BECAUSE YOU’RE MORE THAN YOUR STATUS
THE 2016 ANNUAL HIV AND HEP C TREATMENT GUIDE
CH-CH-CHCHANGES! WILL THESE GUYS FOREVER CHANGE THE BATTLE AGAINST HIV? GMHC’S KELSEY LOUIE BLACK AIDS INSTITUTE’S PHILL WILSON AND NMAC’S PAUL KAWATA
JULY/AUGUST 2016 www.hivplusmag.com
WHAT IS GENVOYA®? GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older. It can either be used in people who are starting HIV-1 treatment and have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. These include having an undetectable viral load (less than 50 copies/mL) for 6 months or more on their current HIV-1 treatment. GENVOYA combines 4 medicines into 1 pill taken once a day with food. GENVOYA is a complete HIV-1 treatment and should not be used with other HIV-1 medicines. GENVOYA does not cure HIV-1 or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking GENVOYA. 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 GENVOYA? GENVOYA may 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 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 and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice), dark “teacolored” 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, or have been taking GENVOYA for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. • Worsening of hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking GENVOYA, your HBV may suddenly get worse. Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to monitor your health.
Who should not take GENVOYA? Do not take GENVOYA if you take: • Certain prescription medicines for other conditions. It is important to ask your healthcare provider or pharmacist about
medicines that should not be taken with GENVOYA. Do not start a new medicine without telling your healthcare provider. • The herbal supplement St. John’s wort. • Any other medicines to treat HIV-1 infection.
What are the other possible side effects of GENVOYA? Serious side effects of GENVOYA may also include: • Changes in body fat, which 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 GENVOYA. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking GENVOYA. • Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones. The most common side effect of GENVOYA is nausea. 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 GENVOYA? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and overthe-counter medicines, vitamins, and herbal supplements. Other medicines may affect how GENVOYA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take GENVOYA with all of your other medicines. • If you take antacids. Take antacids at least 2 hours before or after you take GENVOYA. • If you are pregnant or plan to become pregnant. It is not known if GENVOYA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking GENVOYA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
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 Important Facts about GENVOYA including important warnings on the following page.
Ask your healthcare provider if GENVOYA is right for you, and visit GENVOYA.com to learn more.
GENVOYA does not cure HIV-1 or AIDS.
SHOW YOUR
POWER
Take care of what matters most—you. GENVOYA is a 1-pill, once-a-day complete HIV-1 treatment for people who are either new to treatment or people whose healthcare provider determines they can replace their current HIV-1 medicines with GENVOYA.
IMPORTANT FACTS This is only a brief summary of important information about GENVOYA and does not replace talking to your healthcare provider about your condition and your treatment.
(jen-VOY-uh) MOST IMPORTANT INFORMATION ABOUT GENVOYA
POSSIBLE SIDE EFFECTS OF GENVOYA
Genvoya® may cause serious side effects, including:
GENVOYA can cause serious side effects, including:
• Build-up of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual 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. • Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: 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. • Worsening of Hepatitis B (HBV) infection. GENVOYA is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking GENVOYA. Do not stop taking GENVOYA without first talking to your healthcare provider, as they will need to check your health regularly for several months.
You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking GENVOYA for a long time.
• Those in the “Most Important Information About GENVOYA” section. • Changes in body fat. • Changes in your immune system. • New or worse kidney problems, including kidney failure. • Bone problems. The most common side effect of GENVOYA is nausea. These are not all the possible side effects of GENVOYA. Tell your healthcare provider right away if you have any new symptoms while taking GENVOYA. Your healthcare provider will need to do tests to monitor your health before and during treatment with GENVOYA.
BEFORE TAKING GENVOYA Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection. • Have any other medical condition.
ABOUT GENVOYA
• Are pregnant or plan to become pregnant.
• GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who have never taken HIV-1 medicines before. GENVOYA can also be used to replace current HIV-1 medicines for some people 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 HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements. • GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others. Do NOT take GENVOYA if you: • Take a medicine that contains: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®, Propulsid Quicksolv®), dihydroergotamine (D.H.E. 45®, Migranal®), ergotamine (Cafergot®, Migergot®, Ergostat®, Medihaler Ergotamine®, Wigraine®, Wigrettes®), lovastatin (Advicor®, Altoprev®, Mevacor®), methylergonovine (Ergotrate®, Methergine®), midazolam (when taken by mouth), phenobarbital (Luminal®), phenytoin (Dilantin®, Phenytek®), pimozide (Orap®), rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®), sildenafil when used for lung problems (Revatio®), simvastatin (Simcor®, Vytorin®, Zocor®), or triazolam (Halcion®). • Take the herbal supplement St. John’s wort. • Take any other HIV-1 medicines at the same time.
• Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with GENVOYA.
HOW TO TAKE GENVOYA • GENVOYA is a complete one pill, once a day HIV-1 medicine. • Take GENVOYA with food.
GET MORE INFORMATION • This is only a brief summary of important information about GENVOYA. Talk to your healthcare provider or pharmacist to learn more. • Go to GENVOYA.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit GENVOYA.com for program information.
GENVOYA, the GENVOYA Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners. Version date: November 2015 © 2016 Gilead Sciences, Inc. All rights reserved. GENC0020 03/16
editor in chief DIANE ANDERSON-MINSHALL SVP, group publisher JOE VALENTINO art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL editor at large TYLER CURRY copy editor ELAINE MENDUS contributing editors KATIE PEOPLES, MARK S. KING mental health editor GARY MCCLAIN creative director, digital media & integrated marketing DAVE JOHNSON 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 traffic manager KEVIN BISSADA director, integrated marketing JOHN MCCOURT senior manager, multiplatform advertising solutions PAIGE POPDAN manager, integrated marketing JAMIE TREDWELL art director, integrated marketing PETER OLSON coordinator, integrated ad sales/marketing, CASEY NOBLE senior director, media strategy STEWART NACHT vp, marketing ROBERT HEBERT director of social media LEVI CHAMBERS associate social media editor DANIEL REYNOLDS circulation director JEFF LETTIERE fulfillment manager ARGUS 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, ROBERT HEBERT, LUCAS GRINDLEY 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 LOS ANGELES EDITORIAL OFFICES 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES Retrograde Communications, 43430 E. Florida Ave. Ste. F PMB 330, Hemet, CA 92544 Phone (951) 927-8727 • Email support@retrogradecommunications.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To sign up, just log on to HIVPlusMag.com/signup to subscribe. There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is now available free to individual subscribers—a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To sign up, just log on to HIVPlusMag.com/signup and give us your email address. 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. Plus (ISSN 15223086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Ste., Los Angeles, CA 90024. Plus is a registered trademark of Here Media Inc. Entire contents © 2016 by Here Publishing Inc. All rights reserved. Printed in the USA. FOLLOW US ON FACEBOOK AND TWITTER
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EDITOR’S LETTER W E LCO M E TO O U R 2 0 1 6
DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM
4 | JULY / AUGUST 2016
BECAUSE YOU’RE MORE THAN YOUR STATUS
BECAUSE YOU’RE MORE THAN YOUR STATUS
WHICH IS YOUR FAVORITE COVER? When we started talking with the heads of major HIV organizations we knew there was no way we could put just one person on the cover. We settled on three but we could have done a dozen! We dispatched photographer Chris Hayden to NYC to photograph Kelsey Louie and Julie Napear to Washington, D.C. to shoot a rather camerashy Paul Kawata. (We admit Phill Wilson’s photo already graces our office walls, as an, ahem, kind of dreamy CEO-style pinup.) So which is your favorite cover? A solo guy or this group shot we voted on? Who should we put on the next cover? Tell us at Facebook.com/ HIVPlusMag.
BRADFORD ROGNE
Annual HIV and HCV Treatment Guide. We’ve put together this treatment guide every summer for years now and I can honestly admit that this is sometimes our hardest issue to assemble, largely because it’s filled with facts and numbers and—much to my chagrin—math. (Don’t worry, we did the math so you don’t have to.) Researching this issue requires us to call every single state’s public health officials to check on services, ADAP funding, and more for people living with HIV. Then we check with the Federal Drug Administration on each medication used to treat HIV, hep C, and any other comorbidities or side effects, so you have both a visual and written record of what that medication looks like, what it does, and what your dosage most likely should be. I’m exhausted just telling you about it. But here’s the deal: Yes, this is one of those issues you take once to your doctor, or put on your shelf to refer to each time you are prescribed new medication. But it’s also a must-read because we’ve packed it with update information on new ways to afford your drugs, what to watch for with internet pharmacies, and how doctors are treating common side effects of both HIV and the antiretroviral drugs used to treat it. Of course, our cover story, interviews with three amazing men—Black AIDS Institute’s Phill Wilson, NMAC’s Paul Kawata, and GMHC’s Kelsey Louie—is probably the most inspirational we’ve seen all year, in part because all three are pushing the boundaries of how we talk about HIV, advocate for people living with it, and find a way to really prevent and cure it. These guys all argue that we’re in this together, that ending AIDS and halting the spread of HIV will take a villlage, not a series of hyper-competitive non-profits who won’t share. That’s a message we can all agree on. It’s no surprise, too, that we couldn’t put just one of these guys on the cover. Each of them is magnificent at their jobs, but nobody is going to solve the current AIDS epidemic—yes, people who can’t access medication are still dying—in a vaccum. Too often, we use one organization or one city as an example of how things should be done, but experts know all too well that what works in San Francisco (a city making big strides in stopping the spread of HIV) might not work in Baton Rouge or Miami Beach. That’s how I think of these three orgs represented on our cover. They’re doing some great stuff, and they aren’t alone. There are more groups making changes around healthcare and racial justice, coming out against HIV criminalization (Elton John AIDS Foundation for one) or others (like amfAR) who are innovating around science and forcing HIV researchers to collaborate on a cure. We all know there’s a race to 2020—for a cure, for a change, for an end to AIDS—and I’m going to be waiting at the finish line to see everyone come out ahead. Who’s with me?
ON THE COVER
6 The Change Agents
How Phill Wilson, Kelsey Louie, and Paul Kawata—the men behind Black AIDS Institute, GMHC, and NMAC—are changing the way we think about stopping HIV.
16-42 The 2016 Annual HIV & HCV Treatment Guide
Treatment options, side effects, dosage, and what to watch for.
PLUS
24 Down With OTC
Advice for treating side effects and comorbidities.
29 5 Ways to Manage RX Costs How to save as prices soar
39 Nix The Fake Drugs
Black market meds may save money— and may also kill you.
43 Get Help Paying for Meds Money saving prescription drug programs in every state.
48 Why We Should Never Stop Talking About Being Undetectable
Having your viral load under control leads to safer, not riskier, sex.
