the road from the development lab to your medicine cabinet is usually long and complex. According to the Tufts Center for the Study of Drug Development at Tufts University, it takes an average of 15 years for an experimental drug to go from lab to patient.

Here’s the process:

The Beginning The Food and Drug Administration calls the first step the Investigational New Drug Application, or IND. This is when a pharmaceutical company seeks advice from the FDA about a new medication. But in truth, this stage comes long after that drug is conceived, developed, and tested on animals. One of the early tests must involve a type of animal that has a condition similar to HIV. The burden is on those companies and research institutions to show the FDA the results of their tests on laboratory animals and to explain their proposals for the next stage.

Human Testing Most drugs that undergo animal testing never even make it to human testing and review by the FDA. The human trials phase can begin only after an IND is reviewed by the FDA and an institutional review board—a panel of scientists and nonscientists in hospitals and research institutions that oversees clinical research—and the drug is found reasonably safe to move forward with testing the drug on people.

Phase I The very first human trials, also known as Phase I studies, are usually conducted in healthy volunteers. These studies will reveal are the drug’s most frequent side effects and, often, how the drug is metabolized and excreted. The number of subjects typically ranges from 20 to 80 people. Sometimes one phase is all that’s needed; the drug is determined to be unsafe and the manufacturer goes to the drawing board.

14 |

july / august 2015

Phase II But if there are no serious side effects or deaths, or what the FDA calls “unacceptable toxicity,” the drug moves to Phase II to test its effectiveness in people who have HIV. This is when something called a controlled trial begins. Patients receiving the drug are compared with similar patients receiving only a placebo, or an entirely different drug. The focus is on short-term side effects on the human test subjects, ranging from a few dozen to about 300.

Phase III If the drug works as promised in Phase II, then it’s on to Phase III, where scientists study how the drug affects a variety of populations, what dosages are most effective, and how the drug interacts with other drugs. As few as several hundred people are tested, or as many as about 3,000.

Wrapping It Up There are talks between the FDA and the drug’s developer, called the sponsor, to figure out how it will be sold to the public. And then that sponsor formally asks the FDA for approval. It’s called the New Drug Application, or NDA. The FDA has 60 days to decide whether to take the next step. The agency reviews at least 90 percent of NDAs for standard drugs no later than 10 months after the applications are received. For priority drugs, that timeline is about six months.

Final OK—or Not The final stage is for the FDA to evaluate the sponsor’s research on the drug’s safety and effectiveness, and to review the information that will appear on a drug’s instructional label, specifically the directions for use. The FDA then either approves the application so the drug can be manufactured and sold, or it issues the agency’s equivalent of a “Dear John” letter, a rejection response that explains why the drug is not approved. ✜

ENTRY AND FUSION INHIBITORS Help prevent replication of HIV; drugs in this class help block HIV from entering T cells.

They are always taken with other HIV medications.

MEDICATION Generic name Maker

FUZEON Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

Injection of 90 mg in the upper arm,

Some people use the Biojector 2000, a needle-free device, to administer

Most serious: injection-site infections or

upper leg, or stomach twice daily

Fuzeon, but in some it causes nerve pain, tingling, bruising, and

reactions such as itching, swelling, redness,

collection of blood under the skin.

pain or tenderness, hardened skin, bumps

enfuvirtide

at the site of injection; allergic reactions—

Maker

also, patients taking Fuzeon may develop

Roche Laboratories (brand

bacterial pneumonia more often than

name); Trimeris (generic)

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

SELZENTRY

300 mg twice daily, or 150 mg twice

Do not take Saint-John’s-wort, as it can lower the amount of Selzentry

Most serious: heart or liver disorders,

Generic name

daily if given with potent CYP3A

in the blood. Several medications, including Prezista, Kaletra, Reyataz,

lowered blood pressure when standing

inhibitors, or 600 mg twice daily if given

Sustiva, Atripla, and others, may also affect the amount of Selzentry

up, possible increased risk of cancer and

with potent CYP3A inducers

in the blood. Tell your doctor if you have a history of hepatitis B or C,

other infections, changes in the immune

Maker

have heart or kidney problems, of if you have low blood pressure or take

system, severe rash or allergic reaction

ViiV Healthcare

medication to lower it.

leading to hepatotoxicity Other: cough,

maraviroc

fever, dizziness, headache, lowered blood pressure, nausea, bladder irritation, upper respiratory infection

INTEGRASE INHIBITORS

Help prevent replication of HIV; drugs in this class block integrase, an enzyme HIV needs to reproduce.

They are always taken with other HIV medications.

ISENTRESS

One 400-mg tablet, twice daily, available

Do not take with antacids that contain aluminum or magnesium

Most serious: severe skin reactions and

Generic name

in oral suspension or chewable tablet for

hydroxide. Tell your doctor if you take the tuberculosis medication

allergic reactions, liver problems, changes

children, with dosage varying by weight

rifampin or if you have liver problems or phenylketonuria. If you miss a

in your immune system Other: headache,

dose, skip the missed dose and go back to your regular schedule. Do

trouble sleeping, nausea, tiredness; less

not double your next dose.

common side effects include weakness,

raltegravir

Maker Merck

stomach pain, dizziness, depression, and suicidal thoughts and actions

TIVICAY

One 50-mg tablet, once daily for

Do not take with dofetilide (brand name Tikosyn), a drug used to

Most serious: hypersensitivity reactions

Generic name

those new to integrase inhibitors or

treat atrial fibrillation. Do not take with etravirine (Intelence) without

characterized by rash, constitutional

antiretroviral drugs generally, twice daily

coadministration of Norvir (ritonavir) and either Reyataz (atazanavir),

findings, and sometimes organ

for those patients if given in combination

Prezista (darunavir), or lopinavir (a combination of ritonavir and

dysfunction, including liver injury (consult

Maker

with certain other antiretrovirals, and

lopinavir is sold under the brand name Kaletra). Do not take with

your doctor immediately if these reactions

GlaxoSmithKline

twice daily for patients who have taken

oxcarbazepine, phenytoin, phenobarbital, carbamazepine, or Saint-

occur, as treatment may need to be

integrase inhibitors previously and may

John’s-wort. Take two hours before or six hours after any medication

stopped); worsening of hepatitis B or C;

have resistance to such drugs

containing substances known as polyvalent cations, including certain

accumulation or redistribution of body

antacids and laxatives, the ulcer drug sucralfate (brand name Carafate),

fat; changes in immune system. Other:

oral iron or calcium supplements, and buffered medications. Patients

insomnia, headache

dolutegravir

who are starting or stopping the diabetes drug metformin at the same time as Tivicay should be monitored closely, and dosage of metformin THINKSTOCK

may need to be adjusted. For patients who are also taking rifampin, a drug that treats tuberculosis and other infections, twice-daily dosage of Tivicay is recommended. Tivicay may be taken with or without food.

Take during pregnancy only if potential benefit outweighs risk.

hivplusmag.com

| 15

INTEGRASE INHIBITORS

Drugs in this class block integrase, an enzyme HIV needs to reproduce.

MEDICATION Generic name Maker

VITEKTA Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

One 85-mg or 150-mg tablet once daily

Do not take if you are taking other medications that contain elvitegravir,

Most serious: changes in immune system

with food, in combination a protease

such as Stribild, or if you are taking Tybost with a protease inhibitor.

Other: diarrhea

inhibitor.

Do not take with Sustiva, Viramune, Videx, Videx EC, Rifadin, Rifamate, Rifater, Rimactane, Priftin, Victrelis, Incivek, Saint-John’s-wort. Use

elvitegravir

with caution with Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin,

Maker

Phenytek, Luminal, Mycobutin, hormonal contraceptives, if you have liver

Gilead Sciences

problems, or if you are pregnant or plan to become pregnant. Do not breast-feed. Take antacids at least two hours before or after Vitekta.

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS)

Help prevent replication of HIV; drugs in this class block reverse transcriptase, an enzyme HIV needs to reproduce.

COMBIVIR

One tablet, containing 150 mg of

Do not take with other medicines containing lamivudine, zidovudine,

Most serious: low white and red blood cell

Generic name

lamivudine and 300 mg zidovudine

or emtricitabine (such as Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir,

counts, serious allergic reactions, buildup

(both NRTIs), twice daily

Atripla, Emtriva, and Truvada). Use caution with if taking interferon alfa,

of lactic acid in the blood, liver toxicity or

ribavirin, doxorubicin, or ganciclovir. Tell your doctor if you’ve previously

worsening of liver disease, pancreatitis,

Maker

had any kidney or liver problems (such as hepatitis or cirrhosis),

muscle disorders and inflammation,

ViiV Healthcare (Brand

pancreatitis, or low red/white blood cell counts.

changes in body fat, changes in the

lamivudine and zidovudine

name); Hetero Labs,

immune system Other: headache, nausea,

Aurobindo, Teva

fatigue, diarrhea, cough, stuffy nose,

Pharmaceuticals (Generic)

general feeling of discomfort

EMTRIVA Generic name emtricitabine

One 200-mg capsule or 240 mg of oral

Do not use with other drugs containing emtricitabine, such as Atripla,

Most serious: buildup of lactic acid in the

solution, once daily

Complera, Truvada, or Stribild.

blood, liver problems including flare-up of hepatitis B after discontinuation Other: headache, diarrhea, nausea, fatigue,

Maker

dizziness, depression, insomnia, abnormal

Gilead Sciences

dreams, rash, abdominal pain, asthenia, increased cough, rhinitis

16 |

july / august 2015

MEDICATION Generic name Maker

EPIVIR Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

300 mg daily, in one or two doses, in

Do not take with Emtriva, Combivir, Epzicom, Trizivir, Atripla, Truvada,

Most serious: changes in the immune

tablets or oral solution

Stribild, or Complera. Epivir is not recommended for use in combination

system, buildup of lactic acid in the blood,

with zalcitabine. If you have hepatitis C, there is a chance of severe liver

severe liver problems, changes in body

decomposition if you are taking combination antiretroviral therapy and

fat Other: headache, nausea, malaise and

interferon alfa drugs for hep C.

fatigue, nasal problems, diarrhea, and

lamivudine or 3TC

Maker ViiV Healthcare

cough

EPZICOM

One tablet, containing 600 mg of

Do not take if you have kidney problems or are prone to heart disease.

Most serious: severe allergic reactions,

Generic name

abacavir sulfate and 300 mg of

Use with caution if you already take Atripla, Combivir, Emtriva, Epivir,

buildup of acid in the blood, liver problems

lamivudine (both NRTIs), once daily

Trizivir, Truvada, Ziagen, methadone, or medicines used to treat

Other: insomnia, depression, headache,

hepatitis. If you have hepatitis B, do not run out of Epzicom or stop

tiredness, dizziness, nausea, diarrhea, rash,

taking it without talking to your health care provider. Your provider

and fever

abacavir sulfate and lamivudine

Maker

should monitor your health and do regular blood tests to check your

ViiV Healthcare

liver if you stop taking Epzicom. Do not take if you have moderate to severe liver problems, or if you are breast-feeding.

RETROVIR

600 mg a day, taken in divided doses,

Do not take with other medicines that contain the same active

Most serious: neutropenia and anemia

Generic name

in tablets, capsule, or syrup. Can also be

ingredients, including Combivir and Trizivir. Not recommended for use

(low white and red blood cell counts),

given as an intravenous infusion, one mg

with the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere.

myopathy and myositis (muscle disorders

per kilogram of body weight, over one

Use with caution if taking ganciclovir or interferon alfa. Do not use

and inflammation), buildup of lactic acid in

hour, every four hours

Retrovir with stavudine or doxorubicin. Retrovir can also be used to

the blood, severe liver problems, changes

prevent transmission of HIV from a mother to her unborn child.

in the immune system, changes in body

zidovudine or AZT

Maker ViiV Healthcare; generic versions also available

fat Other: headache, malaise, nausea, anorexia, and vomiting

TRIZIVIR

One tablet (300 mg of abacavir sulfate,

Do not take if you have certain liver problems or weigh less than 90

Most serious: severe or fatal allergic

Generic name

150 mg of lamivudine, and 300 mg of

pounds. Take with caution if you have a particular gene variation called

reactions, heart attack, buildup of lactic

zidovudine, all NRTIs), twice daily

HLA-B*5701, hepatitis B, kidney or heart problems, low blood cell

acid in the blood, liver disorders, blood

counts, high blood pressure, high cholesterol, or diabetes. Use with

problems, muscle weakness, changes

caution if you take Bactrim, Septra, Cytovene, DHPG, interferon-alfa,

in body fat, changes in immune system

Maker

Adriamycin, Copegus, Rebetol, Virazole, bone marrow suppressive

Other: nausea, vomiting, headache,

ViiV Healthcare

medicines or cytotoxic medicines, Atripla, Combivir, Complera, Emtriva,

weakness or tiredness, diarrhea, fever and/

Epivir or Epivir-HBV, Epzicom, Retrovir, Truvada, Zerit, or Ziagen.

or chills, depression, muscle and joint pain,

abacavir sulfate, lamivudine, and zidovudine

skin rashes, cold symptoms, nervousness, and ear, nose, and throat infections

TRUVADA

One tablet, containing 200 mg of

Do not take Truvada if you take Atripla, Combivir, Emtriva, Epivir or

Most serious: buildup of lactic acid in the

Generic name

emtricitabine and 300 mg of tenofovir

Epivir-HBV, Epzicom, Trizivir, or Viread, which have the same or similar

blood, serious liver problems, flare-ups

disoproxil fumarate, once daily

active ingredients. You may need to adjust dosage if also taking Videx,

of hepatitis B virus infection, kidney

Reyataz, or Kaletra. Do not take with Hepsera. If you have had kidney

problems, thinning bones, changes in

problems or take other drugs that can cause kidney problems, your

body fat, symptoms of inflammation

Maker

doctor should do regular blood tests to check your kidneys. In 2012, the

from previous infections Other: diarrhea,

Gilead Sciences

FDA approved Truvada for use in HIV prevention among HIV-negative

dizziness, nausea, vomiting, headache,

people who are at high risk of acquiring the virus. The FDA’s updated

fatigue, abnormal dreams, sleeping

labeling on the drug notes that persons using the drug preventatively

problems, rash, depression, shortness

need to be confirmed as HIV-negative every three months and use

of breath, pain, fatty liver, stomach pain,

the drug as prescribed, in combination with safer-sex practices and

weakness, indigestion, intestinal gas, high

counseling. In treatment of HIV-positive people, Truvada is always used

volume of urine, excessive thirst, skin

in combination with other drugs.

discoloration. In patients using Truvada for

emtricitabine and tenofovir

THINKSTOCK

disoproxil fumarate

prevention, the most common side effects have been headache, abdominal pain, and weight loss.

hivplusmag.com

| 17

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

VIDEX EC

Depends on weight. For individuals

Do not take if you take Lopurin or Zyloprim, which are used to treat

Most serious: pancreatitis, buildup of lactic

Generic name

weighing 132 pounds or more, the

gout and kidney stones, or the antihepatitis drugs Copegus, Rebetol,

acid in the blood, liver disorders, vision

recommended dose is 400 mg in

RibaTab, or Ribasphere. Use with caution if taking methadone or

problems, changes in immune system,

enteric-coated capsules, once daily. For

ganciclovir, or any drugs that may cause toxicity to the pancreas or

changes in body fat, peripheral neuropathy

Maker

adults weighing less than 132 pounds,

nervous system. If you are also taking Viread, the dose of Videx EC

Other: diarrhea, nausea, vomiting,

Bristol-Myers Squibb

the recommended dose is 250 mg,

should be reduced, and it should be taken on an empty stomach or with

headache, stomach pain, skin rash

once daily. Take the drug on an empty

a light meal.

MEDICATION Generic name Maker

didanosine

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

VIREAD

One 300-mg tablet, once daily. Adults

Do not take Viread if you are taking other medicines that contain

Most serious: buildup of lactic acid in the

Generic name

who are unable to swallow tablets

tenofovir (Atripla, Complera, Truvada, or Stribild) or adefovir (Hepsera).

blood, severe liver problems, changes in

whole may take 7 scoops of Viread oral

Dosages may need to be changed if you are taking Videx EC, Reyataz,

body fat, changes in the immune system,

powder. Patients with kidney problems

or Kaletra.

bone pain, softening, or thinning Other:

tenofovir disoproxil fumarate

may be prescribed a lower dose

Maker

nausea, rash, diarrhea, headache, pain, Viread is also used to treat hepatitis B.

depression, weakness

Gilead Sciences

ZERIT

For patients weighing 132 pounds or

Do not take with Retrovir (zidovudine) or any zidovudine-containing

Most serious: buildup of an acid in the

Generic name

more, 40 mg, in capsules or oral solution,

products, such as Combivir or Trizivir. Do not take with hydroxyurea,

blood, serious liver problems, pancreatitis,

twice daily; for patients weighing less

which is marketed under brand names Droxia and Hydrea. Use

changes in body fat, changes in immune

than 132 pounds, 30 mg twice daily

with caution with Videx EC, Adriamycin, Rubex, Copegus, Rebetol,

system, peripheral neuropathy Other:

Maker

Ribasphere, Virazole, Roferon-A, and Intron-A. Use with caution if

headache, diarrhea, rash, nausea, vomiting

Bristol-Myers Squibb

you have liver, pancreas, or kidney problems, peripheral neuropathy,

stavudine or d4T

or gallstones. For patients with renal impairment or undergoing hemodialysis, dosing adjustments may be needed. Do not drink alcohol while on the drug.