ON THE COVER (from left): Kelsey Louie, photographed by Chris Hayden; Phill Wilson, courtesy of Black AIDS Institute; and Paul Kawata, photographed by Julie Napear
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phill wilson won’t shut up silence still equals death for people of color, which is why black aids institute founder phill wilson is shouting “fire!” by karen ocamb
S
I L E N C E = D E AT H was a rallying cry publicized by the AIDS
activist group ACT UP in the early 1980s. Well before that, black, lesbian, feminist poet Pat Parker wrote, “Where will you be when they come?” Her 1978 poem held up a moral mirror up to the LGBT world, challenging closeted gays and lesbians to forsake the pretentious protection of silence and speak out against the slurs, attitudes, and actions that demean and dehumanize all LGBT people. “Citizens, good citizens all/parade into voting booths and in self-righteous sanctity/X away our right to life,” Parker wrote. The poem still has profound meaning for many, including Phill Wilson, the long-term HIV-survivor and founder of the highly-regarded Black AIDS Institute who just turned 60. Wilson was 25 years old in 1981, when he and his boyfriend, Chris Brownlie went to a doctor about their swollen lymph nodes. “Our doctor didn’t know much,” Wilson says now. Even after their doctor suggested it could be related to a mysterious disease called GRID (Gay-Related Immune Deficiency), Wilson recalls, “No one had any information.” Then members of their gay Chicago softball team got sick and died in a matter of weeks. “That’s when it became real.” Wilson and Brownlie moved to Los Angeles the following spring and got involved in the organization Black and White Men Together. “That’s when it got scary,” he says. “We had four or five friends sick at a time and we realized that nobody [else] gave a damn. Either we were going to die or we were going to have to fight—and still we might die.” Pondering whether to “die, or fight, or both,” Wilson kept thinking, “I had just met Chris. I had just found myself. I wasn’t ready to let either go.” It was a jarring epiphany. He decided to fight. “We fought to make sure we did whatever we could to not die—and to make sure our friends did not die.” In some ways, Wilson was spiritually prepared for the fight. “When you are a poor black kid in the 1950’s living in a housing project on the south side of Chicago, there is a lot your parents cannot do or provide,” Wilson says. “But what they can do is to make sure you know that you are loved and you matter.” Wilson’s parents also gave him a sense of responsibility and nurtured his early appreciation of his own “privilege.” He recalls starting kindergarten with a friend of his, a girl with darker skin and fewer resources. Although he already knew how to read and tie his shoes, she didn’t. A teacher’s favorite because he was “cute,” Wilson tried to help his friend, but faced disapproval from teachers. The friends were separated and his
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ARNOLD TURNER/INVISION/AP
Jamar Rogers (left) and Phill Wilson at Robi Reed’s 10th Annual “Sunshine Beyond Summer” Celebration—The Day Party with a Purpose at the Getty House in Los Angeles
friend eventually dropped out of school and became a teenage mother. “I blamed that kindergarten teacher,” he says. “To this day, I believe I could have helped her.” Wilson says, “It was the first time I realized that people could be treated differently because of the way they looked.” In 1986, being treated differently reached a horrific new level with Proposition 64, a California initiative that proposed rounding up and quarantining people with AIDS in concentration camps, which had been sponsored by antigay right winger Lyndon LaRouche. After defeating the initiative, Wilson, Brownlie, Michael Weinstein, Mary Adair, and others activists founded the AIDS Hospice Foundation, which later became the AIDS Healthcare Foundation—now one of the world’s largest HIV service providers. This launched Wilson’s 30-year career fighting against AIDS and for civil rights. He became the director of Stop AIDS Los Angeles, then director of public policy and planning for AIDS Project Los Angeles, co-founder of the National Black Gay and Lesbian Leadership Forum, Los Angeles City AIDS Coordinator, member of the Presidential Advisory Council on HIV/AIDS (PACHA), and eventually, in 1999, founder of the Black AIDS Institute. He’s also
become a frequent guest and expert talking about HIV on TV talk shows (including The Oprah Winfrey Show). Wilson also continued fighting hard to stay alive, taking every HIV drug as it became available (AZT, 3TC, D4T, and others) even as Brownlie succumbed to AIDS-related complications in 1989. By 1997, Wilson says he was on death’s door but still refused to believe it was his time to die. The miracle of combination drug therapy saved his life, as it did for countless others in the late ’90s. Today, widespread access to highly active antiretrovirals has transformed HIV into a chronic but manageable condition for many, which leads some to believe that the AIDS epidemic is over. Not so, counters Wilson, noting that HIV remains a crisis, particularly in black and Latino communities. “Our house is on fire!” Wilson proclaims at every opportunity, hoping others listen, heed his call and respond to the emergency. It’s time for activists to stand their ground and fight back. As Pat Parker might have asked, “Where will you be when HIV comes?”
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8 | JULY / AUGUST 2016
leader of the band pau l k awata h a s t u r n e d n m ac i n to a n o rg a n i z at i o n d e m a n d i n g n o l e s s t h a n racial justice to end the hiv epidemic by diane anderson-minshall
JULIE NAPEAR PHOTOGRAPHY
P
AU L K AWATA’ S A R R E S T outside the White House in 1987 was so civilized, so orderly and orchestrated, you’d think it was little more than empty symbolism. Chained to the gates of the White House to protest then-President Ronald Reagan’s lack of response to the AIDS epidemic, he and the other LGBT activists were told to sit down on the ground in order to be arrested. Kawata, ever stylish, didn’t want to dirty a new cashmere jacket, so a Capitol Police officer got him a blanket to sit on. But back on the bus and handcuffed for hours waiting to be processed, things took a turn for the worst, especially for the protestors living with HIV. Not long before, many of them had started taking the first FDAapproved HIV drug, AZT. That was a time when people were still dying soon after diagnosis. AZT—as tough as it was on the immune system— was the first medication to offer any hope. Though many poz folks shared their prescriptions with friends who couldn’t get their own, AZT’s success, doctors said, required you to be religious about adherence. But how do take your HIV meds when you’re handcuffed? Creatively, recalls Kawata. He and his friends worked in teams to open AZT capsules, pour out the contents, and then lick the meds off the bus seats—all without water to wash them down. Earlier that same year Kawata founded the National Minority AIDS Council with a few other activists in response to the American Public Health Association’s first AIDS workshop, held without any speakers of color. Fueled by the same rage, grief and loss that drove him that day at the White House, Kawata has been at the helm of that organization— recently re-branded NMAC—ever since. He’s gathered strength from the battle, too, and has never wavered in his convictions about having people of color involved in this fight. Today, he’s one of two Asian-American gay
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men heading up the country’s major HIV organizations (along with GMHC’s Kelsey Louie), a fact not lost on him. “I came to Washington in 1985 to fight an epidemic,” the executive director of NMAC says now. “Back then my race didn’t matter because there were so few of us fighting the disease. By the time it could be an issue, I was so ensconced in the fight that I had proven my value as an ally and friend. I also had some great mentors who ‘vouched’ for me.” Indeed, though use of the phrase “minority” has fallen out of favor since the group was named in the 1980s, the organization’s commitment to confronting the role race has played in the now 35-year-old epidemic has been strengthened even more since a 2014 mission re-envisioning. Kawata, who had been at the helm of the organization over two decades (in the world of AIDS activism, he jokes those are “dog years”), took a sabbatical in 2010. When he returned, he was reinvigorated but also frank, telling reporters, “It’s going to take time, maybe the rest of my life, to understand and put into perspective the enormity of the grief and loss so many of us experienced. This sabbatical was the first time I stopped to examine those horrible years and the friends I lost along the way. Like many of the survivors of this pandemic, good mental health seems just out of my reach.” That grief has never stopped Kawata, whose own mission is so strongly tied to NMAC that one can’t help but admire him for making the recent organizational pivots, many the result of a year-long strategic planning process that cumulated with the amendment of NMAC’s name, mission, and vision. “Our new mission was that NMAC will lead with race to urgently fight for health equity and racial justice to end the HIV epidemic,” says Kawata. “NMAC leads with race because we believe that to end the HIV epidemic, we must come to terms with race and its impacts on HIV care, services, and prevention.” The activist admits that too often strategic plans “become paper weights that sit in a bookcase,” but for NMAC, “strategic planning was transformative. It created a new focus and commitment for the staff, board, and constituents. We had permission to talk about racism and the pain that was core to so many of our lives.” What NMAC and others are acknowledging (and perhaps what many activists in the South have known for years) is that though we call it the AIDS epidemic, there’s clearly more than one. “One of NMAC’s biggest concerns is that we will end the epidemic in San Francisco,
10 | JULY / AUGUST 2016
Boston, and New York,” Kawata admits. “But what about Oakland, East L.A., or Anacostia? Don’t get me wrong, we are thrilled for San Francisco, Boston and New York City, but we must always remember that ending HIV in America means ending the epidemic in Newark, Little Havana, and the south side of Chicago, too.” He’s not shy about the “why” behind these discrepancies: “The different epidemics in HIV are based on economics,” Kawata says bluntly. “Communities with access to healthcare, insurance, and a strong social service network are better prepared to meet the challenges of HIV. So we will end the epidemic in certain communities while HIV continues to ravage the have-nots.” So is it time to rethink America’s HIV prevention agenda? “Yes, yes, yes!” Kawata demands. “To fully access the promise of biomedical HIV prevention, health departments and community-based organizations need to modify their infrastructures to meet the demands of a healthcare-centered approach to prevention.” He argues that “those organizations that are not able to adapt will probably close their doors,” largely because when “HIV care is also HIV prevention, there are new expectations about how to be effective. Reduction in the number of newly-infected individuals and increasing rates of viral suppression should be the gold standard for success.” Unlike some leaders, Kawata is bullish on the science behind HIV prevention as well. “Given the latest science, all people living with HIV should be retained in care and on treatment that suppresses their viral load. Everyone who is sexually active should also be retained in care, regularly tested, and treated for sexually-transmitted infections, and educated or prescribed PrEP (pre-exposure prophylaxis).” The longtime survivor was buoyed by a report out of Denmark in May that documented the success of Treatment as Prevention (TasP). “The report postulated that TasP could work in resource rich countries,” he says. “I’m not sure what that means for America; however, regardless of the public health benefit of treatment, all people living with HIV should be retained in care and on treatment for their individual benefit. That’s what makes this so important—we have an opportunity to prolong the lives of people living with HIV using the same mechanism that would also bend the curve of new HIV infections.” Kawata “believes at my core that our work must follow the data,” he adds. “The data
should drive programs, funding, and target populations.” For that, he’s also tapped into some unexpected funding sources: namely real estate. Earlier this year, NMAC sold their former corporate headquarters to EastBanc for $4 million. In 1993 the organization had purchased “a burned out shell of a townhouse,” in a building that had been destroyed in the “riots and fires that engulfed D.C. after Dr. Martin Luther King was assassinated.” Thanks to gentrification, the value of the property skyrocketed and NMAC decided to sell in order to use the extra cash to “quickly develop programs without waiting for government or corporate funding.” Their revamped Treatment program and their new Leadership Pipeline, are two examples of arenas where that quick funding helped out. The latter strives to “promote integration of racial and social justice within NMAC’s overall projects and engage new and emerging leaders with existing champions to build networks between the past, present and future response to HIV.” It also brings together dozens of youth scholars from around the country to attend NMAC’s flagship program: The U.S. Conference on AIDS. The largest gathering of its kind in the country, the 20th annual USCA will be held in September in Southern Florida, an ideal location for this year’s target population: people from the Caribbean diaspora. If Kawata has any say, it’ll be filled with as many opinionated activists as it was last year, when he was interrupted on stage by a “Trans Lives Matter” protest. Instead of shutting it down, Kawata asked the crowd to give the women and men leading the protest a round of applause. “Our movement was founded on the value of protests and civil disobedience,” he says now. “It is in our DNA and something that I will always support. Last year’s protest was a continuation of that great tradition. The protest focused on the White House Office of National AIDS Policy and was not really about NMAC; however, we have been the target of their concerns in the past.” The protest was arguing for transgender inclusion in testing, treatment, and clinical trials, among other things—and for just plain listening to the needs of trans people living with HIV or AIDS. “I will never fully understand what is means to be transgender,” Kawata admits. “But that does not mean I cannot support and stand in solidarity with them.” The conference has moved towards more trans-inclusivity in recent years, with everything from gender neutral bathrooms to
scholarships for transgender attendees. “This year we will continue our work with the trans community,” he says. “This year’s Trans Pathway is being coordinated by TransLatin@ coalition and Positively Trans. We will also have gender neutral bathrooms, a trans lounge, free exhibit space, scholarships for trans delegates, and trans speakers at plenary sessions.” There are only a handful of plenaries, so this feels like a meaningful change. It’s all part of Kawata’s belief that when it comes to HIV, we need the LGBT community to help lead, even in the face of stigma. “Separating HIV stigma from LGBT stigma seems impossible. Maybe that is why the LGBT community must continue to fight HIV. The world sees our issues as inextricably intertwined. It was the LGBT community that first stood up to fight a virus that was killing our friends. I remember hospital trays left in hallways, funeral directors that would not cremate our dead, and families that would abandon their children.” He’s quick to note, “HIV is not a gay disease, but it has forever changed the LGBT community.” It’s changed him too. He still tries to retain some privacy, he says, withholding details of his family and his age, though admitting the latter is partly about vanity (after all, this is still the guy who wouldn’t get his cashmere dirty). But, he adds, “I never thought I would live to be this old, but it seems real disingenuous to complain when there are so many friends who are not here.” It’s hard to figure out what he’s proudest of, if anything, in his storied career as a fighter. “It’s hard to be proud of anything when you are still fighting an epidemic,” he admits. “Ask me this question when it’s over. I hope to be alive when that happens. That moment will be the proudest moment of my life.” No matter what, he’s lived long enough to know he made his father proud, something many gay, HIV-positive men of his generation weren’t able to do. “Right before my father passed, he saw me receive an award at a World AIDS Day breakfast in Seattle,” Kawata recalls. “Sitting at one of the front tables, he was the first to stand and clap at the end of my speech. As we were walking out of the auditorium, he introduced himself to strangers and told them he was my father. Given he was the only old Asian guy in the room, most of the people had already guessed this fact, but he continued to tell everyone he was my father and that he was so proud of me. I will always be thankful for that gift.”
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kelsey louie is transforming the venerable gmhc from inside out by tyler curry and jacob anderson-minshall
12 | JULY / AUGUST 2016
CHRIS HAYDEN PHOTOGRAPHY
the metamorphosis man
I
N AC T I V I S T C I RC L E S , where longterm survivors offer a world weary but wise perspective as leaders, some still think of Kelsey Louie as the new kid on the block. Still baby faced at 41, the executive director of GMHC “was too young to have my peer group decimated by the epidemic. However, the generation right before me certainly was. A lot of my mentors and some colleagues and some friends certainly were impacted during that time in the ’80s. I just wanted to give back.” Wanting to be of service, both to the LGBT world and to those impacted by HIV, Louie started as a child therapist and social worker (he has an MSW from NYU and an MBA from Columbia), focused on issues around substance abuse. That experience gave him an understanding of “the impact of substance abuse and mental health issues, related to HIV and AIDS.” His first job in the HIV-world was as clinical coordinator at GMHC in 2006. He then spent seven years at Harlem United Community AIDS Center, where he “learned the importance that housing plays in the AIDS epidemic and how stable housing is critical.” He continued to move up at Harlem United, eventually becoming the chief operating officer before returning to GMHC, this time as chief executive officer. Louie took over GMHC, New York City’s largest HIV service organization, after tumult threated to tear the organization apart. The board of directors had ousted former CEO Marjorie Hill, who reportedly had angered both staffers and clients with opaque decisions about money, pay cuts, and the group’s spacious new offices that critics argued squandered money. Hill’s departure was painted as a mutual decision, but it’s safe to say, at best, Louie walked into a situation with folks who were cautious all around him. What he did next surprised some. He listened. And some say it was a long time coming. “One of the things that I do at GMHC is that I listen,” Louie says. “I listen to the current clients, I listen to the staff, I listen to my mentors, I listen to long-term survivors. It’s proven to be very valuable to me to listen more and to listen before I take action.” He had to start by rebuilding the relationships with both clients and overworked staff. “I wanted to make sure that the staff felt that they can be proud of working at GMHC. They have a lot of input into the decisions that I make,” he says. He was also intent on making “sure that we are good stewards of public and private dollars and making sure that we’re making the most out of every dollar that we have.” One of his earliest decisions was to consolidate GMHC’s
14 | JULY / AUGUST 2016
space, the offices that were such a point of contention. “We gave up the entire seventh floor and reduced our space by 25 percent, which reduced our rent by 25 percent.” And he mended fences, something that paid off not just in PR and goodwill but on his own professional bucket list. “One of the most exciting things that I have done in my entire career— and life—is to re-engage Larry Kramer back into the arms of GMHC,” says Louie. “And how powerful and meaningful it was for him to receive that embrace and to openly and publicly call GMHC his first child. And for him to push me to make sure that GMHC is being loud in the areas that we need to be and for others to be [quiet]. It’s a lot to live up to.” Kramer, who co-founded what was then called Gay Men’s Health Crisis in 1983, was later booted from the organization because of his brash and often controversial methods of raising awareness about the AIDS epidemic. His story was loosely translated into The Normal Heart, which became a blockbuster film in 2014 starring Mark Ruffalo and Julia Roberts. Over 30 years later, Louie welcomed Kramer back into the fold at GMHC last year, and recently honored Kramer and another surviving founder, Dr. Larry Mass, telling the crowd that the two founders’ “refusal to accept political paralysis and the early public apathy toward the AIDS plague truly changed the world.” “Without Larry Kramer and our founders, there would be no GMHC,” Kelsey later told The Advocate. The founders’ “activism, their relentlessness in the face of a terrifying, unknown disease saved countless lives. Mr. Kramer’s impact is very hard to measure, because it’s so profound and so far-reaching.” Louie himself wants to have a similar impact and he’s brought about some sweeping changes at GMHC to do so. Some symbolic, others substantive, together they make it clear that Louie is determined to stop at nothing short of metamorphosis with New York’s largest HIV service organization. He’s proud that after just two years, “almost all of our processes are [now] transparent,” a bold decision for an organization long charged with being secretive. He’s investing in GMAC’s staff with a new job training program, and doubling down with some heavy-duty partnerships, including some that demonstrate what Louie sees as the intersectional issues at the core of GMHC’s mission. The organization played a significant role in New York’s Blueprint to End the AIDS Epidemic by 2020. What started as a governor’s task force became a 63-person coalition that detailed the efforts needed to reach that goal. It’s a simple plan on paper: identify everyone with HIV, get them into care, and get their viral load suppressed so they can’t transmit HIV to others; while simultaneously getting people at risk for HIV on PrEP so they stay HIV-negative. But the task ahead is staggering: reduce the number of new HIV infections to just 750 (from an estimated 3,000) by 2020 and achieve the first ever decrease in HIV prevalence in New York State. “What came after [the blueprint] is the real, actual work,” says Louie. “What we did is we partnered with other organizations to really attack certain recommendations from that blueprint. For example, we worked with SAGE to work with the older adults and long-term survivors. We have a bunch of strategic initiatives that we turned into action plans rather than things that will sit on a shelf.” GMHC engaged on a federal level too, working with the White House to develop “the National HIV/AIDS Strategy updated to 2020. We’re really strategizing and really capitalizing on all of our resources,” he says. And he says, we can’t forget GMHC’s “not so obvious partners…like Planned Parenthood. We stood in support of Planned Parenthood because they provide hundreds, if not thousands, of HIV tests every year.”
There were also “three simple but meaningful changes” to their logo, a reflection of where and who they are now. “First we changed the color from magenta to red, honoring our past— we wanted to go back to the traditional color of HIV and AIDS. Second, we changed the words ‘Fight AIDS’ to ‘End AIDS.’ And we changed the phrase ‘Love Life’ to ‘Live Life’ because all of our services are geared towards helping people live full and rewarding lives, regardless of their HIV status.” Those may seem small and symbolic, but even clients tell us they’re seeing changes afoot. For many, it’s about knowing they have Louie and his staff’s attention, something many say is happening more now than ever. He’s not only talked to, but has been moved by conversations with long-term survivors who felt forgotten, and with trans people who share similar concerns. One trans client begged Kelsey, “Louie, please use your privilege to help us. Based on the numbers of people who are dying—we are facing our own epidemic.” Indeed, as 60 percent of trans women of color are HIV-positive, there’s an urgent need there. “When you look at the data,” Louie says, “the transgender population is disproportionately impacted by HIV. To know that we could be doing more for them, for our trans brothers and sisters is so critical to what we do. We won’t end the epidemic unless we address this population as well.” Louie feels a particular debt to long-term survivors, the gay and bi men who really formed the GMHC community decades ago. “With the long term survivors, to think that GMHC was no longer meeting the needs of a particular group that we were built to serve, really impacted me,” he admits. “So much that I knew that we needed to do something.” In response the organization enhanced their programs for long-term survivors and re-launched their Buddy Program, which was one of GMHC’s earliest services. Both of those conversations impacted Louie greatly, and in turn impacted the services and leadership GMHC has pursued. The group has been a leader on PrEP education in New York, hosting workshops and science-driven panels for gay and bi men, trans women, and other folks who are most at-risk. “We have a tool that can prevent HIV infection,” Louie says. “Could you imagine what would have happened if we had a pill that could prevent HIV in the ’80s? I’m alarmed at the low uptake of PrEP.” The group’s biggest change yet is still in the works, but it’s a critical part of GMHC’s strategic plan going forward.
“When I first got here… clients [weren’t] really engaged or receiving integrated care. Only 10 percent of our clients were receiving more than one service. Most people were coming in for a hot meal and leaving [or] coming in for a legal services and leaving. We all know that disjointed and uncoordinated care is not as effective as integrated care. We realigned all of our programs to make it easier for staff and clients to understand what we were doing and what we offered. We’re excited to say that right now about 30 percent of our clients receive more than one service. We’re doing more to coordinate their care.” Next up, the organization is going to secure a mental health and substance use license so they’ll be able to expand those services. “More importantly, or larger, is we have decided to pursue health care. Over the last 30-plus years, GMHC has been a cornerstone of HIV/AIDS care, prevention, and support. In order to really move us past the finish line and end this epidemic, we believe that we need to offer medical services.” Louie boasts “that of the people that test positive at our testing center, 90 percent of them become virally suppressed, because of the model that we use to connect people to medical care. It’s that 10 percent that continue to drive the epidemic. We believe that if we can offer our own health care we can capture some of that 10 percent. If we offer healthcare, we might be able to connect even more people to healthcare. So, that is our vision for the next few years—to pursue our own medical license.” That all takes money, of course. “In recent years we’ve been saying, ‘We have the data, and we have the tools—all we need is the political will.’ We’re not there fully because right after political will comes dollars. We need the dollars …[for] programs and health care and access to medication. But we also need to address the secondary drivers of the epidemic: stable housing, mental health, mental illness and substance abuse issues, stigma, racism.” The leader’s speech at GMHC’s spring gala touched on those issues, too, using translation as the key: “Sometimes translation is required to ensure the same meaning for all,” he said. “Translating science into policy is required when irreversible disease progression is an absurd prerequisite to house a homeless person living with HIV. Translating statistics into action is required when the same inequities in access to treatment are repeated again and again in access to PrEP, for black men who sex with men, and high risk women. Translating statistics into action is required when 25 percent of all Latino MSM, and 50 percent of all black MSM are projected to contract HIV during their lifetime. Translating statistics into action is required when Trans women of color are disproportionately impacted by HIV…Translating headlines into real resources is required when flashy press events, hosted by politicians, do not yield the budgeted dollars promised.” Sometimes it’s not about politics or policy, he admits. What he’s fighting is simply the stigma of HIV, of seroconversion itself, and even people with HIV’s own feelings about being poz. “A lot of people don’t think it’s a problem anymore, or not as big as a problem. [Because of] stigma that’s related to it, people don’t talk about it. When people don’t talk about it or are afraid to talk about it, they certainly won’t get tested, they certainly won’t go to health care, and they certainly won’t stay in treatment.” There’s positive change, but, he says, “Stigma has come a long way in becoming a big, bold cap issue for most HIV service organizations. Now what does that mean? You can’t attack stigma [just] one way because it comes in multiple forms. I talk to a lot of HIV positive people who whenever I talk to them I’m like, ‘Your biggest problem is your internal stigma. You are judging yourself before you even utter the words; you can’t even get out the gate because you haven’t actually experienced any real encounter that would make you feel this way but you’ve assumed yourself into a hole.’”