ZIAGEN

600 mg in tablets daily, administered

Do not take if you have moderate to severe liver impairment. Do not

Most serious: severe allergic reaction,

Generic name

as either 300 mg twice daily or 600

breast-feed while taking the drug. If you have a severe allergic reaction,

buildup of lactic acid in the blood with

mg once daily. Also available as an

do not resume taking Ziagen or any other abacavir-containing drug

liver enlargement, changes in body fat,

oral solution. Patients with mild liver

(Epzicom, Trizivir). Risk of allergic reaction is higher if you have a gene

changes in immune system, increased

Maker

impairment should take 200 mg twice

variation called HLA-B*5701.

risk of heart attack, especially if you have

GlaxoSmithKline

daily

abacavir

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

18 |

july / august 2015

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS) Help prevent replication of HIV; drugs in this class attack the same enzyme NRTIs do, in a different way.

EDURANT

One 25-mg tablet, once daily, with a

Edurant is for patients who have not previously taken antiretroviral

Most serious: depression or mood

meal

drugs and have a viral load of 100,000 copies per milliliter of blood or

changes (including suicidal thoughts),

less. It is always administered with other antiretrovirals. Do not take

changes in body fat, changes in immune

Edurant with nonnucleoside reverse transcriptase inhibitors, and use

system, kidney disorders Other: insomnia,

Maker

with caution with protease inhibitors. Do not with antiseizure drugs

headache, rash

Janssen

like Tegretol, Trileptal, and Dilantin; antibacterials Mycobutin, Rifadin,

Generic name rilpivirine

Rimactane, or Priftin; proton pump inhibitors such as Nexium, Vimovo, Prevacid, Prilosec, Protonix, and Aciphex; more than one dose of dexamethasone; or Saint-John’s-wort. Use with caution with antifungals taken orally, antibiotics such as Biaxin and Ketek, and methadone. Take antacids or H2 blockers at least 12 hours before or four hours after Edurant.

INTELENCE

200 mg (one 200-mg tablet or two 100-

Do not take with nonnucleoside reverse transcriptase inhibitors; the

Most serious: severe skin reactions such

mg tablets), twice daily

protease inhibitors Aptivus or Lexiva, or other protease inhibitors

as Stevens-Johnson syndrome Other:

without ritonavir; epilepsy and seizure medicines Tegretol, Carbatrol,

changes in body shape or body fat,

Luminal, Dilantin, or Phenytek; herbal products containing Saint-John’s-

changes in immune system, tingling or pain

Maker

wort; or the antibacterial drugs Mycobutin, Rifadin, Rifater, Rifamate,

in the hands or feet, numbness

Janssen

or Priftin. Use with caution with Tivicay, Triumeq, the antimalarial drug

Generic name etravirine

Coartem and drugs that inhibit or induce the genetic features CYP3A, CYP2C9, and/or CYP2C19. Always take after a meal and swallow the pill with a full glass of water; do not chew.

RESCRIPTOR

400 mg (two or four tablets) three

When taking Rescriptor, do not take Versed, Halcion, Xanax, D.H.E.

Most serious: severe skin rash

times daily

45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Orap, Propulsid,

accompanied by blisters, fever, joint

Hismanal, Seldane, rifampin, phenobarbital, Dilantin, Tegretrol, Saint-

or muscle pain, redness or swelling of

John’s-wort, Mevacor, or Zocor. Talk to your doctor before taking Viagra,

the eyes, or sores in the mouth Other:

Maker

Lipitor, Baycol, or Lescol. If taking Videx or antacids, take an hour before

headache, nausea, diarrhea, and tiredness

ViiV Healthcare

or an hour after taking Rescriptor. Doses of protease inhibitors Crixivan,

Generic name delavirdine

Invirase, Fortovase, Kaletra, Norvir, and Viracept may need to be adjusted. Talk with your doctor if you have liver or kidney disease.

SUSTIVA

600 mg (three capsules at once or one

Do not take with other NNRTIs, Atripla, Vascor, Propulsid, Versed,

Most serious: severe liver problems, rashes,

tablet), taken daily

Orap, Halcion, Victrelis, Olysio, or ergot medications (such as Wigraine

and skin reactions Other: changes in the

and Cafergot). The following medicines may need to be replaced

immune system, changes in body fat,

with another when you are taking Sustiva: Fortovase, Invirase, Biaxin,

dizziness, nausea, headache, insomnia,

Maker

Carbatrol, Tegretol, Noxafil, Sporanox, and Reyataz (if this is not the first

tiredness

Bristol-Myers Squibb

time you have been treated for HIV). The following drugs may require

Generic name efavirenz

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.

VIRAMUNE

One 200-mg tablet daily for first 14

Do not take with Saint-John’s-wort, Sustiva, Atripla, Kaletra, Lexiva,

Most serious: severe psychiatric problems,

Generic name

days, then one 200-mg twice daily; also

Reyataz, Nizoral, Sporanox, Rifadin, Rifamate, Rifater, Victrelis, Incivek,

including suicidal thoughts; liver

available in oral suspension; or 100-mg

or birth control pills. Tell doctor if taking Biaxin, Diflucan, Crixivan,

disorders; severe rash Other: dizziness,

tablet for children. Also available in

methadone, Viracept, Mycobutin, Coumadin, Jantoven, or Invirase.

nausea, vomiting, diarrhea, rash, sleep

Maker

an extended-release formulation, for

Discontinue immediately if you develop signs of hepatitis, severe skin

disturbances, drowsiness, trouble

Boehringer Ingelheim;

which dosage is one 200 mg tablet of

reactions, or rash with systemic symptoms.

concentrating, or unusual dreams

generic versions also

immediate-release Viramune once daily

available

for the first 14 days, followed by one 400

THINKSTOCK

nevirapine

mg tablet of Viramune XR once daily

hivplusmag.com

| 19

COMBINATION DRUGS

Help prevent replication of HIV; drugs in this class combine two or more drugs that attack HIV in different ways.

MEDICATION Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

ATRIPLA

One tablet, once daily, on an empty

Efavirenz is a nonnucleoside reverse transcriptase inhibitor (NNRTI), and

Most serious: severe skin reactions

Generic name

stomach, preferably at bedtime

the other components are nucleoside reverse transcriptase inhibitors

such as Stevens-Johnson syndrome,

(600 mg of efavirenz, 200 mg of

(NRTIs); the different types of drugs attack HIV at different stages in its

buildup of lactic acid in the blood,

emtricitabine, and 300 mg of tenofovir

replication process. Do not take Atripla with anti-HIV drugs Combivir,

severe liver or kidney problems, serious

disoproxil fumarate). If you are also

Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, Truvada,

psychiatric problems, thinning bones

taking Rifadin, add 200 mg of efavirenz

Viread, or Stribild, which have the same or similar active ingredients.

(a vitamin D supplement may be

Maker

Take with Sustiva only if your doctor recommends. If you are taking

indicated for the latter) Other: dizziness,

Bristol-Myers Squibb &

Kaletra, dosage of that drug may need to be adjusted. Do not take with

headache, insomnia, drowsiness, trouble

Gilead Sciences

Vfend or Hepsera. Use with caution with Fortovase, Invirase, Videx,

concentrating, unusual dreams, fatigue,

Reyataz, Crixivan, Selzentry, Biaxin, Noxafil, Sporanox, calcium channel

upset stomach, nausea, vomiting, gas,

blockers (such as diltiazem and verapamil, which have various brand

diarrhea

Generic name Maker

efavirenz, emtricitabine, and tenofovir disoproxil fumarate

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. Do not take if you have severe kidney impairment. Do not take while breast-feeding. Discontinue if severe rash develops.

COMPLERA

One tablet, once daily, with a meal (200

Rilpivirine is an NNRTI, the other components NRTIs. Complera is for

Most serious: buildup of lactic acid in

Generic name

mg of emtricitabine,

patients who have not previously taken antiretroviral drugs and have

the blood, severe liver problems, kidney

25 mg of rilpivirine, and 300 mg of

a viral load of 100,000 copies per milliliter of blood or less, or it can

damage, hepatitis B virus infection

tenofovir disoproxil fumarate)

be used as a replacement regimen for patients who have a viral load

flare-ups, depression, bone thinning, and

of 50 copies/mL or less. Do not take with medicines that contain

changes in the immune system Other:

lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, and Trizivir), other

insomnia, headache, rashes, diarrhea,

Maker

HIV antiretroviral medications, drugs to treat seizures or tuberculosis,

nausea, fatigue, dizziness, depression,

Gilead Sciences

proton-pump inhibitors such as Kapidex or Dexilant, Hespera, Saint-

abnormal dreams, vomiting, stomach or

John’s-wort, or more than one dose of dexamethasone. Use caution

other pain, and skin discoloration

emtricitabine, rilpivirine, and tenofovir disoproxil fumarate

when taking antacids, antifungal medications, H2-receptor antagonists, antibiotics, or methadone.

EVOTAZ

One tablet once daily with food, in

Do not take with Uroxatral, Propulsid, Propulsid Quicksolv, Mitigare,

Most serious: heart rhythm changes, kidney

Generic name

combination with other antiretroviral

Colcrys, Multaq, D.H.E. 45, Embolex, Migranal, Cafergot, Migergot,

or gallbladder problems, worsening of liver

drugs; each tablet contains 300 mg

Ergomar, Ergostat, Medihaler, Wigraine, Wigrettes, Ergotrate,

problems, severe skin rash, diabetes or

of the protease inhibitor atazanavir

Methergine, Crixivan, Camptosar, Advicor, Altoprev, Mevacor, Latuda,

worsening diabetes, increased bleeding in

Maker

(marketed under brand name Reyataz

Versed, Viramune, Viramune XR, Orap, Ranexa, Rimactane, Rifadin,

people with hemophilia, changes in body

Bristol-Myers Squibb

and 150 mg of boosting agent cobicistat

Rifater, Rifamate, Revatio when used for lung problems, Zocor, Vytorin,

fat, changes in immune system Other:

(marketed under brand name Tybost).

Simcor, Halcion, or Saint-John’s-wort or a product that contains it.

nausea, yellowing of the skin or whites of

Use with caution if you have heart problems, liver problems, kidney

the eyes

atazanavir and cobicistat

problems, diabetes, or hemophilia, if you are pregnant or plan to become pregnant, and if you are using hormonal birth control. Do not breast-feed.

PREZCOBIX

One tablet twice daily with food; each

Do not take with Uroxatral, Propulsid, Propulsid Quicksolv, Colcrys,

Most serious: liver problems, severe or

Generic name

tablet contains 800 mg of the protease

Mitigare, Multaq, D.H.E.45, Embolex, Migranal, Cafergot, Ergomar,

life-threatening skin rashes or reactions,

inhibitor darunavir (marketed under

Ergostat, Medihaler, Migergot, Wigraine, Wigrettes, Methergine,

high blood sugar, diabetes or worsening

brand name Prezista) and 100 mg of the

Altoprev, Advicor, Mevacor, Latuda, Versed, Orap, Ranexa), Rifadin,

diabetes, increased bleeding in people

Maker

boosting agent cobicistat (marketed

Rifater, Rifamate, Rimactane, Revatio when used for pulmonary arterial

with hemophilia, changes in body fat,

Janssen

under brand name Tybost).

hypertension, Simcor, Vytorin, Zocor, Saint-John’s-wort or a product

changes in immune system Other: diarrhea,

that contains it, or Halcion. Use with caution if you have liver or kidney

nausea, rash, headache, abdominal pain,

problems, or if you are pregnant, breast-feeding, or plan to become

vomiting

darunavir and cobicistat

THINKSTOCK

pregnant or breast-feed.

20 |

july / august 2015

MEDICATION Generic name

Traditional dosage

Drug interactions, precautions, and recommendations

Side effects

STRIBILD

One tablet, once daily, with a meal (150

Stribild is not approved for treatment of patients who have hepatitis

Most serious: buildup of lactic acid in the

Generic name

mg of elvitegravir, 150 mg of cobicistat,

B, as Stribild can exacerbate the disease and cause flare-ups. Stribild

blood; severe liver or kidney problems,

200 mg of emtricitabine, and 300 mg of

should not be used for patients with an estimated creatinine clearance

which could lead to potentially fatal renal

tenofovir disoproxil fumarate)

below 70 mL per minute. Do not use with other anti-HIV drugs

failure; thinning bones, and changes in

containing emtricitabine or tenofovir disoproxil fumarate, including

the immune system Other: nausea and

Atripla, Complera, Emtriva, Truvada, or Viread; do not use with drugs

diarrhea

Maker

elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate

Maker

containing lamivudine or with drugs or regimens containing ritonavir,

Gilead Sciences

such as Combivir, Epivir, Epivir-HBV, Epzicom, or Trizivir. Do not administer in combination with Hepsera. Do not use with sildenafil when branded as Revatio, though sildenafil when dosed as Viagra may be safe, so consult your doctor. Do not use with alfuzosin, rifampin, cisapride, pimozide, or the herbal remedy Saint-John’s-wort. Do not take Stribild with ergot derivatives (such as dihydroergotamine, ergotamine, or methylergonovine), HMG-CoA Reductase inhibitors (such as lovastatin and simvastatin), or with sedative hypnotics.

TRIUMEQ

One tablet once daily, with or without

Do not take with Epzicom, Trizivir, Ziagen, Combivir, Epivir , Epivir-

Most serious: worsening of hepatitis B or

Generic name

food; each tablet contains 50 mg of

HBV, Epzicom, Emtriva, Atripla, Complera, Stribild, Truvada, Tikosyn,

C, changes in body fat, changes in immune

dolutegravir (an integrase strand transfer

Viramune, Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin, or

system, increased risk of heart attack

inhibitor marketed under brand name

Saint-John’s-wort. Do not take if you have the HLA-B*5701 gene

Other: trouble sleeping, headache, fatigue

Tivicay), 600 mg of abacavir, and 300

variation or moderate to severe liver problems. Use with caution

Maker

mg of lamivudine (both nucleoside

if you have hepatitis B or C or taking interferon, ribavirin, Sustiva,

ViiV Healthcare

reverse transcriptase inhibitors marketed

Norvir combined with Lexiva or Aptivus, Rifadin, Glumetza, Fortamet,

under brand names Ziagen and Epivir,

Glucophage, or Riomet. Take two hours before or six hours after iron or

respectively).

calcium supplements. certain antacids, or buffered medications.

dolutegravir, abacavir sulfate, and lamivudine

hivplusmag.com

| 21

WHAT IS PREZCOBIX™ ?

• It is not known if PREZCOBIX™ is safe and effective in children under 18 years of age.

• When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX™ may help:

Medihaler,® Migergot,® Wigraine,® Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev,® Advicor,® Mevacor ®), lurasidone (Latuda®), oral midazolam (Versed®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin,® Rifater,® Rifamate,® Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor,® Vytorin,® Zocor ®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

○ reduce the amount of HIV-1 in your blood. This is called “viral load.”

• Serious problems can happen if you take any of these medicines with PREZCOBIX.™

○ increase the number of CD4+ (T) cells in your blood that help fight off other infections.

What should I tell my healthcare provider before taking PREZCOBIX™ ?

• PREZCOBIX™ is always taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.

PREZCOBIX™ should be taken once daily with food.

• PREZCOBIX™ does not cure HIV-1 infection or AIDS, and you may still experience illnesses associated with HIV-1 infection.

You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses.

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

• Please read the Important Safety Information below and talk to your healthcare provider to learn if PREZCOBIX™ is right for you.

• About all health problems. Tell your healthcare provider if you have liver problems, including hepatitis B or hepatitis C, have kidney problems, are allergic to sulfa (sulfonamide), have diabetes, have hemophilia, or have any other medical condition, are pregnant, breastfeeding, or plan to become pregnant or breastfeed. Tell your healthcare provider if you become pregnant while taking PREZCOBIX.™ • About all medicines you take. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with PREZCOBIX.™ Keep a list of your medicines to show your healthcare provider and pharmacist. Do not start taking a new medicine without telling your healthcare provider.

Your healthcare provider can tell you if it is safe to take PREZCOBIX™ with other medicines.

IMPORTANT SAFETY INFORMATION

What are the possible side effects of PREZCOBIX™ ?

What is the most important information I should know about PREZCOBIX™ ?

• The most common side effects of darunavir, one of the medicines in PREZCOBIX,™ include diarrhea, nausea, rash, headache, stomach area (abdominal) pain, and vomiting.

• PREZCOBIX™ may cause liver problems. Some people taking PREZCOBIX™ may develop liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX.™ ○ Chronic hepatitis B or C infection may increase your chance of developing liver problems. Your healthcare provider should check your blood tests more often. ○ Signs and symptoms of liver problems include dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite. Tell your healthcare provider if you develop any of these symptoms.

• PREZCOBIX™ may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital.

Call your healthcare provider right away if you develop a rash. ○ Stop taking PREZCOBIX™ and call your healthcare provider right away if you develop any skin changes with symptoms such as fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes like “pink eye” (conjunctivitis).

• PREZCOBIX,™ when taken with certain other medicines, can cause new or worse kidney problems, including kidney failure.

Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.™ Who should not take PREZCOBIX™ ?

• Do not take PREZCOBIX™ with any of the following medicines: alfuzosin (Uroxatral®), cisapride (Propulsid,® Propulsid® Quicksolv), colchicine (Colcrys,® Mitigare,® if you have liver or kidney problems), dronedarone (Multaq®), dihydroergotamine (D.H.E.45®, Embolex ,® Migranal®), ergotamine tartrate (Cafergot ,® Ergomar ®, Ergostat ,®

• Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.™ ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long-term health effects of these changes 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.

These are not all of the possible side effects of PREZCOBIX.™ For more information, ask your healthcare provider.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

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 accompanying full Product Information for more details.

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2015 01/15 008417-140113

027409-150108

• PREZCOBIX™ is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). PREZCOBIX™ contains the prescription medicines PREZISTA® (darunavir) and TYBOST® (cobicistat).

{

Wisdom inspired by real people

B:10.75 in

T:10.5 in

S:9.875 in

DISCOVER YOUR WISDOM WITHIN

Visit PREZCOBIX.com to hear wisdom inspired by experts and people like you living with HIV. Ask your provider if Once-Daily* PREZCOBIX™ is right for you.