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Editor’s note: This info was culled from the National Institutes of Health’s drug database, the FDA, and the individual pharmaceutical companies.
16 | JULY / AUGUST 2016
A NA GA SSENT/F LI CKR
COMPILED BY TRUDY RING, ELAINE MENDUS, and JACOB ANDERSON-MINSHALL
PHOTO CREDIT
MORE THAN EVER, it’s clear that getting on, and staying on, treatment is the smartest thing those of us with HIV can do. Based on two large clinical trials—START and TEMPRANO— the Centers for Disease Control and Prevention now recommends that everyone with HIV start antiretroviral treatment immediately, regardless of CD4 count, both because it’ll reduce your risk of problems down the line and because it helps reduce transmission of HIV to others. To help, Plus offers our most comprehensive guide to the medications approved by the Food and Drug Administration for the treatment of HIV and opportunistic infections.
2016 HIV Treatment Guide HIVPLUSMAG.COM
| 17
PROTEASE INHIBITORS
Help prevent replication of HIV; drugs in this class block activation of protease, an enzyme HIV needs to reproduce.
Medication APTIVUS g e n e r i c n a m e : Tipranavir maker:
Boehringer Ingelheim
CRIXIVAN generic name: maker:
Indinavir
Merck
INVIRASE generic name:
Saquinavir
Mesylate Hoffmann-La Roch
maker:
KALETRA generic name:
and Ritonavir m a k e r : Abbvie
Lopinavir
traditional dosage
drug interactions , precautions , and recommendations
side effects
500 mg (two 250 mg capsules or 5 milliliters of oral solution) with 200 mg (two 100 mg capsules/tablets or 2.5 milliliters of solution) of Norvir, twice daily. If taken with Norvir capsules or solution, may be taken with or without meals; if taking Norvir tablets, must be taken with meals
For treatment-experienced patients only. Take with at least two other anti-HIV drugs, but do not use with other protease inhibitors. Do not take with Rifadin, ergot derivatives, Saint-John’s-wort, certain antiarrhythmic drugs, Revatio, Uroxatral, Altoprev, Mevacor, Orap, Zocor, or Halcion. If taking birth control pills, switch to another method of contraception. Use with caution with Flonase, Viagra, Cialis, Levitra, or Seroquel, or if taking certain antiseizure medications. Use with caution if you have hemophilia or other conditions that increase the chance of bleeding, or liver disorders.
Most serious: severe or fatal liver disease, severe bleeding in the brain, new or worsened diabetes
800 mg, taken every eight hours, with water or another beverage, without food (one hour before or two hours after a meal) or with a light meal
Do not take with oral Versed, Propulsid, Zocor, Mevacor, Orap, Cordarone, Hismanal, Halcion, Xanax, Revatio, Uroxatral, Rifadin, Rimactane, Rifamate, Rifater, Saint-John’s-wort, Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate, Methergine, or Reyataz. Use with caution with Viagra, Cialis, Levitra, Lipitor, Seroquel, and Crestor. Drink plenty of fluids and do not take the drug with meals that are high in calories, fat, and protein.
Most serious: liver failure, kidney stones, changes in body fat, diabetes, anemia, severe pain, muscle weakness
1,000 mg (five 200-mg capsules or two 500mg tablets), in combination with 100 mg of Norvir, twice daily, at least two hours after a meal
Do not use with Aptivus-Norvir combination, Uroxatral, Cordarone, Vascor, Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot medications such as Parlodel, Migranal, Ergonovine, Bellamine, Cafergot, Ergomar, Methergine, or Permax, oral Versed, Orap, Rifadin, Revatio when used to treat pulmonary hypertension, Mevacor, Advicor, Zocor, Juvisync, Simcor, Vytorin, Desyrel, Oleptro, Halcion, Saint-John’s-wort, garlic capsules, or fusidic acid products. Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Rescriptor, 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, Congenital Long QT Syndrome, or complete atrioventricular block. Use with caution if you have other heart or liver problems, hemophilia, or diabetes.
Most serious: worsening of liver problems, increased bleeding with hemophilia, diabetes or high blood sugar, elevated cholesterol or triglycerides, changes in body fat, immune system, or heart rhythm
Do not take with Halcion, midazolam oral syrup, certain steroids, Incivek, Orap, Mevacor, Zocor, Rimactane, Rifadin, Rifater, Rifamate, Revatio when used to treat pulmonary arterial hypertension, Stendra, Uroxatral, Victrelis, Xarelto, Saint-John’s-wort, ergot-containing medicines, including ergotamine (Cafergot and others), dihydroergotamine (D.H.E. 45 and others), ergonovine (Ergotrate), and methylergonovine (Methergine). Use with caution with Viagra, Cialis, Levitra, Adcirca, birth control pills or contraceptive patches containing estrogen, Tasigna, Sprycel, Lipitor, Crestor, Atripla, 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.
Most serious: changes in heart rhythm, severe liver problems, pancreatitis, changes in immune system, changes in body fat, new or worsened diabetes, elevated triglyceride or cholesterol levels
800 mg, typically four tablets, once daily, or 400 mg, typically two tablets, twice daily. Swallow tablets whole; do not chew, break, or crush. An oral solution is available but should be taken with food
18 | JULY / AUGUST 2016
Other: diarrhea, nausea, fever, vomiting, tiredness, headache, stomach pain
Other: abdominal pain, fatigue or weakness, low red blood cell count, flank pain, painful urination, feeling unwell, nausea, upset stomach, diarrhea, vomiting, acid regurgitation, increased or decreased appetite, back or shoulder pain, headache, dizziness, taste changes, rash, itchy skin, yellowing of the skin and/or eyes, upper respiratory infection, dry skin, sore throat
Other: Nausea, vomiting, diarrhea, fatigue, abdominal pain
Other: diarrhea, nausea, stomach pain, vomiting, weakness, headache
Medication LEXIVA generic name:
Fosamprenavir m a k e r : ViiV Healthcare
NORVIR generic name: maker:
Ritonavir
AbbVie
PREZISTA generic name: maker:
Darunavir Janssen
REYATAZ generic name:
Atazanavir m a k e r : Bristol-Myers Squibb
VIRACEPT generic name: maker:
Nelfinavir ViiV Healthcare
traditional dosage
drug interactions , precautions , and recommendations
side effects
For those used to protease inhibitors, 700 mg plus a 100 mg capsule of Norvir, twice daily. For those new to therapy, 1,400 mg of Lexiva twice daily, sometimes paired with Norvir, depending on the patient. Lexiva is available in tablets or oral solution; tablets can be taken with or without food, oral solution without food. Reduced dosage recommended for patients with liver impairment
Do not take with Incivek, Victrelis, Rescriptor, Uroxatral, Rifadin, Rimactane, Saint-John’s-wort, certain arrhythmia medications, ergotbased medications, Propulsid, Zocor, Mevacor, Orap, Revatio when used to treat pulmonary arterial hypertension, Versed, or Halcion. If you take oral contraceptives, consider alternative birth control methods. Do not take with Viramune unless also taking Norvir. Use with caution with Seroquel, H2 blockers and calcium channel blockers. Do not use if you have Stevens-Johnson syndrome or if you take drugs that use the enzyme CYP3A4 to metabolize.
Most serious: severe skin reactions including Stevens-Johnson syndrome, new or worsened diabetes, redistribution of body fat, elevated cholesterol, anemia, spontaneous bleeding, kidney stones
600 mg (six 100 mg tablets), twice daily, with a meal. Swallow tablets whole with water; do not chew, break, or crush. Also available in capsules or oral solution. Reduced dosage recommended for people taking other protease inhibitors
Do not take with Xatral, Cordarone, Tambocor, Vascor, Rythmol, Fucidin, Hismanal, Seldane, Orap, Propulsid, Cafergot, Migranal, D.H.E. 45, Ergotrate, Maleate, Vfend, Mevacor, Zocor, Halcion, Versed, Advair, Serevent, Levitra, Revatio if used for pulmonary arterial hypertension, Saint-John’s-wort. Do not take with both Invirase and any version of rifampin (Rimactane, Rifadin, Rifater, or Rifamate), and use with caution with either of those drugs separately. Use with caution with Seroquel, Olysio, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Tracleer, Rapamune, Flonase, Crixivan, Viracept, Videx, Mycobutin, Aptivus, Rescriptor, Reyataz, Celsentrin, Telzir, Prezista, Tiazac, Adalat, Isoptin, Nizoral, Sporanox, Demerol, Tegretol, Dilantin, phenobarbital, Mycobutin, Biaxin, Duragesic, theophylline, Colcrys used for treatment of gout, certain anticancer medications, certain antidepressants. Use with caution if you have other liver problems or diabetes.
Most serious: worsening of liver disease, pancreatitis, diabetes or high blood sugar, elevated cholesterol or triglycerides, changes in body fat, increased bleeding among hemophiliacs, severe skin reactions
One 800 mg tablet with one 100 mg Norvir capsule, once daily, with food, or one 600 mg tablet for patients without drug resistance
Do not take with Uroxatral, Victrelis, D.H.E. 45, Embolex, Migranal, Cafergot, Ergomar, methylergonovine, Propulsid, Orap, oral midazolam, Halcion, Saint-John’s-wort, Mevacor, Altoprev, Advicor, Zocor, Simcor, Vytorin, Rifadin, Rifater, Rifamate, Rimactane, Revatio when used to treat pulmonary arterial hypertension, Crixivan, Kaletra, Invirase, or Incivek. Use with caution if taking Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Seroquel, Colcrys, or Col-Probenecid, Coartem, or Riamet. May reduce birth control pills’ efficacy; take other precautions.