PREZCOBIX.com *PREZCOBIX™ is taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.

IMPORTANT PATIENT INFORMATION PATIENT INFORMATION PREZCOBIX (prez-koe-bix) (darunavir and cobicistat) tablets Please read this information before you start taking PREZCOBIX and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment. What is the most important information I should know about PREZCOBIX? • PREZCOBIX may cause liver problems. Some people taking PREZCOBIX may develop liver problems which may be lifethreatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems.

Tell your healthcare provider if you have any of the below signs and symptoms of liver problems.

• dark (tea colored) urine • yellowing of your skin or whites of your eyes • pale colored stools (bowel movements) • nausea • vomiting • pain or tenderness on your right side below your ribs • loss of appetite • PREZCOBIX may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. Call your healthcare provider right away if you develop a rash. Stop taking PREZCOBIX and call your healthcare provider right away if you develop any skin changes with symptoms below: • fever • tiredness • muscle or joint pain • blisters or skin lesions • mouth sores or ulcers • red or inflamed eyes, like “pink eye” (conjunctivitis) • PREZCOBIX when taken with certain other medicines can cause new or worse kidney problems, including kidney failure. Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX. See “What are the possible side effects of PREZCOBIX?” for more information about side effects.

What is PREZCOBIX? PREZCOBIX is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

PREZCOBIX contains the prescription medicines PREZISTA (darunavir) and TYBOST (cobicistat).

It is not known if PREZCOBIX is safe and effective in children under 18 years of age.

When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX may help: • reduce the amount of HIV-1 in your blood. This is called “viral load”.

• i ncrease the number of CD4+ (T) cells in your blood that help fight off other infections.

Reducing the amount of HIV-1 and increasing the CD4+ (T) cells in your blood may help improve your immune system.

This may reduce your risk of death or getting infections that can happen when your immune system is weak (opportunistic infections).

PREZCOBIX does not cure HIV-1 infection or AIDS. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses.

Avoid doing things that can spread HIV-1 infection to others.

• Do not share or re-use 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 healthcare provider if you have any questions on how to prevent passing HIV to other people.

Who should not take PREZCOBIX? Do not take PREZCOBIX with any of the following medicines: • alfuzosin (Uroxatral®) • cisapride (Propulside®, Propulsid® Quicksolv) • colchicine (Colcrys®, Mitigare®), if you have liver or kidney problems • dronedarone (Multaq®) • ergot-containing medicines: • dihydroergotamine (D.H.E. 45®, Embolex®, Migranal®) • ergotamine tartrate (Cafergot®, Ergomar®, Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®) • methylergonovine (Methergine®) • lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®) • lurasidone (Latuda®) • midazolam (Versed®), when taken by mouth • pimozide (Orap®) • ranolazine (Ranexa®) • rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) • sildenafil (Revatio®), when used for the treatment of pulmonary arterial hypertension (PAH) • simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®) • St. John’s Wort (Hypericum perforatum), or a product that contains St. John’s Wort • triazolam (Halcion®) Serious problems can happen if you take any of these medicines with PREZCOBIX. What should I tell my healthcare provider before taking PREZCOBIX? Before taking PREZCOBIX, tell your healthcare provider if you: • have liver problems, including hepatitis B or hepatitis C • have kidney problems • are allergic to sulfa (sulfonamide) • have diabetes • have hemophilia • have any other medical condition

IMPORTANT PATIENT INFORMATION • a re pregnant or plan to become pregnant. It is not known if PREZCOBIX will harm your unborn baby. Tell your healthcare provider if you become pregnant while taking PREZCOBIX. • Pregnancy Registry: There is a pregnancy registry for women who take antiretroviral medicines during pregnancy. The purpose of the registry 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.

• are breastfeeding or plan to breastfeed. Do not breastfeed if you take PREZCOBIX. • You should not breastfeed if you have HIV-1 because of the risk of passing HIV to your baby.

• It is not known if PREZCOBIX can pass into your breast milk.

• Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with PREZCOBIX. Keep a list of your medicines to show your healthcare provider and pharmacist.

• You can ask your healthcare provider or pharmacist for a list of medicines that interact with PREZCOBIX. • Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take PREZCOBIX with other medicines.

How should I take PREZCOBIX? • Take PREZCOBIX exactly as your healthcare provider tells you.

• Do not change your dose or stop taking PREZCOBIX without talking to your healthcare provider.

• Take PREZCOBIX 1 time a day with food.

• If you miss a dose of PREZCOBIX by less than 12 hours, take your missed dose of PREZCOBIX right away. Then take your next dose of PREZCOBIX at your regularly scheduled time.

• If you miss a dose of PREZCOBIX by more than 12 hours, wait and then take the next dose of PREZCOBIX at your regularly scheduled time.

• If a dose of PREZCOBIX is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZCOBIX at any one time.

• If you take too much PREZCOBIX, call your healthcare provider or go to the nearest hospital emergency room right away.

What are the possible side effects of PREZCOBIX? PREZCOBIX may cause serious side effects including: • See “What is the most important information I should know about PREZCOBIX?” • Diabetes and high blood sugar (hyperglycemia). Some people who take protease inhibitors including PREZCOBIX can get high blood sugar, develop diabetes, or your diabetes can get worse. Tell your healthcare provider if you notice an increase in thirst or urinate often while taking PREZCOBIX. • Changes in body fat can happen in people who take HIV-1 medications. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the middle of your body (trunk). Loss of fat from the legs, arms, and face may also happen.

The exact cause and long-term health effects of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 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 right away if you start having new symptoms after starting your HIV-1 medicine.

• Increased bleeding for hemophiliacs. Some people with hemophilia have increased bleeding with protease inhibitors including PREZCOBIX. The most common side effects of darunavir, one of the medicines in PREZCOBIX, include: • diarrhea • nausea • rash • headache • stomach area (abdominal) pain • vomiting Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all of the possible side effects of PREZCOBIX. For more information, ask your health care provider.

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 PREZCOBIX? • Store PREZCOBIX tablets at room temperature between 68°F to 77°F (20°C to 25°C).

Keep PREZCOBIX and all medicines out of reach of children.

General information about PREZCOBIX Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use PREZCOBIX for a condition for which it was not prescribed.

Do not give PREZCOBIX to other people, even if they have the same symptoms that you have. It may harm them.

If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about PREZCOBIX that is written for health professionals.

For more information call 1-800-526-7736.

What are the ingredients in PREZCOBIX? Active ingredients: darunavir and cobicistat Inactive ingredients: colloidal silicon dioxide, crospovidone, hypromellose, magnesium stearate, and silicified microcrystalline cellulose. The tablets are film-coated with a coating material containing iron oxide black, iron oxide red, polyethylene glycol, polyvinyl alcohol (partially hydrolyzed), talc, and titanium dioxide.

Manufactured by: Janssen Ortho LLC, Gurabo, PR 00778 Manufactured for: Janssen Therapeutics, Division of Janssen Products, LP, Titusville NJ 08560 Issued: January 2015 © Janssen Pharmaceuticals, Inc. 2015 027415-150108

DRUGS THAT TREAT HIV-RELATED CONDITIONS AMBISOME, AMPHOTEC, ABELCET, AMPHOCIN Generic name: amphotericin B Maker: Astellas, Alkopharma, Sigma-Tau, Pfizer

Traditional dosage: No more than 1.5 mg per kg of body weight,

What it does: Treats fungal infections, including cryptococcal meningitis,

Side effects: Most serious: allergic

which are more common in people with HIV

reaction, kidney problems, rash, irregular heartbeat, muscle cramps or pain,

What to know: Individuals who cannot normally take traditional

weakness, bleeding, hearing loss, blurred

amphotericin B because it causes damage to their kidneys may be able to

vision, hepatitis Other: fever, shaking, chills,

take the formulations in AmBisome, Abelcet, or Amphotec.

weight loss, nausea, headache, jaundice

administered intravenously, once daily

ANDROGEL

Generic name: testosterone gel Maker: AbbVie Traditional dosage: In amount and frequency determined by physician, applied topically. Comes in 1 percent and 1.62 percent concentrations, in packets or bottles. Apply AndroGel 1 percent only to shoulders and upper arms, or stomach area (abdomen), or shoulders, upper arms, and stomach area; 1.62 percent only to shoulders and upper arms.

What it does: Treats low testosterone in adult men, which can be a

Side effects: Most serious: Enlarged

complication of HIV, especially for men over 50

prostate, possible increased risk of prostate cancer, lowered sperm count,

What to know: Apply at same time every day, after bathing or showering,

enlarged or painful breasts, sleep apnea,

to clean, dry skin. Wash hands immediately after applying. Cover the

blood clots in legs or lungs, swelling of

application area with clothing after the gel dries. Avoid letting others,

ankles, feet, or body Other: Increased

especially women and children, have skin-to-skin contact with application

prostate-specific antigens, mood swings,

area; if they do, they should wash the contact area right away. Tell your

high blood pressure, increased red blood

health care provider about all your health conditions, especially if you have

cell count, skin irritation, more frequent or

breast or prostate cancer; difficulty in urination due to enlarged prostate;

longer-lasting erections

heart, kidney, or liver problems; or sleep apnea. Also tell your provider what other medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

AXIRON

Generic name: testosterone topical solution Maker: Lilly Traditional dosage: 30, 60, 90, or 120 mg, as determined by your physician, and with frequency determined by physician.

Apply only under the arms.

What it does: Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50

Side effects: Most serious: Enlarged prostate, possible increased risk of

What to know: Wash hands immediately after applying. Cover the

prostate cancer, lowered sperm count,

application area with clothing after the solution dries. Avoid letting others,

enlarged or painful breasts, sleep apnea,

especially women and children, have skin-to-skin contact with application

blood clots in legs or lungs, swelling of

area; if they do, they should wash the contact area right away. Tell your

ankles, feet, or body Other: Increased

health care provider about all your health conditions, especially if you have

prostate-specific antigens, increased red

breast or prostate cancer; difficulty in urination due to enlarged prostate;

blood cell count, skin irritation or redness,

heart, kidney, or liver problems; or sleep apnea. Should not be used if

headache, diarrhea, vomiting, more

you have breast cancer, or have or might have prostate cancer. Also tell

frequent or longer-lasting erections

your provider what other medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

BACTRIM, SEPTRA, SULFATRIM Generic name: sulfamethoxazole/trimethoprim Maker: Various (see HIVPlusmag.com)

Traditional dosage: 400 mg (two or four tablets) three times

What it does: Treats and helps prevent recurrence of Pneumocystis

Side effects: Most serious: skin rash,

pneumonia in HIV-positive patients; also used on other bacterial infections

joint or muscle aches, sore throat or fever, unusual bleeding or bruising Other:

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

dizziness, nausea, vomiting, diarrhea, loss

Consult with doctor if pregnant, as there is chance of fetal damage.

of appetite, fatigue, headache, low blood sodium

daily

BARACLUDE

Generic name: entecavir Maker: Bristol-Myers Squibb Traditional dosage: 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

26 |

july / august 2015

What it does: Treats chronic hepatitis B. May also help inhibit HIV

Side effects: Most serious: worsening

replication, although this use has not been studied

of hepatitis B after discontinuation of treatment, other liver problems, buildup of

What to know: People with HIV should be receiving antiretroviral treatment

lactic acid in the blood Other: headache,

for that as well, as resistance to anti-HIV drugs may develop otherwise. May

fatigue, dizziness, nausea

affect concentration of drugs that reduce kidney function or vice versa.

Those with decreased kidney function may need to reduce dosage.

BIAXIN

Generic name: clarithromycin Maker: AbbVie Traditional dosage: 500 mg, 2 or 3 times daily, depending on the infection. Available in immediate release tablets, extended

What it does: Fights bacterial infections, especially Mycobacterium avium

Side effects: Most serious: abdominal

complex (MAC)

pain, fever, nausea, vomiting, bleeding or bruising, diarrhea, colitis, liver failure,

What to know: There have been life-threatening interactions with Colcrys

hepatitis Other: milder diarrhea, headache,

and serious interactions with Altacor, Altoprev, Mevacor, Zocor, Lipitor, and

nausea and vomiting, change in taste

blood pressure drugs. Use caution when taking with Viagra.

release tablets, and granules to be mixed with water

COPEGUS

Generic name: ribivarin Maker: Roche Traditional dosage: 800 to 1,200 mg daily, depending on patient’s weight and type of virus, taken twice daily in 200-mg capsules, with food

What it does: In combination with Pegasys, treats chronic hepatitis C

Side effects: Most serious: severe eye,

infection

blood, lung, or liver problems, pancreatitis, depression or suicidal thoughts, high blood

What to know: Do not use if you take Videx or Videx EC. Use caution when

sugar or diabetes, fetal abnormalities

taking with NRTIs like Combivir, Epivir, Epzicom, Retrovir, Trizivir, as drug

Other: flu-like symptoms, tiredness and

interactions could lead to toxicity. Do not take if you have certain blood

weakness, nausea and vomiting, loss of

disorders, such as thalassemia major or sickle-cell anemia, or certain types

appetite, skin reactions, hair thinning,

of hepatitis. Do not take if you are pregnant or if you or your partner plan to

trouble sleeping

become pregnant.

CRESEMBA

Generic name: isavuconazonium sulfate Maker: Astellas Traditional dosage: Initial “loading” dose of 372 mg every eight hours for six doses, through intravenous infusion or two

What it does: Treats rare fungal infections invasive aspergillosis and

Side effects: Most serious: liver problems,

invasive mucormycosis, which are more common in people with HIV

infusion reactions, severe allergic and skin reactions Other: nausea, vomiting,

What to know: Do not take with Norvir, the antiseizure medicine

diarrhea, headache, abnormal liver

carbamazepine, the tuberculosis drug rifampin, Saint-John’s-wort, or long-

blood tests, low potassium levels in the

acting barbiturates.

blood, constipation, shortness of breath, coughing, tissue swelling

capsules 186-mg taken orally, followed by maintenance dose of two capsules once daily or one 372-mg infusion daily, beginning 12 to 24 hours after loading dose. Capsules can be taken with or without food.

CYTOVENE-IV, VITRASERT Generic name: ganciclovir

Maker: Roche Laboratories (Cytovene-IV), Pharmaforce (generic); Bausch and Lomb (Vitrasert)

Traditional dosage: Vitrasert, surgically implanted in the eye, consists of a 4.5-mg pellet of ganciclovir coated with polymers.

For Cytovene-IV, dosages vary but should not exceed 6 mg per kg of body weight

DAUNOXOME

Generic name: daunorubicin liposomal Maker: Galen Traditional dosage: Injected intravenously at a strength of 40

What it does: Treats the eye infection cytomegalovirus retinitis in

Side effects: Most serious: blood

transplant recipients and people with weakened immune systems, such as

disorders, black or tarry stools, cough,

those with HIV

sore throat, fever or chills, pain, painful urination, seeing flashes or sparks of light,

What to know: Do not take with blood dyscrasia-causing medications,

floating spots, or a partial veil across

bone marrow depressants, radiation therapy, nephrotoxic medications, or

vision, unusual bleeding, and unusual

Retrovir. Dosage may need adjustment if you have kidney problems or take

tiredness or weakness Other: abdominal

Videx or Videx EC. Use caution if you take anti-HIV medications containing

pain, changes in behavior, diarrhea, fever,

zidovudine or didanosine.

headache, increased sweating, loss of appetite, vomiting, weight loss

What it does: Treats advanced HIV-related Kaposi’s sarcoma

Side effects: Most serious: suppression of the bone marrow’s production of blood

What to know: Do not use if you have less than advanced KS.

cells and platelets; patients should have regular blood counts Other: back pain, flushing, chest tightness

THINKSTOCK

mg per square meter of body surface area every two weeks

hivplusmag.com

| 27

DIFLUCAN

Generic name: fluconazole Maker: Pfizer Traditional dosage: Doses vary based on targeted infection.

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

What it does: Treats many types of fungal infections, including AIDS-

Side effects: Most serious: liver problems,

related Candida oral, esophageal, urinary, or vaginal yeast infections

potentially severe allergic reaction, seizures Other: rash, nausea, headache,

What to know: Do not take with Quinaglute, Quinidex, Hismanal, Propulsid,

vomiting, diarrhea, dizziness

Orap, or erythromycin. Use with caution with antidiabetic agents, anticonvulsants, blood pressure medications, immunosuppressive drugs, protease inhibitors, blood thinners, and vitamin A nutritional supplements.

Use with caution if pregnant or if you have heart problems or kidney dysfunction. Do not take if you have sugar intolerance.

DOXIL

Generic name: doxorubicin, liposomal Maker: Janssen

What it does: Treats Kaposi’s sarcoma in patients who cannot tolerate

Side effects: Most serious: congestive

other medicines or whose disease is advanced

heart failure, decrease in blood cells, secondary oral cancers Other: tingling or

What to know: Dose may need to be adjusted if you have liver problems.

burning, swelling, blisters, mouth sores, fever, nerve damage and more (see

Traditional dosage: For AIDS-related Kaposi’s sarcoma, 20

HIVPlusMag.com)

mg per square meter of body surface, every three weeks by intravenous infusion

EGRIFTA

Generic name: tesamorelin Maker: EMD Serono Traditional dosage: 2 mg injected subcutaneously (just below the skin), once daily

EPOGEN, PROCRIT

Generic name: epoetin alfa Maker: Amgen (Epogen); Janssen (Procrit) Traditional dosage: 100 units per kilogram of body weight, three times a week, given intravenously

ERAXIS

Generic name: anidulafungin Maker: Pfizer Traditional dosage: For esophageal candidiasis, 100 mg by injection the first day, followed by followed by 50 mg daily dose thereafter for a minimum of 14 days; for candidemia and other Candida infections, 200 mg by injection the first day, followed by 100 mg daily dose, with the number of days depending on the patient. Eraxis comes as a powder that is mixed with sterile water for infusion

28 |

july / august 2015

What it does: Helps reduce HIV-related excess belly fat by encouraging the

Side effects: Most serious: severe allergic

body to produce natural growth hormones that reduce fat

reaction or fluid retention, injection site reactions, or increase in glucose

What to know: Do not take if you have or had issues involving your

intolerance/diabetes Other: pain, swelling,

pituitary gland, if you have active cancer, or if you are pregnant or breast-

muscle soreness, tingling, numbness and

feeding.

pricking, nausea, vomiting, rash, itching

What it does: Treats anemia that results as a side effect of Retrovir

Side effects: Most serious: high blood pressure, seizures, development of

What to know: Do not take if you have uncontrolled high blood pressure.

antibodies against the drug, severe allergic

Iron supplements may be needed for patients who undergo blood

reactions Other: joint, muscle, or bone

transfusions. Talk to your doctor if you have cancer, as there is an increased

pain, fever, cough, rash, nausea, vomiting,

risk of tumor progression or shortened survival.

soreness of mouth, itching, headache, pain at injection site

What it does: Treats esophageal candidiasis, candidemia, and other

Side effects: Most serious: abnormal

Candida infections

liver function, anaphylactic shock Other: nausea, diarrhea, vomiting

What to know: Effects on women who are pregnant or breast-feeding have not been studied, so discuss possibility of pregnancy with your doctor.