Most serious: severe liver disease, severe rash or pustules, high blood sugar or diabetes, changes in body fat or immune system
Do not take with Versed, Halcion, Cafergot, Migranal, D.H.E. 45, Methergine, other ergot medicines, or Orap, Camptosar, Crixivan, Mevacor, Zocor, Uroxatral, Revatio, Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Viramune, Diskus, or Advair. Do not take Vfend or Victrelis if you are taking Reyataz and Norvir, and do not take Tegretol, Dilantin, or drugs containing phenobarbital with Reyataz alone. If you are taking Videx, Videx EC, or antacids, take Reyataz two hours before or one hour after those medicines. Use with caution if taking drugs for indigestion, heartburn, or ulcers; depression; allergies or asthma; abnormal heart rhythm; blood clots; cholesterol; erectile dysfunction; gout; and certain other conditions. If taking Reyataz with Norvir and also taking Lamictal, dosage of the latter may need to be adjusted.
Most serious: severe rash, yellowing of skin or eyes, heart rhythm change, diabetes, kidney stones, changes in body fat, changes in immune system, worsening liver disease, increased bleeding problems, gallbladder disorders
Do not take with Cordarone, Orap, Quinidine, Quinaglute, Cardioquin, Quinidex, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Methergine, Halcion, Versed, Revatio if used for pulmonary arterial hypertension, Uroxatral, Prilosec, Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Mevacor, Zocor, or Serevent. Use with caution with Seroquel, Lipitor, Crestor, Pravachol, Lescol, Viagra, Levitra, Cialis, Adcirca, or Tracleer. If also taking Videx, take Viracept with food one hour after or more than two hours before you take Videx. May reduce effectiveness of birth control pills, so use additional or alternative form of contraception. Doses of Crixivan, Norvir, Invirase, Fortovase, Mycobutin or Dilantin may need to be adjusted. Rescriptor may lower the amount of Viracept in the blood or vice versa. Do not take if you have moderate to severe liver impairment.
Most serious: diabetes and high blood sugar, high blood pressure, changes in body fat, changes in immune system
300 mg, in capsule form, taken with 100 mg of Norvir, once daily, with food. For adults unable to tolerate Norvir, 400 mg of Reyataz with food is recommended. Take at the same time every day
1,250 mg (five 250 mg tablets or two 625 mg tablets), twice daily, or 750 milligrams (three 250 mg tablets) three times daily. Each dose should be taken with a meal. An oral powder is also available
Other: diarrhea, rash, nausea, vomiting, headache
Other: rash, abdominal pain, diarrhea, feeling weak or tired, headache, nausea, vomiting, changes in taste, loss of appetite, dizziness, tingling feeling or numbness (n hands, feet, or around the lips)
Other: diarrhea, nausea, mild rash, headache, stomach pain, vomiting
Other: nausea, headache, stomach pain, vomiting, diarrhea, depression, fever, dizziness, trouble sleeping, muscle pain, numbness, tingling, or burning of hands or feet
Other: diarrhea, nausea, rash
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ENTRY AND FUSION INHIBITORS
Help prevent replication of HIV; drugs in this class help block HIV from entering T cells. Drug interactions, precautions, They are always taken with other HIV medications. Traditional dosage
Medication FUZEON GENERIC NAME:
Enfuvirtide
DRUG INTERACTIONS , PRECAUTIONS , AND RECOMMENDATIONS
SIDE EFFECTS
Injection of 90 mg in the upper arm, upper leg, or stomach twice daily
Some people use the Biojector 2000, a needle-free device, to administer Fuzeon, but it can cause nerve pain, tingling, bruising, and collection of blood under the skin.
Most serious: cutaneous amyloidosis at injection site; itching, swelling, redness, pain or tenderness, hardened skin, bumps at the site of injection, allergic reactions, bacterial pneumonia
Roche Laboratories (brand name); Trimeris (generic)
GENERIC NAME: MAKER:
Maraviroc ViiV Healthcare
Side effects
TRADITIONAL DOSAGE
MAKER:
SELZENTRY
and recommendations
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, pancreas problems
300 mg twice daily, or 150 mg twice daily if given with potent CYP3A inhibitors, or 600 mg twice daily if given with potent CYP3A inducers
Do not take Saint-John’s-wort, as it can lower the amount of Selzentry in the blood. Several medications, including Prezista, Kaletra, Reyataz, Sustiva, Atripla, and others, may also affect the amount of Selzentry in the blood. Tell your doctor if you have a history of hepatitis B or C, have heart or kidney problems, of if you have low blood pressure or take medication to lower it.
Most serious: heart or liver disorders, lowered blood pressure when standing up, possible increased risk of cancer and other infections, changes in the immune system, severe rash or allergic reaction leading to hepatotoxicity Other: cough, 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.
Medication ISENTRESS GENERIC NAME: MAKER:
Raltegravir
Merck
TIVICAY GENERIC NAME:
Dolutegravir M A K E R : GlaxoSmithKline
TRADITIONAL DOSAGE
DRUG INTERACTIONS , PRECAUTIONS , AND RECOMMENDATIONS
SIDE EFFECTS
One 400 mg tablet, twice daily, available in oral suspension or chewable tablet for children, with dosage varying by weight
Do not take with antacids that contain aluminum or magnesium hydroxide. Tell your doctor if you take the tuberculosis medication rifampin or if you have liver problems or phenylketonuria. If you miss a dose, skip the missed dose and go back to your regular schedule. Do not double your next dose.
Most serious: severe skin reactions and allergic reactions, liver problems, immune system changes
One 50 mg tablet, once daily for those new to integrase inhibitors or antiretroviral drugs generally, twice daily for those who take certain other antiretrovirals, have taken integrase inhibitors previously and may have resistance to such drugs, or are also taking rifampin, a drug that treats tuberculosis and other infections. Tivicay may be taken with or without food.
Do not take with dofetilide (brand name Tikosyn), oxcarbazepine, phenytoin, phenobarbital, carbamazepine, or Saint-John’s-wort. Do not take with etravirine (Intelence) without coadministration of Norvir (ritonavir) and either Reyataz (atazanavir), Prezista (darunavir), or lopinavir (a combination of ritonavir and lopinavir sold as Kaletra). Take two hours before or six hours after any medication containing polyvalent cations, including certain antacids and laxatives, the ulcer drug sucralfate (Carafate), oral iron or calcium supplements, and buffered medications. Patients who are starting or stopping the diabetes drug metformin at the same time as Tivicay should be monitored closely; dosage of metformin may need to be adjusted. Take during pregnancy only if potential benefit outweighs risk.
Most serious: hypersensitivity reactions characterized by rash, constitutional findings, organ dysfunction (including liver injury); worsening of hepatitis B or C; accumulation or redistribution of body fat; immune system changes
20 | JULY / AUGUST 2016
Other: headache, trouble sleeping, nausea, tiredness, weakness, stomach pain, dizziness, depression, suicidal thoughts and actions
Other: insomnia, headache
New Odefsey is now available Actual Size (15.4 mm x 7.3 mm)
One small pill contains rilpivirine, emtricitabine, and tenofovir alafenamide (TAF).
Ask your healthcare provider if ODEFSEY is right for you. To learn more visit ODEFSEY.com
Please see Brief Summary of Patient Information with important warnings on the adjacent pages.
Brief Summary of Patient Information about ODEFSEY ODEFSEY (oh-DEF-see) (emtricitabine, rilpivirine and tenofovir alafenamide) tablets Important: Ask your healthcare provider or pharmacist about medicines that should not be taken with ODEFSEY. There may be new information about ODEFSEY. This information is only a summary and 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 ODEFSEY? ODEFSEY can cause serious side effects, including: • Build-up of lactic acid in your blood (lactic acidosis). Lactic acidosis may happen in some people who take ODEFSEY or similar 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 • Severe liver problems. Severe liver problems may happen in people who take ODEFSEY. In some cases, these liver problems can lead to death. Your liver may become large and you may develop fat in your liver. 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 – nausea – pain, aching, or tenderness on the right side of your stomach area • You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking ODEFSEY or a similar medicine for a long time. • Worsening of Hepatitis B virus (HBV) infection. ODEFSEY is not approved to treat HBV. If you have HBV and take ODEFSEY, your HBV may get worse (flare-up) if you stop taking ODEFSEY. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. – Do not run out of ODEFSEY. Refill your prescription or talk to your healthcare provider before your ODEFSEY is all gone. – Do not stop taking ODEFSEY without first talking to your healthcare provider. – If you stop taking ODEFSEY, 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 ODEFSEY.
What is ODEFSEY? ODEFSEY is a prescription medicine that is used to treat HIV-1 in people 12 years of age and older: • who have not received HIV-1 medicines in the past and have an amount of HIV-1 in their blood (“viral load”) that is no more than 100,000 copies/mL, or • to replace their current HIV-1 medicines in people who have been on the same HIV-1 medicines for at least 6 months, have a viral load that is less than 50 copies/mL, and have never failed past HIV-1 treatment. It is not known if ODEFSEY is safe and effective in children under 12 years of age or who weigh less than 77 lb (35 kg). When used to treat HIV-1 infection, ODEFSEY may help: • Reduce the amount of HIV-1 in your blood. This is called “viral load”. • Increase 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). ODEFSEY 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. Ask your healthcare provider about how to prevent passing HIV-1 to others. Do not share or re-use 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.
Who should not take ODEFSEY? Do not take ODEFSEY if you also take a medicine that contains: • carbamazepine (Carbatrol®, Epitol®, Equetro ®, Tegretol®, Tegretol-XR®, Teril®) • dexamethasone (Ozurdex®, Maxidex®, Decadron®, BaycadronTM) • dexlansoprazole (Dexilant®) • esomeprazole (Nexium®, Vimovo ®) • lansoprazole (Prevacid®) • omeprazole (Prilosec ®, Zegerid®) • oxcarbazepine (Trileptal®) • pantoprazole sodium (Protonix®) • phenobarbital (Luminal®) • phenytoin (Dilantin®, Dilantin-125 ®, Phenytek®) • rabeprazole (Aciphex®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • rifapentine (Priftin®) • the herb St. John’s wort or a product that contains St. John’s wort
What should I tell my healthcare provider before taking ODEFSEY? Before taking ODEFSEY, tell your healthcare provider if you: • have liver problems including hepatitis B or C virus infection • have kidney and bone problems • have had depression or suicidal thoughts • have any other medical conditions • are pregnant or plan to become pregnant. It is not known if ODEFSEY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking ODEFSEY.
Pregnancy registry: there is a pregnancy registry for women who take HIV-1 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. • are breastfeeding or plan to breastfeed. Do not breastfeed if you take ODEFSEY. – You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. – At least one of the medicines in ODEFSEY can pass to your baby in your breast milk. It is not known if the other medicines in ODEFSEY 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. Some medicines may interact with ODEFSEY. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. • You can ask your healthcare provider or pharmacist for a list of medicines that interact with ODEFSEY. • Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take ODEFSEY with other medicines. How should I take ODEFSEY? • Take ODEFSEY exactly as your healthcare provider tells you to take
• •
• • •
it. ODEFSEY is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection. Take ODEFSEY 1 time each day with a meal. Do not change your dose or stop taking ODEFSEY without first talking with your healthcare provider. Stay under a healthcare provider’s care when taking ODEFSEY. Do not miss a dose of ODEFSEY. If you take too much ODEFSEY, call your healthcare provider or go to the nearest hospital emergency room right away. When your ODEFSEY supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short time. The virus may develop resistance to ODEFSEY and become harder to treat.
What are the possible side effects of ODEFSEY? ODEFSEY may cause serious side effects, including: • See “What is the most important information I should know about ODEFSEY?” • Severe skin rash and allergic reactions. Skin rash is a common side effect of ODEFSEY. Rash can be serious. Call your healthcare provider right away if you get a rash. In some cases, rash and allergic reaction may need to be treated in a hospital. If you get a rash with any of the following symptoms, stop taking ODEFSEY and call your healthcare provider right away: – fever – skin blisters – mouth sores – redness or swelling of the eyes (conjunctivitis) – swelling of the face, lips, mouth or throat – trouble breathing or swallowing – pain on the right side of the stomach (abdominal) area – dark “tea-colored” urine
• Depression or mood changes. Tell your healthcare provider right
away if you have any of the following symptoms: – feel sad or hopeless – feel 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 ODEFSEY. Liver problems can also happen during treatment with ODEFSEY 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 ODEFSEY. • 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. • 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 ODEFSEY. Your healthcare provider may tell you to stop taking ODEFSEY if you develop new or worse kidney problems. • Bone problems can happen in some people who take ODEFSEY. Bone problems may include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones. The most common side effects of rilpivirine, one of the medicines in ODEFSEY, are depression, trouble sleeping (insomnia), and headache. The most common side effect of emtricitabine and tenofovir alafenamide, two of the medicines in ODEFSEY, is nausea. 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 ODEFSEY. For more information, ask your healthcare provider or pharmacist. • Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. This Brief Summary summarizes the most important information about ODEFSEY. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about ODEFSEY that is written for health professionals. For more information, call 1-800-445-3235 or go to www.ODEFSEY.com. Keep ODEFSEY and all medicines out of reach of children. Issued: March 2016
ODEFSEY, the ODEFSEY logo, EMTRIVA, GILEAD, the GILEAD Logo, and GSI are trademarks of Gilead Sciences, Inc., or its related companies. All other trademarks referenced herein are the property of their respective owners. © 2016 Gilead Sciences, Inc. All rights reserved. GILC0216 03/16
h i v s i d e e f f e ct s a n d t h e m e d s t h at t r e at t h e m h e r e a r e a h a n d f u l o f c o m m o n c o m o r b i d i t i e s a n d m e d i c at i o n s i d e e f f e c t s t h at p e o p l e l i v i n g w i t h h i v e x p e r i e n c e — a n d t h e m o s t c o m m o n t r e at m e n t f o r e a c h . side effect : changes in distribution of fat ( lipodystrophy )
h o w c o m m o n : According to AIDS Map, a 2001 study showed that 83 percent of people on certain antiretroviral drugs “experienced some symptoms of lipodystrophy after 21 months of therapy, while 11 percent experienced severe body fat changes.” Another study in France showed that 85 percent of people with HIV taking these drugs experienced at least one physical change during the first 18 months including “increased abdominal wall thickness, enlargement of veins in the legs and arms, increased waist size, and wasting of the lower limbs and/or buttocks.” t r e at m e n t : Some options are injections of polylactic acid (New Fill, Sculptra) in face; liposuction to redistribute fat to other parts of the body; and RX of tesamorelin (Egrifta), which reduces excess belly fat in people who take HIV medicine. side effect : diarrhea
h o w c o m m o n : Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their HIV meds. t r e at m e n t : Three options: over-the-counter anti-diarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Fulyzaq (crofelemer), the only Food and Drug Administration-approved drug to relieve diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Fulyzaq is only the second botanical prescription drug approved by the FDA. side effect : mood changes , including depression and anxiety
how common : In one recent study, according to AIDS Beacon, 63 percent of HIV-positive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.” treatment options : Serotonin reuptake inhibitors (SSRIs) are most effective. According to the National Institute of Health, medications that have shown efficacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxaine, nefazodone, trazodone, bupropion, and mirtazapine. comorbidity : osteoporosis and osteopenia
how common : Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it. t r e at m e n t : Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast. comorbidity : cardiovascular disease
how common : It’s the second leading cause of death among people living with HIV.
t r e at m e n t : A multi-prong approach may include a variety of treatments.
There are cholesterol-lowering statin drugs such as Crestor, Lipitor, Zocor, Vytorin, Lescol, Mevacor, Altoprev, Livalo, Pravachol, Advicor, and Simlup. Programs that help you stop smoking, shed excess pounds, and exercise more are all useful. Reduce alcohol and sodium consumption. If your blood pressure is not in a healthy range, your doctor may prescribe medication. Among the options are ACE inhibitors (Vasotec, Prinivil, Zestril, and Altace); angiotensin II receptor blockers (Cozaar, Atacand and Diovan); beta blockers (Lopressor, Toprol XL,
24 | JULY / AUGUST 2016
WHY TAKE YOUR MEDS? Nearly 30% of individuals with HIV still die from an AIDS-related cause AIDS complications is still the most common cause of death among people with HIV Cancers (15%) were the most frequent causes of non-AIDS deaths Liver disease is second (13%), mainly due to hepatitis) And then cardiovascular disease (11%)
Corgard, and Tenormin); or calcium channel blockers (Norvasc, Cardizem, Dilacor XR, and Adalat CC, and Procardia). comorbidity : diabetes
how common : There’s a type of diabetes caused
by pancreatic damage brought on by HIV medications. It’s less common than the other two types but equally damaging. t r e a t m e n t : Controlling blood sugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easy-to-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more. side effect : hypertension / high blood pressure how common : Very. The U.S. Deptartment of
Veterans Affairs, for example, reports that 45 percent of their patients with HIV also have a hypertension diagnosis. Nobody is sure why; whether it has to do with HIV itself, antiretroviral treatments, or a combination of factors. t r e at m e n t : Stop smoking. Medications include
vasodilators (Hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE Inhibitors (Prinivil, Benazepril), channel blockers (Norvasc, Procardia, Plendil), diuretics (Microzide, Diuril, Zestoretic). —DIANE ANDERSON-MINSHALL
INTEGRASE INHIBITORS
Drugs in this class block integrase, an enzyme HIV needs to reproduce.
Medication VITEKTA generic name:
traditional dosage
drug interactions , precautions , and recommendations
side effects
One 85 mg or 150 mg tablet once daily with food, in combination a protease inhibitor.
Do not take with other medications that contain elvitegravir (such as Stribild), or if you are taking Tybost with a protease inhibitor. Do not take with Sustiva, Viramune, Videx, Videx EC, Rifadin, Rifamate, Rifater, Rimactane, Priftin, Victrelis, Incivek, Saint-John’s-wort. Use with caution with Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin, Phenytek, Luminal, Mycobutin, hormonal contraceptives, if you have liver problems, or if you are pregnant or plan to become pregnant. Do not breastfeed. Dose might need to be increased with methadone. Watch for sedation and cognitive effects if also taking taking Buprenex, Butrans, norbuprenorphine, or Evzio (naloxone). Take antacids at least two hours before or after Vitekta.
Most serious: changes in immune system
Elvitegravir m a k e r : Gilead Sciences
Other: diarrhea, abdominal pain, fatigue
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS) Help prevent replication of HIV; drugs in this class block reverse transcriptase, an enzyme HIV needs to reproduce. Medication COMBIVIR generic name:
Lamivudine and Zidovudine m a k e r : ViiV Healthcare (Brand name); Hetero Labs, Aurobindo, Teva Pharmaceuticals (Generic)
EMTRIVA generic name:
traditional dosage
drug interactions , precautions , and recommendations
side effects
One tablet, containing 150 mg of lamivudine and 300 mg zidovudine (both NRTIs), twice daily
Do not take with other medicines containing lamivudine, zidovudine, or emtricitabine (such as Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir, Atripla, Emtriva, or Truvada). Use caution with if taking interferon alfa, ribavirin, doxorubicin, or ganciclovir. Tell your doctor if you’ve previously had any kidney or liver problems (such as hepatitis or cirrhosis), pancreatitis, or low red/white blood cell counts.
Most serious: low white and red blood cell counts, serious allergic reactions, buildup of lactic acid in blood, liver toxicity, worsening liver disease, pancreatitis, muscle disorders, inflammation, changes in body fat, changes in the immune system, exacerbation of hepatitis B after discontinuation Other: headache, nausea, fatigue, diarrhea, cough, stuffy nose, general discomfort
One 200 mg capsule or 240 mg of oral solution, once daily
Do not use with other drugs containing emtricitabine, such as Atripla, Complera, Truvada, or Stribild.
Emtricitabine m a k e r : Gilead Sciences
EPIVIR generic name:
Lamivudine or 3TC m a k e r : ViiV Health
Most serious: buildup of lactic acid in the blood, liver problems including flare-up of hepatitis B after discontinuation Other: headache, diarrhea, nausea, fatigue, dizziness, depression, insomnia, abnormal dreams, rash, abdominal pain, asthenia, increased cough, rhinitis
300 mg daily, in one or two doses, in tablets or oral solution
Do not take with Emtriva, Combivir, Epzicom, Trizivir, Atripla, Truvada, Stribild, or Complera. Epivir is not recommended for use in combination with zalcitabine. If you have hepatitis C, there is a chance of severe liver decomposition if you are taking combination antiretroviral therapy and interferon alfa drugs for hep C.
Most serious: immune system changes, buildup of lactic acid, severe liver problems, changes in body fat Other: headache, nausea, malaise and fatigue, nasal problems, diarrhea, cough
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NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS) Help prevent replication of HIV; drugs in this class block reverse transcriptase, an enzyme HIV needs to reproduce. Medication EPZICOM generic name:
Abacavir sulfate and Lamivudine m a k e r : ViiV Healthcare
RETROVIR generic name:
Zidovudine
or AZT maker:
ViiV Healthcare; generic versions also available
TRIZIVIR generic name:
Abacavir Sulfate, Lamivudine, and Zidovudine m a k e r : ViiV Healthcare
TRUVADA generic name:
Emtricitabine and Tenofovir Disoproxil Fumarat m a k e r : Gilead Sciences
traditional dosage
drug interactions , precautions , and recommendations
side effects
One tablet, containing 600 mg of abacavir sulfate and 300 mg of lamivudine (both NRTIs), once daily
Do not take if you have kidney problems or are prone to heart disease. Use with caution if you already take Atripla, Combivir, Emtriva, Epivir, Trizivir, Truvada, Ziagen, methadone, or medicines used to treat hepatitis. If you have hepatitis B, do not run out of Epzicom or stop taking it without talking to your health care provider. Your provider should monitor your health and do regular blood tests to check your liver if you stop taking Epzicom. Do not take if you have moderate to severe liver problems, or if you are breastfeeding.
Most serious: severe allergic reactions, buildup of lactic acid in the blood, liver problems
Do not take with other medicines that contain the same active ingredients, including Combivir and Trizivir. Not recommended for use with the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere. Use with caution if taking ganciclovir or interferon alfa (Pegasys, PegIntron). Do not use with stavudine or doxorubicin.
Most serious: low white and red blood cell counts, myopathy and myositis (muscle disorders and inflammation), buildup of lactic acid in blood, severe liver problems, immune system or body fat changes
600 mg a day, taken in divided doses, in tablets, capsule, or syrup. Can also be given as an intravenous infusion, one mg per kilogram of body weight, over one hour, every four hours
Other: insomnia, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever
Other: headache, malaise, nausea, anorexia, and vomiting
One tablet (300 mg of abacavir sulfate, 150 mg of lamivudine, and 300 mg of zidovudine, all NRTIs), twice daily
One tablet, containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate, once daily. In treatment of HIV, Truvada is always used in combination with other drugs In 2012, the FDA approved Truvada for use in HIV prevention among HIV-negative people who are at high risk of acquiring the virus. As prevention must be paired with regular HIV tests; most common side effects headache, abdominal pain, weight loss
26 | JULY / AUGUST 2016
Do not take if you have certain liver problems or weigh less than 90 pounds. Take with caution if you have a particular gene variation called HLA-B*5701, hepatitis B, kidney or heart problems, low blood cell counts, high blood pressure, high cholesterol, or diabetes. Use with caution if you take Bactrim, Septra, Cytovene, DHPG, interferon-alfa (Pegasys, PegIntron), Adriamycin, Copegus, Rebetol, Virazole, bone marrow suppressive medicines or cytotoxic medicines, Atripla, Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Retrovir, Truvada, Zerit, or Ziagen.