ETOPOPHOS

Generic name: etoposide Maker: Bristol-Myers Squibb Traditional dosage: Dosages vary for small cell lung cancer and testicular cancer, used in combination with other chemotherapeutic agents

FAMVIR

Generic name: famciclovir Maker: Novartis Traditional dosage: 500 mg in tablets twice daily for seven days; tablets come in 125, 250, or 500 mg strengths

FORTESTA

Generic name: Testosterone gel Maker: Endo Pharmaceuticals Traditional dosage: Initial dose is 40 mg of gel, applied to the thighs once daily, in the morning; amount may be adjusted by your physician

What it does: Treats various types of cancer; being tested for treatment of

Side effects: Most serious: severe allergic

non-Hodgkin’s lymphoma and Kaposi’s sarcoma

reaction, alopecia (hair loss), chills or fever, nausea, constipation, abdominal pain

What to know: High-dose cyclosporine and drugs such as levamisole

Other: rash, unusual tiredness

hydrochlor can cause interactions. Use of a live virus vaccine could be complicated by weakened immune mechanisms. Do not deliver by bolus intravenous injection.

What it does: Treats recurrent episodes of orolabial herpes (cold sores) or

Side effects: Most serious: acute kidney

genital herpes

failure Other: headache, nausea, skin or subcutaneous tissue disorders, heart

What to know: Dosage may need to be reduced for patients with kidney

palpitations

impairment. The drugs Benemid and Probalan, used to treat gout, may increase the level of Famvir in the patient’s body, so this level should be monitored.

What it does: Treats low testosterone in adult men, which can be a

Side effects: Most serious: enlarged

complication of HIV, especially for men over 50

prostate, possible increased risk of prostate cancer, lowered sperm count,

What to know: Apply at same time every day, after bathing or showering,

enlarged or painful breasts, sleep apnea,

to clean, dry skin. Wash hands immediately after applying. Cover the

blood clots in legs or lungs, swelling of

application area with clothing after the gel dries. Avoid letting others,

ankles, feet, or body Other: increased

especially women and children, have skin-to-skin contact with application

prostate-specific antigens, skin redness or

area; if they do, they should wash the contact area right away. Tell your

irritation, abnormal dreams

health care provider about all your health conditions, especially if you have breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Also tell your provider what other medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

FOSCAVIR

Generic name: foscarnet sodium Maker: Hospira Traditional dosage: Initial dose of Foscavir, a liquid solution, is an intravenous infusion of 90 mg per kilogram of weight every

What it does: Treats CMV retinitis

Side effects: Most serious: impairment of kidney function, electrolyte abnormalities,

What to know: May be used in combination with ganciclovir drugs in

seizures, anemia Other: headache, nausea,

patients who have relapsed after treatment with either drug by itself, but no

vomiting, diarrhea, fever

other drug should be delivered in the same infusion. Use with caution with intravenous pentamadine.

12 hours or 60 mg/kg every eight hours for two to three weeks, followed by a maintenance dose of 90 mg/kg to 120 mg/kg daily.

Dosage should be individualized according to patients’ kidney function but should not exceed the recommended amount or

THINKSTOCK

frequency

hivplusmag.com

| 29

FULYZAQ

Generic name: crofelemer Maker: Salix

What it does: Relieves diarrhea that is a side effect of antiretroviral drugs

Side effects: Most serious: upper respiratory tract infection, bronchitis,

What to know: Patients should be tested to make sure the diarrhea is not

cough, flatulence, and increased levels of

caused by an infection or gastrointestinal disease.

the liver enzyme bilirubin

Traditional dosage: One 125-mg delayed-release tablet, twice daily, with or without food. Tablets should be swallowed whole and not crushed or chewed

GAMIMUNE N, GAMUNEX, GAMMAGARD

Generic name: immune globulin Maker: Bayer Biological, Talecris Biotherapeutics, Baxter

What it does: Helps fight bacterial infections in children with HIV

Side effects: Most serious: depression, suicidal behavior, severe pain, difficulty

What to know: May interfere with immune response to live-virus vaccines

breathing, vision problems, high fever,

for measles, mumps, or rubella.

bleeding or bruising Other: headache, nausea, diarrhea, chills, fatigue

Healthcare

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

HARVONI

Generic name: ledipasvir and sofosbuvir Maker: Gilead Traditional dosage: One tablet daily, containing 90 mg of ledipasvir and 400 mg of sofosbuvir (the latter is marketed separately under the brand name Sovaldi). Treatment duration is either 12 or 24 weeks, depending on whether a patient has been treated for hepatitis C previously and whether the patient also has cirrhosis of the liver.

HEPSERA

Generic name: adefovir dipivoxil Maker: Gilead Traditional dosage: One 10-mg tablet daily

What it does: Treats chronic hepatitis C infection

Side effects: General: fatigue, headache

What to know: Unlike other hep C drugs, Harvoni does not need to be taken with ribavarin or interferon. Do not use with Saint-John’s-wort, Cordarone, Crestor, Mycobutin, Rifadin, Olysio, Sovaldi, anticonvulsant drugs, the combination of HIV drugs Aptivus and Norvir, or the combo drug Stribild, Use with caution with HIV drugs that contain tenofovir, such as Viread, Truvada, and Atripla. If taking antacids, leave at least four hours between Harvoni and antacid consumption. Use with caution if pregnant or breast-feeding.

What it does: Treats chronic hepatitis B infection

Side effects: Most serious: worsening of hepatitis B, kidney malfunction, buildup of

What to know: Do not take with Viread, Atripla, Truvada, Complera, or

lactic acid in the blood Other: weakness,

Stribild. Use caution when taking with drugs that affect kidney function or

headache, abdominal pain, nausea,

are eliminated by the kidneys, or with other NRTIs.

diarrhea, indigestion, gas

What it does: Treats chronic hepatitis B infection

INTRON A

Generic name: interferon alfa-2b Maker: Schering Traditional dosage: 30 million international 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

30 |

july / august 2015

What it does: Treats AIDS-related Kaposi’s sarcoma and hepatitis infection,

Side effects: Most serious: depression,

especially hepatitis C

suicidal thoughts, severe flu-like symptoms Other: difficulty sleeping, nervousness,

What to know: Use caution if taken with Retrovir, theophylline, or Tyzeka.

muscle pain or numbness, blood in urine

Do not take if you have autoimmune hepatitis, decompensated liver disease,

or stools, painful or difficult urination,

thalassemia major, sickle-cell anemia, or problems with creatinine clearance.

chest pain, fever, chills, unusual bleeding

Use with caution if you have history of cardiovascular or cerebrovascular

or bruising

diseases.

MARINOL

Generic name: dronabinol Maker: AbbVie Traditional dosage: Varies, but usually starts with one 2.5-mg

What it does: Helps stimulate the appetite of HIV patients What to know: Can interact dangerously with alcohol, Valium, Librium,

feelings of unreality, hallucinations,

Seconal, Xanax, or Nembutal. Do not smoke marijuana, as this can cause an

depression, nervousness, anxiety, and

overdose. Can become habit-forming.

rapid heartbeat Other: clumsiness or unsteadiness, dizziness, drowsiness,

capsule taken twice daily, before lunch and dinner. Also available

euphoria, trouble thinking, nausea,

in 5-mg or 10-mg capsules. Take the capsules whole; do not

vomiting

crush or chew

MEGACE ES

Generic name: megestrol acetate Maker: Strativa Traditional dosage: 625 mg (one teaspoon), once daily

Side effects: Most serious: amnesia, confusion, delusions, mood changes,

What it does: Treats appetite loss, severe malnutrition, or unexplained,

Side effects: Most serious: Cushing’s

significant weight loss

syndrome, development or worsening of diabetes

What to know: May decrease effectiveness of Crixivan. If you have a history

Other: decreased sexual desire or

of blood clots, check with your doctor before taking.

performance, flatulence, rash, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding

MEGACE ORAL SUSPENSION Generic name: megestrol acetate Maker: Bristol-Myers Squibb Traditional dosage: 800 mg, once daily

MEPRON

Generic name: atovaquone Maker: GlaxoSmithKline Traditional dosage: For prevention, 1,500 mg of oral solution,

What it does: Treats severe malnutrition, appetite loss, or significant weight

Side effects: Most serious: Cushing’s

loss

syndrome, diabetes Other: decreased libido, flatulence, high blood pressure,

What to know: No significant interactions discovered to date. If you have a

insomnia, upset stomach, increased blood

history of blood clots, check with your doctor before taking.

sugar, between-period bleeding

What it does: Helps prevent and treat mild to moderate Pneumocystis

Side effects: Most serious: rash, diarrhea,

pneumonia in patients who cannot tolerate other drugs

nausea

What to know: If also taking rifampin, consider alternatives, as it may reduce the amount of Mepron in the body.

once daily, with a meal; for treatment, 750 mg of solution, twice daily, with meals

MYCOBUTIN

Generic name: rifabutin Maker: Pfizer (Mycobutin); Lupin Ltd. (generic) Traditional dosage: 300 mg in capsules, once daily. If prone to

Side effects: Most serious: neutropenia

(MAC) disease

Other: rash, gastrointestinal disorders, flu-like symptoms

What to know: 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.

THINKSTOCK

nausea or vomiting, split into two doses daily, with food

What it does: Helps prevent disseminated Mycobacterium avium complex

hivplusmag.com

| 31

NEBUPENT

Generic name: pentamidine isethionate Maker: APP Pharmaceuticals Traditional dosage: 300 mg every four weeks, via oral inhalation

What it does: Helps prevent Pneumocystis pneumonia in patients with a

Side effects: Most serious: acute

history of the disease or low T-cell counts

pancreatitis Other: night sweats, anemia, bronchitis, nonspecific herpes, herpes

What to know: Use with caution with aminoglycosides (a class of

zoster, nonspecific influenza, oral Candida,

antibiotics), amphotericin B (an antifungal drug marketed under various

pharyngitis, sinusitis, headache, chest pain,

brand names), Platinol, Foscavir, or Vancocin. If breast-feeding, take only if

cough, wheezing

doctor determines benefits outweigh risks.

OLYSIO

Generic name: simeprevir Maker: Janssen

Traditional dosage: 150-mg capsule, once daily, with food, in combination with ribivarin (marketed under brand names

What it does: Treats chronic hepatitis C infection

Side effects: Most serious: severe rash, fetal damage Other: milder rash, itching,

What to know: Do not take if you or partner are pregnant or plan to be, as

sensitivity to light, nausea

birth defects or fetal death can result. Use with caution if taking Tegretol, Mycobutin, Rifadin, Saint-John’s-wort, Norvir, Kaletra, Biaxin, cimetidine, antifungal meds, or grapefruit juice.

Copegus, Rebetol, and others) and peginterferon alfa (PegIntron or Pegasys). Has also been approved for prescribing in combination with another hepatitis C drug, Sovaldi

PANRETIN GEL Generic name: alitretinoin Maker: Eisai

What it does: Provides topical treatment for KS lesions

Side effects: Most serious: toxic skin reactions

What to know: Avoid using with products that contain DEET, a common ingredient of insect repellents. Minimize skin’s exposure to sun.

Traditional dosage: This topical gel should initially be applied twice a day to KS lesions, with frequency increased to three or four times a day, depending on tolerance, or reduced if skin is irritated or if there is a toxic reaction. Apply enough to cover the lesion thoroughly, but avoid getting on normal skin surrounding the lesion, and allow the gel to dry before covering the skin with clothing. Treatment can continue as long as needed

PEGASYS

Generic name: peginterferon alfa-2a Maker: Genentech Traditional dosage: 180 micrograms, once weekly, by subcutaneous injection

What it does: Treats chronic hepatitis C or B, alone or in combination with

Side effects: Most serious: severe

other drugs

eye, blood, liver, nerve, thyroid, or lung problems, pancreatitis, colitis, high blood

What to know: Do not take if you have autoimmune hepatitis or liver

sugar or diabetes, allergic reaction Other:

problems. Do not take with Copegus or Rebetol if you are pregnant, if you

flu-like symptoms, tiredness and weakness,

or your partner plan to become pregnant, or if you take Videx. Use with

stomach problems, loss of appetite, skin

caution if taking Tyzeka, Theo-24, Elixophyllin, Uniphyl, Theolair, methadone,

reactions, hair thinning, trouble sleeping

Azasan, or Imuran.

PEGINTRON

Generic name: peginterferon alfa-2b Maker: Merck Traditional dosage: 1.5 micrograms per kilogram of body weight, once weekly, by subcutaneous injection

32 |

july / august 2015

What it does: Treats chronic hepatitis C, alone or in combination with other

Side effects: Most serious: severe

drugs

eye, blood, liver, nerve, thyroid, or lung problems, pancreatitis, colitis, high blood

What to know: Use with caution with drugs metabolized by CYP2C8/9 or

sugar or diabetes, allergic reaction Other:

CYP2D6. Monitor for toxicities when used with NRTIs. Do not take if you

flu-like symptoms, tiredness, appetite

have autoimmune hepatitis or certain other liver problems.

problems, skin reactions, hair thinning

If you’re on HIV meds, Fulyzaq may help you...

Is diarrhea holding you back? If you are on HIV medications, Fulyzaq is a plant-based, FDA-approved prescription medication that may help manage your diarrhea.

Fulyzaq may help manage your diarrhea over time by making your bowel movements less frequent and loose. Fulyzaq works by normalizing the flow of water in your gut. Fulyzaq did not interfere with commonly used HIV medications, and did not affect CD4 count or viral load in a 4-week study.

It’s time to stop dealing with diarrhea and ‘Start the Conversation’ about Fulyzaq today.

Indication FULYZAQ ® (crofelemer) is an antidiarrheal indicated for the symptomatic relief of noninfectious diarrhea in adult patients with HIV/AIDS on antiretroviral therapy.

Important Safety Information about FULYZAQ FULYZAQ® (crofelemer) delayed-release tablets should not be used for the treatment of infectious diarrhea. It is important that your healthcare provider considers infectious causes of diarrhea before you start taking FULYZAQ. If infectious causes are not considered, and you begin taking FULYZAQ based on a probable diagnosis of noninfectious diarrhea, there is a risk that you will not receive the appropriate treatments, and your disease may worsen.

• FULYZAQ tablets should be swallowed whole. FULYZAQ tablets should not be crushed or chewed. You may take FULYZAQ with or without food. You should follow the instructions of your healthcare provider. • If you are pregnant, or planning to become pregnant, talk to your healthcare provider before taking FULYZAQ. The safety and effectiveness of FULYZAQ have not been established in people younger than 18 years of age. • In clinical studies, the most common adverse reactions associated with FULYZAQ – occurring in at least 3% of patients taking FULYZAQ – were upper respiratory tract infection, bronchitis (inflammation of the lining of the tubes which carry air to and from your lungs), cough, flatulence (intestinal gas passed through your rectum), and increased bilirubin (a waste product of the breakdown of red blood cells). • 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 following page for brief summary of Prescribing Information for FULYZAQ. Snap a picture of our logo and show your doctor to ‘Start the Conversation’

IMPORTANT PATIENT INFORMATION

Under 18 or Over 65 Years of Age?

The following is a brief summary only. See complete Prescribing Information at Fulyzaq.com or request complete Prescribing Information by calling 1-800-508-0024. This information does not take the place of talking with your doctor about your medical condition or your treatment.

• FULYZAQ has not been studied in children under 18 years of age

WHAT IS FULYZAQ?

Talk to your doctor to find out if FULYZAQ is right for you.

FULYZAQ is a prescription medication used to improve symptoms of noninfectious diarrhea (diarrhea not caused by a bacterial, viral, or parasitic infection) in adult patients with HIV/AIDS who take HIV medication.

• FULYZAQ studies did not contain a large number of patients over the age of 65; therefore, it is unclear if this age group will respond differently

HOW SHOULD I TAKE FULYZAQ? • FULYZAQ should be taken orally, by mouth 2 times per day • FULYZAQ tablets may be taken with or without food

WHO SHOULD NOT TAKE FULYZAQ?

• FULYZAQ tablets should not be crushed or chewed

• FULYZAQ should not be taken if you have diarrhea caused by an infection

• FULYZAQ tablets should be swallowed whole

• Your doctor and you should make sure your diarrhea is not caused by an infection (such as bacteria, virus, or parasite) before you start taking FULYZAQ

WHAT ARE THE POSSIBLE SIDE EFFECTS OF FULYZAQ? • Upper respiratory tract infection (nasal or sinus infection) • Bronchitis (inflammation of the lining of the tubes which carry air to and from your lungs) • Cough • Flatulence (intestinal gas passed through your rectum) • Increased bilirubin (a waste product of the breakdown of red blood cells) For a full list of side effects, please talk to your doctor.

Tell your doctor if you have any side effect that bothers you or does not go away.

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.

SHOULD I TAKE FULYZAQ IF I AM: Pregnant or Planning to Become Pregnant?

• Studies in animals show that FULYZAQ could cause harm to an unborn baby or affect the ability to become pregnant • There are no studies in pregnant women taking FULYZAQ

WHAT SHOULD I KNOW ABOUT TAKING FULYZAQ WITH OTHER MEDICATIONS? • If you are taking any prescription or over-the-counter (OTC) medications, or herbal supplements or vitamins, tell your doctor before starting FULYZAQ

WHAT IF I HAVE MORE QUESTIONS ABOUT FULYZAQ? • For more information, please see the full Prescribing Information at Fulyzaq.com or speak to your doctor or pharmacist To report side effects, a product complaint, or for additional information, call: 1-800-508-0024.

Rx Only Manufactured by Patheon, Inc. for Salix Pharmaceuticals, Inc. 8510 Colonnade Center Drive, Raleigh, NC 27615 www.salix.com Copyright © Salix Pharmaceuticals, Inc. US Patent Nos. 7,341,744 and 7,323,195.

FUL-RALAB49-062014 Fulyzaq is manufactured for Salix Pharmaceuticals, Inc. by Patheon, Inc. and distributed under license from Napo Pharmaceuticals, Inc. ©2014 Salix Pharmaceuticals, Inc. All rights reserved. Printed in USA. FUL50-0614

• This drug should only be used during pregnancy if clearly needed

A Nursing Mother?

• It is not known whether FULYZAQ is passed through human breast milk • If you are nursing, you should tell your doctor before starting FULYZAQ • Your doctor will help you to make a decision whether to stop nursing or to stop taking FULYZAQ

The botanical drug substance of FULYZAQ is extracted from Croton lechleri (the botanical raw material) that is harvested from the wild in South America.

RADIESSE

Generic name: calcium hydroxylapatite Maker: Merz Aesthetics

Traditional dosage: Varies; the drug is available in single-use vials with 0.3, 1, or 1.3 milliliters of calcium hydroxylapatite

What it does: Treats facial fat loss (lipoatrophy) and stimulates the body’s

Side effects: Most serious: prolonged

collagen production to combat HIV-related facial wasting

swelling, irritation, redness, swelling, itching, burning, or tenderness at the

What to know: Users of blood thinners or aspirin may have bleeding or

injection site may occur, but typically

bruising at the injection site. For 24 hours after treatment, avoid significant

resolve shortly after treatment

movement, massage, sun exposure, or makeup use.

suspended in a water-based gel. It is injected into the skin, and results can last up to a year

REBETOL

Generic name: ribivarin Maker: Schering, Merck Traditional dosage: 800-1,400 mg daily, based on patient’s weight, by capsule or oral solution, taken with food

What it does: In combination with Intron-A or PegIntron, treats chronic

Side effects: Most serious: severe eye,

hepatitis C infection

lung, or blood problems, pancreatitis, severe depression or suicidal thoughts,

What to know: Do not use if you take Videx or Videx EC. Do note take if

dental problems caused by dry mouth

you have autoimmune hepatitis, certain blood disorders, or severe kidney

Other: less serious mood changes, flu-like

disease. Do not take if you are pregnant or if you or your partner plan to

symptoms, headache, fever, stiffness,

become pregnant. Use caution when taking with NRTIs such as Combivir,

anorexia

Epivir, Epzicom, Retrovir, or Trizivir.

RIFADIN, RIFADIN IV Generic name: rifampin Maker: Sanoifi-Aventis

Traditional dosage: 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

What it does: Helps prevent or treat infections caused by a certain type of

Side effects: Most serious: gastrointestinal

bacterium, including the one that causes tuberculosis

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

What to know: Do not take if taking Reyataz, Prezista, Lexiva,

irregularities, jaundice, darkened urine

Fortovase, Invirase, or Aptivus. Dosage of anticoagulant drugs should be

Other: loss of appetite, fever, joint pain

adjusted. Use with caution if you have diabetes. Switch to nonhormonal contraceptives.

should be one hour before or two hours after a meal with water

ROFERON-A

Generic name: interferon alfa-2 Maker: Roche Traditional dosage: 3 million IUs per square meter of body

What it does: Treats chronic hepatitis C What to know: Use caution if taken with Retrovir and similar anti-HIV

vision problems, fever, bleeding or

drugs; theophylline, marketed under various names to treat breathing

bruising Other: flu-like symptoms, sleep

problems; or Tyzeka.

disturbances, headache, thyroid problems, fatigue

surface, subcutaneously or intramuscularly, three times a week

SCULPTRA

Generic name: injectable poly-L-lactic acid Maker: Dermik Laboratories Traditional dosage: Amount and frequency varies by patient;

Side effects: Most serious: depression, suicidal behavior, pain, breathing and

What it does: Helps restore or correct signs of facial fat loss (lipoatrophy)

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

What to know: 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.

THINKSTOCK

delivered by subcutaneous injection

hivplusmag.com

| 35

SEROSTIM

Generic name: somatropin Maker: EMD Serono Traditional dosage: 0.1 mg per kilogram of body weight daily

What it does: Treats wasting (HIV-related weight loss) What to know: Do not use if you have acute critical illness following open

of diabetes medications for patients with

heart or abdominal surgery, multiple accidental trauma, or acute respiratory

this disorder; musculoskeletal discomfort;

failure. Do not use if you have neoplasia.

carpal tunnel syndrome; swelling of the hands and feet

(up to 6 mg), injected subcutaneously at bedtime

SOVALDI

Generic name: sofosbuvir Maker: Gilead Traditional dosage: One 400-mg tablet, once daily, in combination with ribivarin (marketed under brand names

Side effects: Most serious: glucose intolerance, which may require adjustment

What it does: Treats chronic hepatitis C infection

Side effects: Most serious: fetal damage Other: fatigue, headache, nausea, insomnia,

What to know: Do not take if you or partner are pregnant or plan to be, as

anemia

birth defects or fetal death can result. Do not take with Aptivus, Tegretol, Dilantin, Tileptal, Mycobutin, Rifadin, Priftin, Saint-John’s-wort, or drugs containing phenobarbital.

Copegus, Rebetol, and others); with some types of hep C virus, peginterferon alfa (PegIntron or Pegasys) should be used

SPORANOX

Generic name: itraconazole Maker: Janssen Traditional dosage: 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

TAXOL

Generic name: paclitaxel Maker: Bristol-Myers Squibb (name brand); Teva Parenteral Medicines (generic)

Traditional dosage: 135 mg per square meter of body surface,

What it does: Treats fungal infections such as oral candidiasis, also known

Side effects: Most serious: liver failure,

as thrush

neuropathy, hearing loss Other: nausea, diarrhea, vomiting, fever, respiratory

What to know: Do not take if taking D.H.E. 45, Migranal, Germinal,

disorders, rash, headache

Hydergine, Ergotrate, Bellergal-S, Cafergot, Ergomar, Wigraine, Methergine, Sansert, Altocor, Altoprev, Mevacor, Zocor, Halcion, methadone or felodipine. Use caution if you have heart, lung, or kidney disease or take protease inhibitors. Do not take capsules if you have heart failure.

What it does: Provides second-line treatment for Kaposi’s sarcoma

Side effects: Most serious: bone marrow disorders Other: tiredness, weakness,

What to know: Use caution when taking with Versed, Buspar, Vansar,

shortness of breath, nausea, vomiting,

Plendil, Altocor, Altoprev, Mevacor, Zocor, Relpax, Revatio, Viagra, Halcion,

diarrhea, unusual bleeding or bruising, joint

Reyataz, Biaxin, Crixivan, Sporanox, Feoris, Nizoral, Serzone, Viracept,

pain or numbness, hair loss

Norvir, and several other drugs. (See HIVPlusMag.com for others.)

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

TESTIM

Generic name: Testosterone gel Maker: Endo Pharmaceuticals Traditional dosage: 50 mg in premeasured tube, applied to upper arms and shoulders, once daily

What it does: Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50

What to know: Apply at same time every day, after bathing or showering,

prostate cancer, lowered sperm count,

to clean, dry skin. Wash hands immediately after applying. Cover the

enlarged or painful breasts, sleep apnea,

application area with clothing after the gel dries. Avoid letting others,

blood clots in legs or lungs, swelling of

especially women and children, have skin-to-skin contact with application

ankles, feet, or body Other: Skin irritation

area; if they do, they should wash the contact area right away. Tell your

at application site, increased red blood

health care provider about all your health conditions, especially if you have

cell count

breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Also tell your provider what other medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

36 |

july / august 2015

Side effects: Most serious: Enlarged prostate, possible increased risk of

TYZEKA

Generic name: telbivudine Maker: Idenix/Novartis Traditional dosage: One 600-mg tablet, once daily, or 30

What it does: Treats hepatitis B What to know: Do not take Pegasys. If using oral solution, close bottle and

muscle pain or weakness, nerve problems,

clean dosing cup immediately after dosing, keep cup dry between uses, and

flare-up of hepatitis B after discontinuation

do not use for anything else.

Other: diarrhea, abdominal pain or swelling, cough, headache, dizziness, sore

milliliters of oral solution for patients who have difficulty

throat, fever

swallowing tablets

VALCYTE

Generic name: valganciclovir Maker: Genentech Traditional dosage: Two 450 mg tablets, twice daily, for 21 days,

Side effects: Most serious: buildup of lactic acid in body, severe liver problems,

What it does: Treats the eye infection cytomegalovirus retinitis

Side effects: Most serious: anemia, fertility impairment, fetal abnormalities, kidney

What to know: Use with caution if also taking Retrovir, Benemid, CellCept,

failure Other: diarrhea, vomiting, fever,

Myfortic, or Videx. Since Valcyte can cause seizures, do not drive until you

tremors, and seizures

know how the medication affects you.

then two tablets once daily

VFEND

Generic name: voriconazole Maker: Pfizer Traditional dosage: For esophageal candidiasis, 200 mg in tablets or oral solution, every 12 hours, at least an hour before or

What it does: Treats fungal infections, such as esophageal candidiasis

Side effects: Most serious: severe liver problems, heart arrhythmias, visual

What to know: Do not use with Atripla or high-dose Norvir; use with

disturbances Other: fever, nausea, rash,

caution with low-dose Norvir. Do not use with Saint-John’s-wort, ergot

vomiting, chills, headache

alkaloids, terfenadine, astemizole, cisapride, pimozide, quinidine, or rifabutin. Use with caution in patients with heart arrhythmias.

after a meal. For other fungal infections, treatment starts with an intravenous infusion of 6 mg per kilogram of weight every 12 hours for the first 24 hours, followed by a maintenance dose of either 4 mg per kilogram of weight every 12 hours or 200 mg in tablets or oral solution every 12 hours. Duration of treatment varies according to the infection

VISTIDE

Generic name: cidofovir Maker: Gilead Traditional dosage: Delivered by intravenous infusion, the initial dose depends on the patient’s weight, gender, and kidney function, with the latter measured by a test that determines how well the kidneys clear creatinine from the blood. Maintenance

What it does: Treats CMV retinitis

Side effects: Most serious: kidney toxicity, decreased interocular pressure

What to know: The antigout drug probenecid (brand name Benemid or

Other: nausea, vomiting, fever

Probalan) should be taken orally with each Vistide treatment. Retrovir should be temporarily discontinued or the dosage halved on the day of each Vistide infusion. Do not use with any drugs that have the potential to cause kidney toxicity. Do not take if you have high creatinine levels, as measured by creatinine clearance test.

dose is 5 mg per kilogram of body weight, by infusion, once

THINKSTOCK

every two weeks

Continued on page 47 hivplusmag.com

| 37

Use of complementary or alternative medicine used in conjunction with antiretrovirals has proved popular with those who have HIV, with studies showing 70 percent have tried it at some point. Here’s a look at what works and what can cause more harm than good. By Jacob Anderson-Minshall

PROBIOTICS

ALGAE

SELENIUM

SAINT-JOHN’SWORT

A study conducted by the National Institutes of Health showed this herb has negative interactions with both protease inhibitors and nonnucleoside reverse transcriptase inhibitors. The Food and Drug Administration also recommends that Saint-John’swort not be combined with any type of antiretroviral medication.

38 |

july / august 2015

A deficiency in zinc occurs in over half of HIV-positive adults, and studies indicate that zinc delays immunological failure and decreases a nasty side effect, diarrhea.

Supplements You Should Consider

A study in Journal of Acquired Immune Deficiency Syndromes found that blue-green algae (also known as spirulina) inhibited HIV replication.

Some studies suggest that HIV needs selenium in order to reproduce. Add that to the fact that most of us get more than enough selenium in our food and there’s no reason to take this supplement.

ZINC

Three of the top four side effects of HIV meds are gastrointestinal, such as chronic diarrhea. That’s because the gut is a major spot for HIV replication, which then diminishes immune cells. But probiotics—essentially live bacteria and yeasts—do more for a good gut than anything else, reducing inflammation and improving CD4-cell counts.

MULTIVITAMINS

One study found that multivitamins reduced HIV-positive women’s risk of death by 30 percent.

COLLOIDAL SILVER

The FDA doesn’t consider it to be safe.

Among its many side effects is argyria, an irreversible bluish discoloration of the skin.

Things You Should Avoid

SUTHERLANDIA

Many traditional healers in southern and western Africa give people with HIV Sutherlandia, derived from a native bush, to treat HIV, but studies have shown it puts users at risk of treatment failure, viral resistance, or drug toxicity.

MANGANESE

Studies from over a decade ago showed that increasing manganese in cells can decrease HIV’s ability to replicate, but since then there’s been little further research and no evidence that dietary manganese has any effect on HIV.

VITAMIN D

Up to 75 percent of the general population is deficient in vitamin D. For people with HIV, vitamin D reduces the risk of osteoporosis, produces proteins that help fight bacteria, reduces inflammation, improves muscle strength, and improves blood sugar control, reducing the risk of diabetes, according to numerous studies.

TRANSCENDENTAL MEDITATION

Over 340 studies on the benefits of TM have shown it reduces stress, anxiety, depression, anger, PTSD symptoms, high blood pressure, and more. When used in conjunction with HIV antiretroviral medication, studies indicate that TM decreases HIV-related physical problems by 51 percent and increases vitality by 43 percent. (That’s one reason why the David Lynch Foundation last year announced a new initiative to teach TM to 10,000 people living with HIV across the nation.

TAI CHI

ACUPUNCTURE

It reduces symptoms of HIV and side effects of medications, including fatigue, pain, headache, forgetfulness, and nausea.

Complementary Therapies That Work

Studies indicate that practitioners see significant improvements in quality of life, HIVrelated psychological distress, and coping skills.

YOGA

MASSAGE

Mayo Clinic says it lowers anxiety, pain, and blood pressure; releases endorphins, improves circulation, and boosts overall immunity.

Numerous studies have shown it has a positive physiological effect and helps alleviate symptoms of HIV or medication side effects.

TRADITIONAL CHINESE MEDICINE

AYURVEDIC MEDICINE

This traditional system of healing arts originated in India and involves using preparations of spices, herbs, vitamins, proteins, minerals, and metals. Unfortunately, Ayurvedic products are generally not reviewed or approved by the Food and Drug Administration. There’s also little or no research into how these preparations interact with HIV meds.

REIKI

THINKSTOCK

According to the National Institutes of Health, the few studies that have been done on this therapy that purports to move the body’s energies to improve health has been poorly structured and failed to show any positive health outcome.

Bottom line: “Reiki hasn’t been clearly shown to be useful for any health-related purpose.”

Few studies on the effectiveness of using these herbal remedies to treat HIV have been published by peer-reviewed medical journals. One published in 2014, concluded they “could increase survival and lengthen the life span of people living with HIV,” but with too many unknowns about the interactions between herbal medications and HIV drugs, “could” help isn’t worth the risk.

JUICING

Those That Haven’t Been Proven

HOMEOPATHY

Some poz folks rely on liquid diets because they have difficulty chewing or digesting whole foods.

There’s no scientific evidence that juice cleanses and liquid-only “detox” diets that offer quick weight loss or claim to flush out toxins actually work.

But they can be downright dangerous for those with HIV because they don’t provide enough protein and other nutrients to maintain health.

Homeopathic remedies are prepared from diluted extracts of animal, plant, and mineral substances. Several clinical trials in Europe suggest that they shouldn’t be dangerous. But there are no studies on using homeopathy to treat HIV.

hivplusmag.com

| 39

HOW ARE YOU GOING TO AFFORD THIS?

HIV meds are often expensive, but if you don’t have private insurance or a low enough income to qualify for Medicaid, there are other programs that can help you pay.

Also, if you are insured but have a high co-pay, help is available for that as well.

The Affordable Care Act, a.k.a.

Obamacare, requires insurers to provide prescription drug coverage, whether it’s a policy you buy through the ACA marketplace or (in most cases) another plan, such as insurance provided by your employer. They also must cover at least one drug in every class and count your out-of-pocket drug costs—usually meaning co-pays—toward your lifetime cap on out-of-pocket expenses. The ACA marketplace has made coverage available to millions of previously uninsured Americans, as has Medicaid expansion, enacted through the ACA and a related bill. Find more information at Healthcare.gov.

Also, the federally created, statemanaged AIDS Drug Assistance Program (ADAP) can help uninsured or underinsured people pay for their HIV medications.

The requirements vary by state, but typically you have to be a resident, have HIV, and earn less than a certain amount per year, calculated as a percentage of the federal poverty level.

Following is a guide to ADAP income requirements and contact information. Each state’s Maximum Qualifying Income (MQI) to be in ADAP is shown as a percentage of the federal poverty level as well as the dollar amount for a one-person household (for 2015, in the 48 contiguous states the federal poverty level for one person is $11,770; add $4,160 per family member).