Most serious: severe or fatal allergic reactions, heart attack, buildup of lactic acid, liver disorders, blood problems, muscle weakness, body fat changes, immune system changes, hepatitis B flare up
Do not take Truvada if you take Hepsera, Atripla, Combivir, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, or Viread, which have the same or similar active ingredients. You may need to adjust dosage if also taking Videx, Reyataz, or Kaletra. If you have had kidney problems or take other drugs that can cause kidney problems, have regular blood tests.
Most serious: buildup of lactic acid in blood, serious liver problems, flare-ups of hepatitis B, kidney problems, thinning bones, changes in body fat, inflammation
Other: nausea, vomiting, headache, weakness, diarrhea, fever/chills, depression, muscle and joint pain, skin rashes, cold symptoms, nervousness, ear, nose, and throat infections
Other: diarrhea, dizziness, nausea, vomiting, headache, fatigue, abnormal dreams, sleeping problems, rash, depression, shortness of breath, pain, fatty liver, stomach problems, weakness, high volume of urine, excessive thirst, skin discoloration
Medication VIDEX EC generic name:
Didanosine m a k e r : Bristol-Myers Squibb
VIREAD generic name:
Tenofovir Disoproxil Fumarate m a k e r : Gilead Sciences
ZERIT generic name:
Stavudine or D4T m a k e r : Bristol-Myers Squibb
ZIAGEN generic name: maker:
Abacavir GlaxoSmithKline
traditional dosage
drug interactions , precautions , and recommendations
side effects
400 mg in enteric-coated capsules, once daily, for individuals weighing 132 pounds or more. 250 mg, once daily, for adults weighing less than 132 pounds. Take on an empty stomach, swallow the capsules whole; do not chew, break, crush, or dissolve. A powder form to be mixed with water is available for children
Do not take with Lopurin or Zyloprim, which are used to treat gout and kidney stones, or the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere. Use with caution with methadone or ganciclovir, or any drugs that may cause toxicity to the pancreas or nervous system. If you are also taking Viread, reduce Videx EC dose.
Most serious: pancreatitis, buildup of lactic acid in the blood, liver disorders, vision problems, immune system changes, body fat changes, peripheral neuropathy
One 300 mg tablet, once daily. Adults who are unable to swallow tablets whole may take 7½ scoops of Viread oral powder. Patients with kidney problems may be prescribed a lower dose
Do not take Viread if you are taking other medicines that contain tenofovir (Atripla, Complera, Truvada, or Stribild) or adefovir (Hepsera). Dosages may need to be changed if you are taking Videx EC, Reyataz, or Kaletra.
Most serious: buildup of lactic acid in blood, severe liver problems, changes in immune system, body fat and bones
For patients weighing 132 pounds or more, 40 mg, in capsules or oral solution, twice daily; for patients weighing less than 132 pounds, 30 mg twice daily
Do not take with Retrovir (zidovudine) or any zidovudine-containing products, such as Combivir or Trizivir. Do not take with hydroxyurea, (Droxia and Hydrea). Use with caution with Videx EC, Adriamycin, Rubex, Copegus, Rebetol, Ribasphere, Virazole, Roferon-A, and Intron-A. Use with caution if you have liver, pancreas, or kidney problems, peripheral neuropathy, or gallstones. Dosing adjustments may be needed if you have renal impairment or are undergoing hemodialysis, Do not drink alcohol while on the drug.
Most serious: buildup of an acid in blood, serious liver problems, pancreatitis, changes in immune system or body fat, peripheral neuropathy
Do not take if you have moderate to severe liver impairment. Do not breast-feed while taking the drug. If you have a severe allergic reaction, do not resume taking Ziagen or any other abacavir-containing drug (Epzicom, Trizivir). Risk of allergic reaction is higher if you have a gene variation called HLA-B*5701.
Most serious: severe allergic reaction, buildup of lactic acid in blood with liver enlargement, changes in body fat or immune system, increased risk of heart attack, especially if you have other risk factors (smoking, diabetes, etc)
600 mg in tablets daily, administered as either 300 mg twice daily or 600 mg once daily. Also available as an oral solution. Patients with mild liver impairment should take 200 mg twice daily
Viread is also used to treat hepatitis B.
Other: diarrhea, nausea, vomiting, headache, stomach pain, skin rash
Other: nausea, rash, diarrhea, headache, pain, depression, weakness
Other: headache, diarrhea, rash, nausea, vomiting
Other: nausea, vomiting, tiredness, headache, diarrhea, trouble sleeping, fever and chills, loss of appetite
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NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS) Help prevent replication of HIV; drugs in this class attack the same enzyme NRTIs do, in a different way. Medication EDURANT generic name:
Rilpivirine m a k e r : Janssen
INTELENCE generic name: maker:
Etravirine Janssen
RESCRIPTOR
traditional dosage
drug interactions , precautions , and recommendations
side effects
One 25 mg tablet, once daily, with a meal For those who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less. It is always taken with other antiretrovirals.
Do not take with nonnucleoside reverse transcriptase inhibitors; antiseizure drugs like Tegretol, Trileptal, and Dilantin; antibacterials Mycobutin, Rifadin, Rimactane, or Priftin; proton pump inhibitors such as Nexium, Vimovo, Prevacid, Prilosec, Protonix, and Aciphex; more than one dose of dexamethasone; or Saint-John’s-wort. Use with caution with antifungals taken orally, antibiotics such as Biaxin and Ketek, methadone, or protease inhibitors. Take antacids or H2 blockers at least 12 hours before or four hours after Edurant.
Most serious: depression or mood changes, including suicidal thoughts; changes in body fat or immune system, kidney disorders
200 mg (one 200 mg tablet or two 100 mg tablets), twice daily. Always take after a meal and swallow the pill with a full glass of water; do not chew.
Do not take with nonnucleoside reverse transcriptase inhibitors; the protease inhibitors Aptivus or Lexiva, or other protease inhibitors without ritonavir; epilepsy and seizure medicines Tegretol, Carbatrol, Luminal, Dilantin, or Phenytek; herbal products containing SaintJohn’s-wort; or the antibacterial drugs Mycobutin, Rifadin, Rifater, Rifamate, or Priftin. Use with caution with Tivicay, Triumeq, the antimalarial drug Coartem and drugs that inhibit or induce the genetic features CYP3A, CYP2C9, and/or CYP2C19.
Most serious: severe skin reactions such as Stevens-Johnson syndrome
400 mg (two or four tablets) three times daily
Do not take Versed, Halcion, Xanax, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Orap, Propulsid, Hismanal, Seldane, rifampin, phenobarbital, Dilantin, Tegretrol, Saint-John’s-wort, Mevacor, or Zocor. Talk to your doctor if you have liver or kidney disease, or before taking Viagra, Lipitor, Baycol, or Lescol. If taking Videx or antacids, take an hour before or an hour after taking Rescriptor. Doses of protease inhibitors Crixivan, Invirase, Fortovase, Kaletra, Norvir, and Viracept may need to be adjusted.
Most serious: severe skin rash accompanied by blisters, fever, joint or muscle pain, redness or swelling of the eyes, mouth sores
600 mg (three capsules at once or one tablet), taken daily. Take Sustiva on an empty stomach, preferably at bedtime, with water.
Do not take with other NNRTIs, Atripla, Vascor, Propulsid, Versed, Orap, Halcion, Victrelis, Olysio; ergot medications (such as Wigraine and Cafergot); or Mepron or Paludrine. The following medicines may need to be replaced with another when you are taking Sustiva: Fortovase, Invirase, Biaxin, Carbatrol, Tegretol, Noxafil, Sporanox, and Reyataz. These drugs may require a change in the dose of either Sustiva or the other medicine: Cardizem, Tiazac, Covera HS, Isoptin SR, Lipitor, Pravachol, Zocor, Crixivan, Kaletra, methadone, Mycobutin, Reyataz, Rifadin, Rifamate, Rifater, Selzentry, Vfend, Gengraf, Neoral, Sandimmune, Prograf, Rapamune, Wellbutrin, Zoloft, and Zyvan. If you are taking Sustiva and Reyataz, you should also be taking Norvir. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures.
Most serious: severe liver problems, rashes, and skin reactions
One 200 mg tablet daily for first 14 days, then one 200 mg twice daily; also available in oral suspension; or 100 mg tablet for children. Also available in an extended-release formulation, for which dosage is one 200 mg tablet of immediate-release Viramune once daily for the first 14 days, followed by one 400 mg tablet of Viramune XR once daily
Do not take with Saint-John’s-wort, Sustiva, Atripla, Kaletra, Lexiva, Reyataz, Nizoral, Sporanox, Rifadin, Rifamate, Rifater, Victrelis, Incivek, or birth control pills. Tell doctor if taking Biaxin, Diflucan, Crixivan, methadone, Viracept, Mycobutin, Coumadin, Jantoven, or Invirase. Discontinue immediately if you develop signs of hepatitis, severe skin reactions, or rash with systemic symptoms.
Most serious: severe psychiatric problems, including suicidal thoughts; liver disorders; severe rash
generic name: maker:
Delavirdine ViiV Healthcare
SUSTIVA generic name:
Efavirenz m a k e r : Bristol-Myers Squibb
VIRAMUNE generic name:
Nevirapine m a k e r : Boehringer Ingelheim; generic versions also available
28 | JULY / AUGUST 2016
Other: insomnia, headache, rash
Other: changes in body shape or body fat, changes in immune system, tingling or pain in the hands or feet, numbness
Other: headache, nausea, diarrhea, and tiredness
Other: changes in the immune system, changes in body fat, dizziness, nausea, headache, insomnia, tiredness
Other: dizziness, nausea, vomiting, diarrhea, rash, sleep disturbances, drowsiness, trouble concentrating, unusual dreams
5 Ways to Manage Prescription Costs Lower your costs even as drug prices soar.
EKING1989/FLI CKR
by keith jacobs
O V E R T H E PA S T F E W months, people all across the country have gone to refill their prescriptions only to find that the cost has dramatically increased—in some cases by more than 1,000 percent. These sudden price increases for prescription drugs (including generics) have been so abrupt and dramatic that federal and state governments are taking notice. The Pennsylvania Medical Society recently alleged that increases in generics were likely the result of anti-competitive collusion. The Obama administration has just announced that it will be exploring new ways of reducing prescription drug costs for Medicare patients. Additionally, legislatures in eight states—Massachusetts, New York, California, North Carolina, Pennsylvania, Oregon, Vermont, and Colorado—have introduced “drug pricing transparency” bills that would gather detailed internal information from pharmaceutical companies about their research and operations costs. In at least one case, the bill would also authorize the state to set a “maximum allowable price” for medications. Whether these tactics and specific legislation will succeed is a question that’s still up in the air. But there’s no denying that the escalating price of drugs is causing immense frustration and concern among the public. Fortunately, here are five things consumers can do right now in order to better manage—and even lower—their prescription drug costs.