40 |

july / august 2015

FLORIDA Website: floridaADAP.org Phone: (800) 352-2437 MQI: 400% or $47,080

LOUISIANA Website: hiv.dhh.louisiana.gov Phone: (504) 568-7474 MQI: 300% or $35,310

ALASKA Website: bit.ly/ALASKAadap (907) 452-4222 MQI: 300% or $44,160

GEORGIA Website: bit.ly/GEORGIAadap Phone: (404) 657-3100 MQI: 300% or $35,310

MAINE Website: bit.ly/MEadap Phone: (207) 287-3747 MQI: $55,850, add $3,960 per dependent

ARIZONA Website: bit.ly/ARIZadap Phone: (800) 334-1540 MQI: 300% or $35,310

HAWAII Website: bit.ly/adapHawaii Phone: (808) 586-4400 MQI: 400% or $54,200

MARYLAND Website: bit.ly/MDadap Phone: (800) 205-6308 MQI: 500% or $58,850

ARKANSAS Website: bit.ly/ARadap Phone: (501) 661-2408 MQI: 200% or $23,540

IDAHO Website: safesex.idaho.gov Phone: (208) 334-6527 MQI: 200% or $23,540

MASSACHUSETTS Website: bit.ly/MAadap Phone: (800) 228-2714 MQI: 500% or $58,850

CALIFORNIA Website: bit.ly/CAadap Phone: (916) 449-5900 MQI: less than $50,000

ILLINOIS Website: bit.ly/ILLadap Phone: (217) 782-4977 MQI: 300% or $35,310

MICHIGAN Website: michigan.gov/dap Phone: (888) 826-6565 MQI: 450% or $52,965

COLORADO Website: bit.ly/COadap Phone: (303) 692-2716 MQI: 400% or $47,080

INDIANA Website: bit.ly/indianaADAP Phone: (866) 588-4948 MQI: 300% or $35,210

MINNESOTA Website: bit.ly/minnesotaADAP Phone: (800) 657-3761 MQI: 300% or $35,310

CONNECTICUT Website: bit.ly/CTadap Phone: (800) 233-2503 MQI: 400% or $47,080

IOWA Website: bit.ly/iowaADAP Phone: (515) 281-0926 MQI: 200% or $23,540

MISSISSIPPI Website: bit.ly/mississippiADAP Phone: (601) 362-4850 MQI: 400% or $47,080

DELAWARE Website: bit.ly/DEadap Phone: (302) 744-1050 MQI: 500% or $58,350

KANSAS Website: bit.ly/KANadap Phone: (785) 368-8218 MQI: 300% or $35,310

MISSOURI Website: bit.ly/missouriADAP Phone: (866) 628-9891 MQI: 300% or $35,310

DISTRICT OF COLUMBIA Website: bit.ly/DCadap Phone: (202) 671-4900 MQI: 500% or $58,850

KENTUCKY Website: bit.ly/kentuckyADAP Phone: (866) 510-0005 MQI: 300% or $35,310

MONTANA Website: bit.ly/montanaADAP Phone: (406) 444-4744 MQI: 330% or $38,841

THINKSTOCK

ALABAMA Website: adph.org/aids Phone: (334) 206-5364 MQI: 250% or $29,425

hivplusmag.com

| 41

NEBRASKA Website: bit.ly/NEadap Phone: (402) 559-4673 MQI: 200% or $23,540

OHIO Website: bit.ly/OHadap Phone: (800) 777-4775 MQI: 300% or $35,310

TEXAS Website: bit.ly/texasADAP Phone: (800) 255-1090 MQI: 200% or $23,540

NEVADA Website: bit.ly/nevadaADAP Phone: (775) 684-4247 MQI: 400% or $47,080

OKLAHOMA Website: bit.ly/OKADAP Phone: (405) 271-4636 MQI: 200% or $23,540

UTAH Website: bit.ly/utahADAP Phone: (801) 538-6197 MQI: 250% or $29,425

NEW HAMPSHIRE Website: bit.ly/NHadap Phone: (603) 271-4502 MQI: 300% or $35,310

OREGON Website: bit.ly/oregonADAP Phone: (800) 805-2313 MQI: 400% or $47,080

VERMONT Website: bit.ly/vermontADAP Phone: (802) 863-7245 MQI: 500% or $58,850

NEW JERSEY Website: bit.ly/newjerseyADAP Phone: (877) 613-4533 MQI: 500% or $58,850

PENNSYLVANIA Website: bit.ly/PennADAP Phone: (800) 922-9384 MQI: 500% or $58,850

VIRGINIA Website: bit.ly/virginiaADAP Phone: (855) 362-0658 MQI: 400% or $47,080

NEW MEXICO Website: nmhivguide.org Phone: (505) 827-2435 MQI: 400% or $47,080

RHODE ISLAND Website: bit.ly/RhodeIslandADAP Phone: (401) 462-3294 MQI: 400% or $47,080

WASHINGTON Website: bit.ly/WAadap Phone: (360) 236-3426 MQI: 400% or $47,080

NEW YORK Website: bit.ly/adapNewYork Phone: (800) 542-2437 MQI: 435% or $51,199

SOUTH CAROLINA Website: bit.ly/SCadap Phone: (800) 569-9954 MQI: 300% or $35,310

WEST VIRGINIA Website: bit.ly/WestVAADAP Phone: (304) 558-2195 MQI: 400% or $47,080

NORTH CAROLINA Website: bit.ly/adapNCar Phone: (877) 466-2232 MQI: 300% or $35,310

SOUTH DAKOTA Website: bit.ly/SDakADAP Phone: (605) 773-3737 MQI: 300% or $35,310

WISCONSIN Website: bit.ly/WIadap Phone: (800) 991-5532 MQI: 300% or $35,310

NORTH DAKOTA Website: ndhealth.gov/HIV Phone: (800) 472-2180 MQI: 300% or $35,310

TENNESSEE Website: bit.ly/TNadap Phone: (615) 532-2392 MQI: 300% or $35,310

WYOMING Website: bit.ly/WYadap Phone: (307) 777-5856 MQI: $40,150-$45,100, depending on county

ADAP also covers Puerto Rico, Guam, the Virgin Islands, and Pacific Island Territories.

Visit bit.ly/HHSadap for more information.

42 |

july / august 2015

PHARMACEUTICAL COMPANIES’ PATIENT ASSISTANCE PROGRAMS Major pharmaceutical companies have patient assistance programs, which can help with prescription costs, including co-pays. Find the maker of your specific medication and contact it directly.

Abbott, AbbVie www.abbviepaf.org (800) 222-6885

Bristol-Myers Squibb www.bmspaf.org (800) 736-0003

Boehringer Ingelheim us.boehringer-ingelheim.com (800) 556-8317

Genentech (includes Hoffman-LaRoche) www.genentech-access.com/patients (866) 422-2377

Gilead www.gilead.com (800) 226-2056

GlaxoSmithKline www.gskforyou.com

Janssen www.janssenprescriptionassistance.com

Merck www.merckhelps.com

ViiV

THINKSTOCK

www.viivhealthcareforyou.com

hivplusmag.com

| 43

Hey Vacation! ou.

I’m so ready for y

ns. So I V treatment optio ore about my HI m ow kn to rt of my HIV ed pa I want ENTRES S as and we chose IS or ct do y m th spoke wi HIV and may it could fight my e m ld to or ct do regimen. My d lifest yle. fit my needs an r next time. aking plans fo I’m already m

HIV Positive Model

ISENTRESS® (raltegravir) has been shown to have a low rate of side effects.

In a long-term clinical study lasting more than 4 years (240 weeks) of patients being treated with HIV medicine for the first time, it was found that: The side effects of ISENTRESS plus Truvada that interfered with the daily activities of 2% or more of those who participated in the study were: – Trouble sleeping (4% of participants)

– Dizziness (2% of participants)

– Headache (4% of participants)

– Tiredness (2% of participants)

– Nausea (3% of participants) INDICATION ISENTRESS is a prescription HIV-1 medicine used with other antiretroviral medicines to treat human immunodeficiency virus (HIV-1) infection in people 4 weeks of age and older. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

It is not known if ISENTRESS is safe and effective in babies under 4 weeks of age.

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-1 infection or AIDS. You must stay on continuous HIV therapy to control HIV-1 infection and decrease HIV-related illnesses.

IMPORTANT RISK INFORMATION Some people who take ISENTRESS develop serious skin reactions and allergic reactions that can be severe, and may be life-threatening or lead to death. If you develop a rash with any of the following symptoms, stop using ISENTRESS and call 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, such

as your liver. Call your doctor right away if you have any of the following signs or symptoms of liver problems: yellowing of your skin or whites of your eyes, dark or tea-colored urine, pale-colored stools (bowel movements), nausea or vomiting, loss of appetite, pain, aching or tenderness on the right side of your stomach area.

Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 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-1 medicine.

you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. These may be signs of a rare serious muscle problem that can lead to kidney problems.

These are not all the possible side effects of ISENTRESS. For more information, ask your doctor or pharmacists. Tell your doctor if you have any side effect that bothers you or that does not go away.

People taking ISENTRESS may still develop infections or other conditions associated with HIV infections.

Tell your doctor about all your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed.

ISENTRESS is not recommended for use during pregnancy. Do not breastfeed if you take ISENTRESS. Women with HIV should not breastfeed because their babies could be infected with HIV through their breast milk.

The most common side effects of ISENTRESS include: trouble sleeping, headache, dizziness, nausea, and tiredness. Less common side effects include: depression, hepatitis, genital herpes, herpes zoster including shingles, kidney failure, kidney stones, indigestion or stomach area pain, vomiting, suicidal thoughts and actions, and weakness.

Tell your doctor about all the medicines you take, including, prescription and over-thecounter medicines, vitamins, and herbal supplements.

Some medicines interact with ISENTRESS. Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take ISENTRESS with those other medicines.

Tell your doctor before you take ISENTRESS if you have a history of a muscle disorder called rhabdomyolysis or myopathy or increased levels of creatine kinase in your blood.

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

Tell your doctor right away if

Please read the adjacent Patient Information for ISENTRESS and discuss it with your doctor.

Having trouble paying for your Merck medicine?

Merck may be able to help. www.merckhelps.com

Talk to your healthcare professional about ISENTRESS and visit isentress.com.

Brands mentioned are the trademarks of their respective owners.

Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. INFC-1141322-0000 03/15

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) film-coated 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 antiretroviral medicines to treat Human Immunodeficiency Virus (HIV-1) infection in people 4 weeks of age and older. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

It is not known if ISENTRESS is safe and effective in babies under 4 weeks of age.

When used with other HIV medicines to treat HIV-1 infection, ISENTRESS may help: • reduce the amount of HIV in your blood. This is called “ viral load”.

• increase the number of white blood cells called CD4+ (T) cells in your blood, which help fight off other infections.

• reduce the amount of HIV-1 and increase the CD4+ (T) cells in your blood, which may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak (opportunistic infections).

ISENTRESS does not cure HIV-1 infection or AIDS. You must stay on continuous HIV therapy to control HIV-1 infection and decrease HIV-related illnesses.

Avoid doing things that can spread HIV-1 infection to others: • Do not share needles or re-use 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 any body fluids such as 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 a history of a muscle disorder called rhabdomyolysis or myopathy • have increased levels of creatine kinase in your blood • 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: There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your doctor about how you can take part in this registry.

• are breastfeeding or plan to breastfeed. Do not breastfeed if you take ISENTRESS. ° You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 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 overthe-counter medicines, vitamins, and herbal supplements. Some medicines interact with ISENTRESS. Keep a list of your medicines to show your doctor and pharmacist.

• You can ask your doctor or pharmacist for a list of medicines that interact with ISENTRESS. • Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take ISENTRESS with other medicines.

How should I take ISENTRESS? • Take ISENTRESS exactly as prescribed by your doctor.

• Do not change your dose of ISENTRESS or stop your treatment without talking with your doctor first.

• Stay under the care of your doctor while taking ISENTRESS. • ISENTRESS film-coated tablets must be swallowed whole.

• ISENTRESS chewable tablets may be chewed or swallowed whole.

• ISENTRESS for oral suspension should be given to your child within 30 minutes of mixing. See the detailed Instructions for Use that comes with ISENTRESS for oral suspension, for information about the correct way to mix and give a dose of ISENTRESS for oral suspension. If you have questions about how to mix or give ISENTRESS for oral suspension, talk to your doctor or pharmacist.

• Do not switch between the film-coated tablet, the chewable tablet, or the oral suspension without talking with your doctor first.

• Do not run out of ISENTRESS. Get a refill of your ISENTRESS from your doctor or pharmacy before you run out.

• 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 ISENTRESS than prescribed.

• If you take too much ISENTRESS, call your doctor or go to the nearest hospital emergency room right away.

What are the possible side effects of ISENTRESS? ISENTRESS can cause serious side effects including: • Serious skin reactions and allergic reactions. Some people who take ISENTRESS develop serious skin reactions and allergic reactions that can be severe, and may be life-threatening or lead to death. 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, such as your liver. Call your doctor right away if you have any of the following signs or symptoms of liver problems: ° yellowing of the skin or whites of your eyes ° dark or tea colored urine ° pale colored stools (bowel movements) ° nausea or vomiting ° loss of appetite ° pain, aching, or tenderness on the right side of your stomach area • Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 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-1 medicine.

The most common side effects of ISENTRESS include: • trouble sleeping • nausea • headache • tiredness • dizziness Less common side effects include: • depression • kidney stones • hepatitis • indigestion or stomach area pain • genital herpes • vomiting • herpes zoster • suicidal thoughts and actions including shingles • weakness • kidney failure Tell your doctor right away if you get unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. These may be signs of a rare serious muscle problem that can lead to kidney problems.

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).

Keep ISENTRESS and all medicines out of the reach of children.

General information about ISENTRESS Medicines are sometimes prescribed for purposes other than those listed in a Patient Information Leaflet. 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.

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: calcium phosphate dibasic anhydrous, hypromellose 2208, lactose monohydrate, magnesium stearate, microcrystalline cellulose, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate.

The film coating contains: black iron oxide, polyethylene glycol 3350, polyvinyl alcohol, red iron oxide, talc and titanium dioxide.

This Patient Information has been approved by the U.S. Food and Drug Administration.

usppi-mk0518-mf-1502r026 Issued: 02/2015 Copyright © 2007, 2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

INFC-1141322-0000 03/15

Continued from page 37

VIEKIRA PAK

Generic name: ombitasvir, paritaprevir, and ritonavir tablets packaged with dasabuvir tablets

Maker: AbbVie Traditional dosage: Two ombitasvir, paritaprevir, ritonavir 12.5/75/50-mg tablets once daily (in the morning) and one dasabuvir 250 mg tablet twice daily (morning and evening) with a meal without regard to fat or calorie content, for 12 weeks. For patients with HCV genotype 1a and cirrhosis, ribivarin should be added.

What it does: Treats chronic hepatitis C infection

Side effects: With ribavirin: tiredness, nausea, itching, skin reactions such as

What to know: Do not take with Uroxatral, Carbatrol, Epitol, Equetro,

redness or rash, sleep problems, feeling

Tegretol, Sustiva, Atripla, Cafergot, Migergot, Ergomar, Ergostat, Medihaler,

weak Without ribavirin: nausea, itching,

Wigraine, Wigrettes, D.H.E. 45, Migranal, Ergotrate, Methergine, ethinyl

sleep problems

estradiol-containing medicines, Lopid, Advicor, Altoprev, Mevacor, oral midazolam, Dilantin, Phenytek, Luminal, Orap, Zocor, Vytorin, Simcor, SaintJohn’s-wort or a product that contains it, Halcion, Rifadin, Rifamate, Rifater, Rimactane, or Revatio when taken for pulmonary artery hypertension. Do not take if you have severe liver problems or have had a severe skin rash after taking ritonavir (Norvir). Use with caution if you have any liver problem other than hep C, if you have had a liver transplant and take the medicines Prograf, Gengraf, Neoral, or Sandimmune, or if you are pregnant or plan to become pregnant or if you are breast-feeding or plan to breast-feed.

ZITHROMAX

Generic name: azithromycin Maker: Pfizer (Zithromax); various others (generic) Traditional dosage: For treatment of Mycobacterium avium complex, one 600-mg tablet daily, with 15 mg of Myambutol;

What it does: Treats and helps prevent Mycobacterium avium complex

Side effects: Most serious: irregular heart activity, in rare cases fatal; liver enzyme

What to know: When this drug is used with Viracept, which can increase

abnormalities and other liver problems,

concentrations of Zithromax, the patient should be monitored closely for

severe diarrhea, hearing impairment

known side effects of Zithromax, such as liver enzyme abnormalities and

Other: nausea, vomiting, mild to moderate

hearing impairment.

diarrhea, abdominal pain

for prevention, two 600-mg tablets, once weekly, which may be combined with Mycobutin

ZOVIRAX

Generic name: acyclovir Maker: GlaxoSmithKline Traditional dosage: Dosage varies depending on type of infection; available in capsules, tablets, oral suspension, topical cream, and as intravenous injectable

What it does: Treats and controls herpes viral infections, like shingles,

Side effects: Most serious: severe allergic

genital warts, and chicken pox

reaction, blood and liver disorders, hepatitis, peripheral edema (blood clotting

What to know: Use with caution with Retrovir, antifungal agents, Benemid,

leading to swelling of the legs or arms),

interferon, intrathecal methotrexate, and drugs that can cause kidney

gastrointestinal upset, nausea, alopecia

toxicity. Drink plenty of fluids while taking the drug.

(hair loss), jaundice, seizures, confusion, hallucination Other: headache, visual impairment, tremors, rash or stinging skin

THINKSTOCK

with topical ointment

hivplusmag.com

| 47

The Chopping Block From Queer Eye to Chopped, Ted Allen is our go-to foodie, but he’s also a huge HIV activist

By Raffy Ermac

Ted Allen, who rose to fame on Queer Eye for the Straight Guy and is now a Food Network star, has two passions in life. The first and, of course, most obvious is food. With career highlights including being a regular culinary contributor for Esquire magazine, judging on Top Chef, hosting the extremely popular reality cooking competition Chopped, and helping straight guys with all of their food and wine needs on Queer Eye for the Straight Guy, it’s a no-brainer to conclude that Allen has had a love for all things food for a long time.

His second passion, though, is not as obvious or well-known to many, and it isn’t until you learn about his track record of supporting a variety of charitable organizations that it starts to make itself clear.

He loves to help people, especially those with HIV. The combination of these two passions led Allen to become (for the seventh year in a row) a spokesman for Dining Out for Life, the annual springtime event that encourages people nationwide to eat at over 3,000 participating restaurants with the purpose of raising money and awareness for HIV organizations around the country.

We caught up with Allen right before Dining Out for Life this spring, and he talked about his role in increasing LGBT visibility in television, what he would do if he was ever a contestant on Chopped, and the continuing importance of HIV awareness.

Let’s talk about Dining Out for Life. You’ve been a spokesman for seven years now. Why is this so important to you?

I try to help Dining Out for Life get the word out. I love working with this organization because it’s just such a cool, very low overhead operation that raises more than $4 million for American HIV and AIDS service organizations in a single day. Four million bucks in one day—60 cities, more than 3,000 restaurants. It also helps restaurants and chefs get new people coming in to try what they’re doing.

It just seems like such a win-win-win for everybody.

Do you remember the first time HIV impacted you?

By the time I came out, HIV was already widely known in the culture. I have some friends who are positive. One I’m thinking of in particular became positive in the ’80s and has devoted his life to a career of raising funds to fight HIV and AIDS. He’s still kickin’ and he’s in great shape. The people we’re trying to reach now are the people who weren’t there when the epidemic first happened.

We’re in a time now where we have preventative medicine, we have good treatment for AIDS and HIV, and the generation now has only known that world.

But that doesn’t mean that the AIDS crisis is over. Unfortunately, it’s not. Those drugs are expensive; they have side effects. There are lots and lots of reasons to continue trying to avoid being infected.

We’re not just talking about gay white people either. This virus impacts all walks of life these days, so unfortunately, we still need to bring awareness to it.

48 |

july / august 2015

We eat really well once a year during Dining Out for Life, and a ton of money is raised for HIV on that day, but how do you think that passion people have for raising awareness and money can be sustained all year long?

I’d like to hope that when people who are new to this movement go to that restaurant on April 30 and make their contribution, there are going to be people who are ready to talk to them about what they could do to continue the fight. There are lots of organizations that operate year-round, and Dining Out for Life is doing more to join that effort.

Everything has to start somewhere. If this is somebody’s first introduction to the information that this is still a problem, then that’s an accomplishment. We all have to make our own decisions about what to do after that meal is over, but hopefully it will inspire people.

There is a lot of talk of PrEP. What is your take?

I think something that will keep a person from becoming infected sounds like a great idea to me. I wish we had had that in 1983. I think it’s a great leap forward to have that available to people.

Why do you think it’s so important for HIV-negative people to raise awareness and money for people with HIV? Because that’s how you prevent other people from becoming HIV-positive. The people who do have HIV or AIDS are still misunderstood by the population in general and still need help and still need to be respected and included. It doesn’t mean that everybody has to drop everything they’re doing and become an activist. When you have children, when you are in the Marine Corps, when you’re an accountant, you’ve already committed yourself to a lot of hours doing something else, but I think it’s good for all of us to keep the awareness up and try to prevent other people from having this health calamity. Yes, PrEP is there, yes, there are great therapies for people with AIDS, but that doesn’t mean that isn’t still a serious thing.

What are little things that people can do to raise awareness?

Most cities have an AIDS Walk. This is another simple way people can raise funds and do something healthy, do something civic, do something with other people in the community that you didn’t know before, and raise awareness about something important. Dining Out for Life is just one of many ways that can be done. It’s a particularly good fit for me because it not only benefits the gay community and the HIV community, but it benefits chefs and restaurateurs, which are some of my very favorite people in the world.

Tell me about your first HIV test.

My partner, Barry, and I would go to Howard Brown Health Center, which was created in response to the epidemic back in the day

and still provides service to thousands of people. I’m proactive about health in every area. I’m not one of those men who refuses to go to the doctor or refuses to get tested. Any disease is better treated if you catch it early, and that is certainly true of HIV. It’s very important to know your status, in my opinion. I can’t imagine not.

You’re one of the most visible gay personalities Food Network has ever had. How does it feel knowing that you could be paving the way for other aspiring gay foodies?

It feels great. I don’t pretend to be an important person. Queer Eye gave me this freedom to be out and very publicly out. Food Network is a very inclusive employer. There are lots of LGBT people in prominent positions at the network, and it’s really important to them. It was President Clinton who I first heard say that we can’t afford to overlook anybody’s talent. We need all we can get.

Back when we were making Queer Eye, we got hundreds and hundreds and hundreds of letters from gay kids who said, “Thank you for being out and gay and on the television in my living room.

My parents like you…” I just read an interview that somebody did with me where they described Queer Eye as a Trojan horse. We were ostensibly a makeover show and we were ostensibly playing off the stereotypical tension between gay guys and straight guys, but what we were really doing was being out in people’s living rooms and being funny enough that people liked us. It was one of several shows that started getting people accustomed to gay people, one of many shows that’s helping this culture wake up to the fact that gays are your brothers and your kids and your cousins. We’re not trying to hurt anybody; we just want to be treated fairly.

What’s it like knowing the impact Queer Eye had?

I’m just trying to have a fun, satisfying career doing something that I love, and the fact that I get to play any tiny part in the gay rights movement is a privilege and an obligation. I love my people! They’re fun.

PE TER ROSS

Do you recall the first time you saw a queer person on TV? I remember what you used to see on television when journalism was talking about gay people—it used to be only going to Pride parades in San Francisco and they would show people in bondage gear. Not that there is anything at all wrong with a parade like that, as far as I’m concerned, but I do know that I didn’t see myself reflected in that. I’m much less interesting than that—I don’t have any whips at all. What takes a while for people to realize is that the gay community is really not that different from any other community of humans. There are people who do unusual things, and there are people who are just basically accountants wearing khakis to work every day.

Which is the benefit of a show like Queer Eye, a show like Will & Grace, a show like Modern Family. All of them flawed, but they create visibility for different kinds of gay people, and people gradually have gotten a little more accustomed to us.

Do you have any memorable stories about being flirted with while on the set of Chopped?

About being flirted with? [Laughs] I don’t know! I don’t really get flirted with the way that I used to, not that I ever really did. I don’t really have a good story of that nature, because when we’re doing Chopped it’s super focused and super serious. There’s not a lot of time to fool around. It’s all about “Can you cook this stuff or not?”

You have very little time to spend doing any flirting. We’ve definitely had contestants that I thought were really cute.

Whenever I’m in the company of chefs, what I want to do is chat with them and learn from them. They’re often really enter-

taining people, but on Chopped it’s kind of my job to try to help preserve an atmosphere of tension and fear, so we’re strongly discouraged from hanging out with contestants. In between shots we tend to put them off in a room. We want to keep them focused on the prize.

If the roles were reversed and you were a contestant on Chopped, what do you think your go-to dish would be?

I don’t think I’m a very good candidate for cooking on Chopped.

I’m actually a really slow cook, ironically. I tend to cook with NPR on the radio and a glass of wine in my hand, and, for me, it’s fun.

Chefs have to be trained to cook really fast. In a restaurant it’s very fast. When you come on Chopped it’s super fast—and you don’t even have control of the ingredients. That would be tricky for me.

I have cooked a couple of times on Chopped After Hours, our Web series. I think I might do it again. There’s a lot less at stake there.

It’s only one round, we already know what the ingredients are, and that’s a little bit less scary for me. That’s more my speed.

What’s the meanest thing you’ve ever heard a judge say to a contestant on Chopped?

Probably “I hate this!” And that was from Marc [Murphy], if I’m not mistaken. You’ve got to be candid. I like our judging because I think our people are very serious and passionate about this craft that they’ve devoted their lives to. We want to be useful. I don’t think our judges are trying to be mean per se, but if you come in there and you act like a jerk and you do offensive things to food, and then you act like you’re the next Thomas Keller [who was once named Outstanding Chef by James Beard Foundation, among many other awards] or that you think you’re better than the judges, then you’re going to get a response that you deserve. It takes a lot of ego to be a chef, but you also have to show a lot of graciousness. When you don’t do that, that tends to make people cranky. ✜ hivplusmag.com

| 49

Is Television Finally Ready for Real HIV-Positive Characters?

50 |

july / august 2015

With groundbreaking portrayals, How to Get Away With Murder star Conrad Ricamora and Looking’s Daniel Franzese played the only HIV-positive characters on television in 2015. Here’s why they agree that’s a huge problem and what TV producers should do about it

By Daniel Reynolds

Photography by Joshua Spencer and Catalina Kulczar Photography hivplusmag.com

| 51

T

wo days before the filming of the finale of How to Get Away With Murder, a legal drama that shows how a murder upends the lives of a law professor (Viola Davis) and her students, actor Conrad Ricamora was approached by his cast mate Jack Falahee with some troubling news.

“Did you hear? Did you hear?” Falahee asked Ricamora.

“No, what?” he responded.

“You tested positive,” Falahee said.

Falahee, who plays gay character Connor Walsh, was referring to Ricamora’s character, Oliver, who is Connor’s romantic interest on the hit ABC drama. The show regularly features shocking surprise twists that involve murder, sex, intrigue, and scandal.

But this twist floored Ricamora in a way the others hadn’t.

“I just stood there, stunned, staring off into space…like I had just found out a real person tested positive, and going though all the grief and denial,” he said.

It was a reaction shared by many of the 9 million viewers of Murder’s season finale, who came to adore Oliver for being, as Ricamora describes him, “an open, honest, and levelheaded” person in a show full of schemers and backstabbers.

Oliver had been the one to encourage Connor, who often engaged in risky sex, to get tested for HIV. When Connor’s results came back negative and Oliver tested HIV-positive, the scales of justice—and the audience’s preconceptions about who has HIV—were turned upside down.

“People have demanded it be rewritten,” Ricamora says of viewers’ responses to the news. “Some people are really, really heartbroken and sad. People come up to me and tell me all

52 |

july / august 2015

the time, ‘Oh! I cried so much when I found out!’ Just a lot of sad people, because, I guess, everybody loves Oliver.”

But the cloud has a silver lining. With the stroke of a pen from the writers’ room, Conrad became the first major HIV-positive character to appear on a U.S. broadcast network TV series since a gay character, Saul Holden, tested positive on ABC’s Brothers & Sisters. That series ended in 2011.

For years, Hollywood has avoided telling HIV-related stories—or even just including poz characters—like, well, the plague HIV once was. This lack of storylines does not reflect reality. The Centers for Disease Control and Prevention estimates that more than 1.2 million Americans are living with HIV, and more than 35 million are living with the virus worldwide, reports the World Health Organization.

Oliver’s positive test has helped break this small-screen dry spell. Though the character’s future remains uncertain, his presence on such a popular prime-time TV show could very well save lives by sparking conversation and encouraging others to get tested and seek treatment.

“It’s a huge honor to be able to bring this back into the consciousness,” Ricamora says. “I remember growing up in the ’90s, it was such a big educational topic.… [But] in the last couple of years, it’s slid out of the consciousness of mainstream America.”

He adds that it’s “good to remember that this still can happen—it still does happen—and just to be aware and let people know that safe sex still matters.”

Before How to Get Away With Murder revealed Oliver’s positive status, the only other television show to include an HIV-positive character in 2015 was HBO’s Looking, a little-seen but well-reviewed cable series following the lives of gay men in San Francisco. Because the city has many resi-

hivplusmag.com

| 53

dents living long, healthy lives with HIV, it’d be a surprise if there wasn’t at least one character that was positive.

In telling HIV-related stories, other TV writers and showrunners might benefit by looking to Looking for an example of a character that defies the stereotypes and stigma associated with people who are living with HIV in the U.S. today.

Throughout its second season, Daniel Franzese (already popular from his influential role in Mean Girls) portrayed Eddie, a character who works with queer and trans youth. He is HIV-positive and also “body-positive,” as Franzese puts it. He also loves the fact that neither of those features defines his character, though.

Defying stereotypes, Eddie is sexy and healthy, has admirable self-esteem—and he is romantically pursued on the show by an HIV-negative character, a guy who begins a regimen of PrEP, the daily dose of a pill that can reduce the risk of HIV infection by up to 99 percent, so that the pair can have sex without worry about transmission.

“Eddie’s not sick,” Franzese says. “There are no sad things that have to do with Eddie. There are problematic things that he has to deal with in his life, but most of them are social. There’s not going to be a ‘very special episode’ about Eddie. I found that to be so progressive.”

Another person who was thrilled by the character is Franzese’s real-life best friend, Ryan. In a situation similar to Eddie’s, Ryan found out he had HIV after his (now former) partner cheated on him. And like Franzese, he was frustrated that his experience was never represented in media. Major recent movies that dealt with HIV, like Dallas Buyers Club and HBO’s The Normal Heart, were period pieces set during the height of the AIDS crisis, when a positive diagnosis meant a death sentence. Today, people living with HIV are largely having the same types of lives as those around them, except with some extra medication and doctor’s appointments, so many advocates ask, Why can’t TV producers simply give more characters HIV without it needing to be a feature of a shocking bombshell episode?

54 |

july / august 2015

Franzese remembers Ryan’s excitement when hearing about Eddie, a character who is healthy and thriving in the present day, who is never shown as a victim. “I’ve never seen that before,” Ryan told Franzese.

“It’s really cool to see Daniel playing a character like Eddie,” Ryan later told Plus. “As someone who is living with HIV, it’s refreshing to see that Hollywood is beginning to show characters who are HIV-positive and depicting them in a healthy way.”

In fact, when Looking tackled PrEP, or pre-exposure prophylaxis, it did so without the usual pearl-clutching, eyebrow-raising “special episode” story arcs we’ve seen on TV. “The brief conversation that we have in the Halloween episode happens in a way that I’ve heard PrEP come up amongst my friends,” Franzese says, “and whenever I’ve heard it come up in public amongst people who are discussing it: just a matter-of-fact way, not too preachy. I really like the way that it’s handled.”

He should be proud; Looking made TV history as the first scripted show to talk about PrEP, an HIV prevention method that experts say could cut worldwide HIV incidence by 25 percent and U.S. incidence even more.

Although he is pleased with the way Looking has represented HIV-positive gay men, Franzese would like to see Hollywood tell stories of characters living with HIV who are not gay. Men who have sex with men are indeed an at-risk group in the United States—people in this demographic accounted for 63 percent of new infections in 2010, according to the CDC. But other groups are also disproportionately affected, and their representations are nearly absent from media. For example, according to the CDC, the HIV rate among African-American women is 20 times that of white women—and black women’s stories are ones that Franzese says he would “love to see.” He notes, “All groups would like to see themselves represented on-screen,” stressing the need “to help educate the world about how diverse we all are.”

Sadly, the smartest HIV portrayal on TV is going away. HBO has not picked up Looking for a third season, though a movie is

“Eddie’s not sick. There are no sad things that have to do with Eddie. There are problematic things that he has to deal with in his life, but most of them are social. There’s not going to be a ‘very special episode’ about Eddie.

I found that to be so progressive.”

hivplusmag.com

| 55

“ People have demanded it be rewritten. Some people are really, really heartbroken and sad.

People come up to me and tell me all the time, ‘Oh! I cried so much when I found out!’ Just a lot of sad people, because, I guess, everybody loves Oliver.”

56 |

july / august 2015

currently in the works as a final sendoff for fans. (Since Oliver finds out he has HIV in the season finale of How to Get Away With Murder, it remains to be seen how the character will be handled. But there will be a chance to find out: The Shonda Rhimes drama was one of the highest-rated new series of the past season, and ABC will bring it back for season 2 this fall.

And while Franzese is out of a job, he’s not leaving HIV work behind. After talks with his friend Quinn Tivey, an HIV activist and Elizabeth’s Taylor’s grandson, Franzese joined the Elizabeth Taylor AIDS Foundation as an ambassador, using his platform to increase dialogue on issues related to HIV and AIDS. He also works with GLAAD, a national organization that promotes positive representations of LGBT people in the media, in examining how television and film can raise awareness of the virus and its prevention.

“There’s a direct correlation between representation of a story in media and people knowing about it,” Franzese says. “If it’s not being seen, it’s not being talked about, and it’s not being learned.”

Earlier this year, GLAAD announced a partnership with the Elizabeth Taylor AIDS Foundation and AIDS United on what would have been Taylor’s 83rd birthday in order to renew the public conversation on HIV. In addition to releasing a style guide for journalists on how to cover current issues on HIV (on which Plus editors consulted), the three organizations, alongside spokespeople like Franzese, are calling on Hollywood to create more characters and storylines about those with HIV. “It’s time to put our red ribbons back on,” GLAAD president and CEO Sarah Kate Ellis said at the time. “Just as we advocated for accurate coverage of HIV and AIDS in the 1980s, it is equally important today that we ensure fair, accurate, and inclusive stories in the media to build understanding that leads to better prevention.”

In terms of prevention, both Franzese, 37, and Ricamora, 36, are gay, HIV-negative men who are leading by example. Both

men have set rules about their sexual health that they readily offer as guidelines for others.

“I would say start using condoms immediately when you start having sex,” Franzese offers as advice to LGBT youth. “That way, it’s never an issue. And stay healthy and be tested and be aware.” It’s what he would tell the character he is most famous for, Damien in Mean Girls.

“Always use protection,” Ricamora stresses. “Always talk about your sexual history with the person that you’re with. And always know what your status is.”

Conversations about sex may not be easy. Particularly in Hollywood, sex, if it is portrayed at all, is depicted in the high heat of the moment and not the less sexy aftermath. But Ricamora says the U.S. and the media need to overcome their hang-ups in order to have conversations that will help save lives.

“People are scared to talk about sex in general, especially in this country,” Ricamora says. “C’mon, people are having sex! Why not make it something that’s comfortable to talk about…or be uncomfortable, but still talk about it? Because there are consequences—whether it’s getting pregnant or whether it’s getting an STD—that can go along with sex that can either be prevented or planned for.”

He adds, “If sex is continually regarded as a taboo in this country, then that means more people are going to make less smart decisions.”

Franzese agrees. Conversations, which can be encouraged and sparked by the media, lead to education. Education leads to testing. And testing leads to treatment and an end to an epidemic that has plagued the world for far too long.

“We have the tools out there currently right now to end new HIV infections by 96 percent,” he says. “They exist. But the first step is knowing your status and making sure that we’re able to stop it. It’s time that we make this new commitment to stopping HIV and AIDS once and for all.” ✜

hivplusmag.com

| 57

COMPLERA is a prescription medicine for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood. COMPLERA can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. COMPLERA combines 3 medicines into 1 pill to be taken once a day with food. COMPLERA should not be used with other HIV-1 medicines.

Just the

one

for me

COMPLERA is a complete HIV-1 treatment that combines the medicines in TRUVADA + EDURANT in only 1 pill a day.*

Ask your healthcare provider if COMPLERA may be the one for you. *COMPLERA is a combination of the medicines in TRUVADA (emtricitabine and tenofovir disoproxil fumarate) and EDURANT (rilpivirine).

Pill shown is not actual size.

COMPLERA does not cure HIV-1 infection or AIDS.

To control HIV-1 infection and decrease HIV-related illnesses you must keep taking COMPLERA. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids.

Never reuse or share needles or other items that have body fluids on them.

It is not known if COMPLERA is safe and effective in children under 18 years old.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about COMPLERA?

COMPLERA can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• Serious liver problems. The liver may become large (hepatomegaly) and fatty (steatosis). Symptoms of liver problems include your skin or the white part of your eyes turns yellow (jaundice), dark “tea-colored” urine, light-colored bowel movements (stools), loss of appetite for several days or longer, nausea, and/or stomach pain.

• You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.

• Worsening of hepatitis B (HBV) infection. If you also have HBV and stop taking COMPLERA, your hepatitis may suddenly get worse. Do not stop taking COMPLERA without first talking to your healthcare provider, as they will need to monitor your health. COMPLERA is not approved for the treatment of HBV.

Who should not take COMPLERA?

Do not take COMPLERA if you: • Take a medicine that contains: adefovir (Hepsera), lamivudine (Epivir-HBV), carbamazepine (Carbatrol, Equetro, Tegretol, TegretolXR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek), rifampin (Rifater, Rifamate, Rimactane, Rifadin), rifapentine (Priftin), dexlansoprazole (Dexilant), esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole sodium (Protonix), rabeprazole (Aciphex), more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate, or the herbal supplement St. John’s wort.

• Take any other medicines to treat HIV-1 infection, unless recommended by your healthcare provider.

What are the other possible side effects of COMPLERA?

Serious side effects of COMPLERA may also include: • Severe skin rash and allergic reactions. Call your doctor right away if you get a rash. Some rashes and allergic reactions may need to be treated in a hospital. Stop taking COMPLERA and get medical help right away if you get a rash with any of the following symptoms: severe allergic reactions causing a swollen face, lips, mouth, tongue or throat which may lead to difficulty swallowing or breathing; mouth sores or blisters on your body; inflamed eye (conjunctivitis); fever, dark urine or pain on the right side of the stomach-area (abdominal pain).

• New or worse kidney problems, including kidney failure. Your healthcare provider should do blood tests to check your kidneys before starting treatment with COMPLERA. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may also check your kidneys during 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.

• Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 medicines.

• Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. •

The most common side effects of COMPLERA include trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Other common side effects include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), and pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking COMPLERA?

All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, mental health, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist.

Do not start any new medicines while taking COMPLERA without first talking with your healthcare provider.

• If you take rifabutin (Mycobutin). Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take.

• If you take antacids. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. • If you take stomach acid blockers. Take acid blockers at least 12 hours before or at least 4 hours after you take COMPLERA. Ask your healthcare provider if your acid blocker is okay to take, as some acid blockers should never be taken with COMPLERA. • If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking COMPLERA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in COMPLERA can pass into breast milk, and it is not known if this can harm the baby.

•

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 Brief Summary of full Prescribing Information with important warnings on the following pages.

Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information.

What is COMPLERA? • COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements.

• COMPLERA is a complete HIV-1 medicine and should not be used with any other HIV-1 medicines.

• COMPLERA should always be taken with food. A protein drink does not replace food.

• COMPLERA does not cure HIV-1 or AIDS. You must stay on continuous HIV-1 therapy to control HIV-1 infection and decrease HIV-related illnesses.

• Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or reuse needles, injection equipment, or personal items that can have blood or body fluids on them. Do not have sex without protection. Always practice safer sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood.

What is the most important information I should know about COMPLERA? COMPLERA can cause serious side effects, including: • Build-up of an acid in your blood (lactic acidosis). Lactic acidosis can happen in some people who take COMPLERA or similar (nucleoside analogs) medicines. Lactic acidosis is a serious medical emergency that can lead to death. Lactic acidosis can be hard to identify early, because the symptoms could seem like symptoms of other health problems. Call your healthcare provider right away if you get any of the following symptoms which could be signs of lactic acidosis: – feel very weak or tired – have unusual (not normal) muscle pain – have trouble breathing – having stomach pain with nausea or vomiting – feel cold, especially in your arms and legs – feel dizzy or lightheaded – have a fast or irregular heartbeat • Severe liver problems. Severe liver problems can happen in people who take COMPLERA. 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). Call your healthcare provider right away if you get any of the following symptoms of liver problems: – your skin or the white part of your eyes turns yellow (jaundice) – dark “tea-colored” urine – light-colored bowel movements (stools) – loss of appetite for several days or longer – nausea – stomach pain • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

• Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider.

– Do not run out of COMPLERA. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone.

– 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 often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA. Who should not take COMPLERA? Do not take COMPLERA if you also take any of the following medicines: • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) • Medicines used for tuberculosis: rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) • Certain medicines used to block stomach acid called proton pump inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) • Certain steroid medicines: More than 1 dose of dexamethasone or dexamethasone sodium phosphate • Certain herbal supplements: St. John’s wort • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) Do not take COMPLERA if you also take any other HIV-1 medicines, including: • Other medicines that contain emtricitabine or tenofovir (ATRIPLA, EMTRIVA, STRIBILD, TRUVADA, VIREAD) • Other medicines that contain lamivudine (Combivir, Epivir, Epzicom, Triumeq, Trizivir) • rilpivirine (Edurant), unless you are also taking rifabutin (Mycobutin) COMPLERA is not for use in people who are less than 18 years old.

What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects: • See “What is the most important information I should know about COMPLERA?” • Severe skin rash and allergic reactions. Skin rash is a common side effect of COMPLERA but it can also be serious. Call your doctor right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. Stop taking COMPLERA and call your doctor or get medical help right away if you get a rash with any of the following symptoms: – severe allergic reactions causing a swollen face, lips, mouth, tongue or throat, which may cause difficulty swallowing or breathing – mouth sores or blisters on your body – inflamed eye (conjunctivitis) – fever, dark urine or pain on the right side of the stomach-area (abdominal pain) • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking COMPLERA. If you have had kidney problems in the past or need to take another medicine 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 • Change in liver enzymes. People with a history of hepatitis B or C virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease.

Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA. • 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 tests to check your bones.

• Changes in body fat can happen in people taking HIV-1 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-1 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 any new symptoms after starting your HIV-1 medicine.

The most common side effects of COMPLERA include: • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, depression Additional common side effects include: • Vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), 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.

• Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my healthcare provider before taking COMPLERA? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, mental health, bone, or liver problems, including hepatitis B or C infection.

• If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child.

– There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry 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.

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you take COMPLERA. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

– Two of the medicines in COMPLERA can pass to your baby in your breast milk. It is not known if this could harm your baby.

– Talk to your healthcare provider about the best way to feed your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements: • COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works.

• If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help control your HIV-1 infection. The HIV-1 virus in your body may become resistant to COMPLERA or other HIV-1 medicines that are like it.

• Be sure to tell your healthcare provider if you take any of the following medicines: – Rifabutin (Mycobutin), a medicine to treat some bacterial infections.

Talk to your healthcare provider about the right amount of rilpivirine (Edurant) you should take.

– Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. – Certain medicines to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. Some acid blocking medicines should never be taken with COMPLERA (see “Who should not take COMPLERA?” for a list of these medicines).

– Medicines that can affect how your kidneys work, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte).

– clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan) – itraconazole (Sporanox) – ketoconazole (Nizoral) – methadone (Dolophine) – posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider.

Keep COMPLERA and all medicines out of reach of children.

This Brief Summary summarizes the most important information about COMPLERA. If you would like more information, talk with your healthcare provider. You can also ask your healthcare provider or pharmacist for information about COMPLERA that is written for health professionals, or call 1-800-445-3235 or go to www.COMPLERA.com.

Revised: May 2015

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners.

©2015 Gilead Sciences, Inc. All rights reserved. CPAC0167 06/15

DAILY DOSE

Finney and her fiancé

PARTING GLANCES

Shawndell Finney discovered she had HIV two weeks after her husband was hospitalized. Her life has been a journey ever since

W

By Diane Anderson-Minshall

hen her husband, Roger, collapsed in 2000, Shawndell Finney had no idea what a life changer it would be. A mere 28 days later, her beloved Roger was in a hospital, diagnosed with AIDS and progressive multifocal leukoencephalopathy, or PML, which is one of the AIDS-defining illnesses among people with HIV. “Then they took me back and explained to us what would happen next. They told us he had AIDS/PML and I had to be tested for HIV,” she recalls. “At that time both my daughters were with us and very tired and scared, and they asked me to walk with an adviser/nurse to the children’s hospital to test them. I had to wait two long weeks for my results—and for my kids’.”

Finney was HIV-positive. Her daughters were not. She started her own cleaning business to support the family while her oldest daughter helped her take care of her husband until the task got too much for them and Roger was placed in hospice. By then the stress of juggling caretaking, being the family breadwinner, and dealing with the needs of two growing school-age girls had taken a toll on Finney, and her own health declined.

“It affected my children a lot,” she says. “It was an emotional roller coaster. Elizabeth was close to her daddy—he taught her how to play soccer. And our younger daughter, Rusti, kind of rebelled.

They blamed me.”

Eventually Roger was moved from hospice to nursing care, and though the couple divorced prior to his death, Finney says she still took care of him until his last days, even while juggling two jobs, the kids, and her own HIV. It took a toll on her health, but she coped by having a “close relationship in faith” and a strong

62 |

july / august 2015

support system including a mentor, her best friend, and her parents, who have since died. “I wish they were alive to see how far I’ve come,” she laments.

Finney also became a firm believer in staying on her medication regimen. “The doctors told me to take my meds and I will live, so that’s what I did,” she says. She switched medications once—one of her early meds gave her neuropathy in both legs—and she also battled a common comorbidity, hepatitis C. “I went on a clinical trial to be cured, and it worked,” she says.

Today this grandmother is healthy, happy, and about to be remarried—to the man of her dreams. She met Robert, her fiancé, on PositiveSingles.com, a website for people living with sexually transmitted infections, including HIV. “As for meeting on the website, I personally didn’t want to meet a person that is negative,” Finney says about finding love online.

Both poz, the two are also “an interracial couple and can show others [these relationships] work.”

Practically swooning when she talks about her new fiancé—and their wedding, set for Valentine’s Day, 2016—Finney says that best of all, “he’s proud of my drive to inspire others to have no shame and stop the ignorance of this disease.”

She still thinks of Roger, though, who had battled AIDS complications for 14 years, never having recovered from his late start on antiretrovirals. Finney dreams of adding a panel for him to the AIDS Memorial Quilt someday, emblazoned with a red flannel shirt, a remembrance of the man who gave her so much, even if some of it came with unexpected baggage. ✜

THE BARBERSHOP DIARIE S

(POZ) SEX AND THE CITY Luis Oyola is like any 20-something trying to find his way—and learning to speak up for the first time

By Neal Broverman

104_30_Feat_MariaDavis_v1.pdf 104_36_Feat_MariaDavis_v1.indd

D

ating is never easy, but it’s especially complicated for Luis Oyola. The 24-year-old is trying to find love in the Bronx, but it’s no Sex and the City.

“It just seems to be guys wanting to just get in my pants, and if I do find someone that I’m interested in, I get nervous telling them my status,” Oyola says. “I taught myself to just brush off [the nerves].”

Oyola doesn’t shy away from the subject of HIV, even if not everyone is comfortable with it. “I know I shouldn’t tell someone my status unless I’m getting intimate with them, [but] I just feel like breaking the ice with it.”

Oyola tested positive about four years ago, and it was a surprise.

A persistent cough brought him to the emergency room, and after three days in the hospital, he tested positive for chronic bronchitis.

His doctor urged him to take an HIV test and later brought him into what seemed like an “airlock chamber for contagious disease.”

“The thoughts that went through my mind were scary,” Oyola says about receiving the news. “I [felt] like, I’m going to die. I wanted to hit the doctor and scream at the top of my lungs. Instead I told the doctor to leave the room and I punched the wall.”

After talking to some loved ones—and eating a mammoth amount of Chinese food and chicken nuggets—Oyola calmed down. But he remained depressed, and it took him a while to realize he wasn’t going to die.

Even though he doesn’t have a romantic relationship right now, he has worked to improve another important relationship in his life—the one with his mother. First Oyola had to come out to her about being gay. Before he could find his own way to tell her, gossip got to her. But his “old-school Puerto Rican mom” surprised him.

“When I came out to my mom, I expected a Bible to the head and holy water,” Oyola says. “Instead, she told me, ‘It’s OK, I still love you, just know to be careful out there.’ ” Then he had to come out about his HIV-positive status. When he was in the hospital for bronchitis, his mother suspected more was going on with her son’s health. Then she decided to speak to the doctor herself.

“I got up so fast from the bed with the IV in me and ran to the doc and told him not to tell my mom,” Oyola recalls. “He said he won’t due to confidentiality.” Not long after, Oyola told his mother himself, and eventually she grew to accept it.

Oyola is now working on his high school equivalency exam and considering studying technology, computer science, or anatomy at college. While he puts himself out in the dating world, he’s also getting better about talking about his status.

“Most guys around my age do talk about HIV,” Oyola says.

“They are aware of some info, and it’s awesome to educate others about it.” ✜ hivplusmag.com

| 63

ADVERTISEMENT

PHARMACIES THAT GO BEYOND PRESCRIPTIONS The HIV/AIDS community is an important support system that supplies information, education, encouragement, friendship and advocacy. Pharmacies that go beyond traditional HIV/AIDS medication management can make a broader impact in the communities they serve.

Helping people afford medications With the launch of the Affordable Care Act, many more people living with HIV are now covered by medical and prescription insurance. But even for those with coverage, medication copays can still be high. Clearly, the easier it is for people to afford their medications, the easier it can be for them to stay on therapy. Pharmacies located right in the communities are in a perfect position to help.

In addition to their expertise in medication therapy, the staff at more than 800 Walgreens HIV-specialized pharmacies are trained to help customers find ways to afford their medications.

They coordinate with insurance companies and doctors to help minimize copays. Even for those with little or no insurance, Walgreens can help find copay assistance programs.

Making testing easily accessible Almost one in seven people living with HIV is unaware of their status.1 Getting more people tested is vital, but obstacles such as inconvenient locations and a fear of stigmatization can get in the way. A recent research study found that pharmacies offer easier access to HIV testing, as well as an environment that can be less stigmatizing than a doctor’s office or health department.2

To help improve access to HIV testing, Walgreens teams up with Greater Than AIDS to promote free testing events in more than 200 stores every June.

Since 2010, nearly 19,000 free HIV tests have been administered. Testing is also offered in many stores year-round. More information is available at greaterthan.org/Walgreens.

It’s all part of Walgreens mission to not only care for their customers living with HIV/AIDS, but to support the HIV/AIDS community. To locate an HIV-specialized pharmacy, visit HIV.Walgreens.com. ■ See how Walgreens pharmacists help support people living with HIV/AIDS with the HIV Plus Ask the Expert video series at HIVPlusMag.com.

1. HIV in the United States: At a glance. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hiv/statistics/basics/ataglance.html. Updated March 12, 2015. Accessed March 27, 2015. 2. Weidle PJ, Lecher S, Botts LW, et al. HIV testing in community pharmacies and retail clinics: A model to expand access to screening for HIV infection. J Am Pharm Assoc. (2003) 2014;54:486-492. ©2015 Walgreen Co. All rights reserved.

15CS0003-0515

WE KNOW HIV/AIDS medication therapy

But we also know you want a pharmacy that cares for you and the community.

From participating in AIDS walks to offering education and free HIV testing in select stores nationwide, Walgreens is committed to giving back to the local groups and organizations that bring people together and bring us closer to new treatments, avenues of support— and a cure.

To learn more, visit HIV.Walgreens.com.

Š2014 Walgreen Co. All rights reserved.

14CS0017-A-0814

HIV TREATMENT CAN GET YOUR VIRAL LOAD SO LOW, IT’S UNDETECTABLE. GO FOR UNDETECTABLE.

There is no cure for HIV, but being undetectable helps protect your health. See how. Watch “The Goal of Undetectable” at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1853 03/15