Check to see if there is a generic available. Make sure to always ask your doctor or pharmacist for less expensive, generic options. According to the Food and Drug Administration, on average, generic drugs cost about 80 to 85 percent less than brand name versions of the same medication. 2 Use a prescription savings discount card. There are a few to choose from and some are better than others, so do your research. Find one that’s accepted at major pharmacies. Savings card programs are typically accepted in conjunction with pharmacies’ own loyalty programs, which helps members to maximize their savings opportunities. These discount card programs not only benefit the uninsured, but can provide cost saving benefits to those that are insured as well. 3 Compare drug prices and shop around. Consumer Reports recently reported that prices for generic drugs varied drastically from one pharmacy to the other. 4 Make sure your insurance plan is right for you. Choosing a health plan can be complicated, and they are hardly one size fits all. But choosing the right one can save you hundreds of dollars annually. To do so, compare monthly premiums and out-of-pocket costs of different plans. Also, before you sign up, make sure that the plan’s “formulary,” or list of covered drugs, includes the prescriptions you take regularly. 5 Apply for help. Medicare has a prescription drug program that helps seniors pay for their medicines, regardless of their income level. Medicaid also provides assistance for low-income individuals but access varies depending on whether your state chose to support the expansion program offered through the Affordable Care Act. To see if you qualify for Medicaid, visit Healthcare.Gov. 1
Keith Jacobs co-founded RefillWise, a free prescription drug savings card program that saves over one million members up to 80 percent on their medications, by negotiating for discounts with over 50,000 pharmacies across America (including CVS, Walgreens, and Walmart).
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COMBINATION DRUGS
Help prevent replication of HIV; drugs in this class combine two or more drugs that attack HIV in different ways.
Medication ATRIPLA GENERIC NAME:
Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate M A K E R : Bristol-Myers Squibb & Gilead Sciences
COMPLERA GENERIC NAME:
Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate M A K E R : Gilead Sciences
EVOTAZ GENERIC NAME:
Atazanavir and Cobicistat M A K E R : Bristol-Myers Squibb
ODEFSEY GENERIC NAME:
Emtricitabine, Rilpivirine, and Tenofovir Alafenamide M A K E R : Gilead
TRADITIONAL DOSAGE
DRUG INTERACTIONS , PRECAUTIONS , AND RECOMMENDATIONS
SIDE EFFECTS
One tablet, once daily, on an empty stomach, preferably at bedtime (600 mg of efavirenz, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate). If also taking Rifadin, add 200 mg of efavirenz. Efavirenz is a nonnucleoside reverse transcriptase inhibitor (NNRTI), and the other components are nucleoside reverse transcriptase inhibitors (NRTIs); the different types of drugs attack HIV at different stages in its replication process.
Do not take with anti-HIV drugs Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, Truvada, Viread, or Stribild, which have the same or similar active ingredients. Take with Sustiva only if your doctor recommends. If you are taking Kaletra, dosage of that drug may need to be adjusted. Do not take with Vfend or Hepsera. Use with caution with Fortovase, Invirase, Videx, Reyataz, Crixivan, Selzentry, Biaxin, Noxafil, Sporanox, calcium channel blockers (such as diltiazem and verapamil, various brand names), immunosuppressant drugs (like cyclosporine, tacrolimus, and sirolimus, various brand names), methadone, Mycobutin, Rifadin, Rimactane, Lipitor, Pravachol, Zocor, Zoloft, or seizure meds (phenytoin, carbamazepine, and phenobarbital). Do not take if you have severe kidney impairment or while breastfeeding. Discontinue if severe rash develops
Most serious: severe skin reactions such as Stevens-Johnson syndrome, buildup of lactic acid in blood, severe liver or kidney problems, serious psychiatric problems, thinning bones, hepatitis B flare-up upon stopping treatment
One tablet, once daily, with a meal (200 mg of emtricitabine, 25 mg of rilpivirine, and 300 mg of tenofovir disoproxil fumarate). Rilpivirine is an NNRTI, the other components NRTIs. Complera is for patients who have not previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less, or it can be used as a replacement regimen for patients who have a viral load of 50 copies/mL or less.
Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, and Trizivir), other HIV antiretroviral medications, drugs to treat seizures or tuberculosis, proton-pump inhibitors (such as Kapidex or Dexilant), Hespera, Saint-John’s-wort, or more than one dose of dexamethasone. Use caution when taking antacids, antifungal medications, H2-receptor antagonists, antibiotics, or methadone. If taken with Harvoni, you should be monitored
Most serious: buildup of lactic acid in blood, severe liver problems, kidney damage, hepatitis B flare-ups, depression, bone thinning, changes in immune system
One tablet once daily with food, in combination with other antiretroviral drugs; each tablet contains 300 mg of the protease inhibitor atazanavir (Reyataz) and 150 mg of boosting agent cobicistat (Tybost).
Do not take with protease inhibitors, roxatral, Propulsid, Propulsid Quicksolv, Mitigare, Colcrys, Multaq, D.H.E. 45, Embolex, Migranal, Cafergot, Migergot, Ergomar, Ergostat, Medihaler, Wigraine, Wigrettes, Ergotrate, Methergine, Crixivan, Camptosar, Advicor, Altoprev, Mevacor, Latuda, Versed, Viramune, Viramune XR, Orap, Ranexa, Rimactane, Rifadin, Rifater, Rifamate, Revatio when used for lung problems, Zocor, Vytorin, Simcor, Halcion, or Saint-John’s-wort. Use with caution if you have heart problems, liver problems, kidney problems, diabetes, or hemophilia, if you are pregnant, plan to become pregnant, or if you are using hormonal birth control. Do not breastfeed.
Most serious: heart rhythm changes, kidney or gallbladder problems, worsening liver problems, severe skin rash, diabetes or worsening diabetes, increased bleeding with hemophilia, changes in body fat or immune system
Do not take if you have kidney problems or if you take any of the following: anticonvulsants (carbamazepine, oxcarbazepine, phenobarbital, phenytoin); antimycobacterials (rifampin and rifapentine); proton pump inhibitors (such as dexlansoprazole, omeprazole, and pantoprazole); dexamethasone; Saint-John’s-Wort. Use caution with drugs that induce or inhibit CYP3A; those that strongly affect P-gp activity, or drugs that reduce renal function (such as acyclovir, cidofovir, ganciclovir, aminoglycosides). Take antacids at least two hours before or at least four hours after taking Odefsey.
Most serious: exacerbations of hepatitis B, build-up of lactic acid in blood, severe skin and hypersensitivity reactions, severe depressive disorders, changes in body fat or immune system, kidney problems, bone loss
One tablet taken orally once daily with a meal. Each tablet contains 200 mg emtricitabine, 25 mg rilpivirine, and 25 mg tenofovir alafenamide. Odefsey is a combination of two nucleoside analog reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor.
30 | JULY / AUGUST 2016
Other: dizziness, headache, insomnia, drowsiness, trouble concentrating, unusual dreams, fatigue, upset stomach, nausea, vomiting, gas, diarrhea
Other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, weight gain, and skin discoloration
Other: nausea, yellowing of the skin or whites of the eyes
Other: insomnia, headache, nausea
Medication PREZCOBIX GENERIC NAME:
Darunavir
and Cobicistat Janssen
MAKER:
STRIBILD GENERIC NAME:
Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate M A K E R : Gilead Sciences
TRIUMEQ GENERIC NAME:
Dolutegravir, Abacavir Sulfate, and Lamivudine M A K E R : ViiV Healthcare
GENVOYA GENERIC NAME:
Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide M A K E R : Gilead
TRADITIONAL DOSAGE
DRUG INTERACTIONS , PRECAUTIONS , AND RECOMMENDATIONS
SIDE EFFECTS
One tablet twice daily with food; each tablet contains 800 mg of the protease inhibitor darunavir (Prezista) and 100 mg of the boosting agent cobicistat (Tybost).
Do not take with Uroxatral, Propulsid, Propulsid Quicksolv, Colcrys, Mitigare, Multaq, D.H.E.45, Embolex, Migranal, Cafergot, Ergomar, Ergostat, Medihaler, Migergot, Wigraine, Wigrettes, Methergine, Altoprev, Advicor, Mevacor, Latuda, Versed, Orap, Ranexa), Rifadin, Rifater, Rifamate, Rimactane, Revatio when used for pulmonary arterial hypertension, Simcor, Vytorin, Zocor, Saint-John’s-wort, or Halcion. Use with caution if you have liver or kidney problems, or if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed. Don’t take if you are on Quetiapine for schizophrenia.
Most serious: liver problems, severe or life-threatening skin rashes or reactions, high blood sugar, diabetes or worsening diabetes, increased bleeding with hemophilia, changes in body fat or immune system
Do not take if you have hepatitis B, or a creatinine clearance below 70 mL per minute. Do not use with other anti-HIV drugs containing emtricitabine or tenofovir disoproxil fumarate, including Atripla, Complera, Emtriva, Truvada, or Viread; do not use with drugs containing lamivudine or with drugs or regimens containing ritonavir, such as Combivir, Epivir, Epivir-HBV, Epzicom, or Trizivir. Do not use with Revatio, Hepsera, alfuzosin, rifampin, cisapride, pimozide, Saint-John’s-wort, ergot derivatives (such as dihydroergotamine, ergotamine, or methylergonovine), HMG-CoA Reductase inhibitors (such as lovastatin and simvastatin), or with sedative hypnotics. Avoid if taking Quetiapine for schizophrenia or Ledipasvir for hep C treatment.
Most serious: buildup of lactic acid in blood; severe liver or kidney problems, which could lead to potentially fatal renal failure; thinning bones, and changes in the immune system
One tablet once daily, with or without food; each tablet contains 50 mg of dolutegravir (Tivicay, an integrase strand transfer inhibitor), 600 mg of abacavir, and 300 mg of lamivudine (Ziagen and Epivir both nucleoside reverse transcriptase inhibitors).
Do not take with Epzicom, Trizivir, Ziagen, Combivir, Epivir , EpivirHBV, Epzicom, Emtriva, Atripla, Complera, Stribild, Truvada, Tikosyn, Viramune, Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin, or Saint-John’s-wort. Do not take if you have the HLA-B*5701 gene variation or moderate to severe liver problems. Use with caution if you have hepatitis B or C; or are taking interferon, ribavirin, Sustiva, Norvir combined with Lexiva or Aptivus, Rifadin, Glumetza, Fortamet, Glucophage, or Riomet. Take two hours before or six hours after iron or calcium supplements. certain antacids, or buffered medications.
Most serious: worsening of hepatitis B or C,
One tablet taken orally once daily with food. Each tablet includes 150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide. Genvoya is a four-drug combination of elvitegravir (an HIV-1 integrase strand transfer inhibitor or INSTI), cobicistat (a CYP3A inhibitor), and emtricitabine and tenofovir alafenamide (TAF), both nucleoside analog reverse transcriptase inhibitors (NRTIs).
Genvoya should not be taken with other antiretroviral medications. Do not use with drugs containing elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate, lamivudine, ritonavir, or adefovir dipivoxil or drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious adverse events. You must be assessed for creatinine clearance, urine glucose, and urine protein before starting Genvoya. Monitor serum phosphorus in patients with chronic kidney disease. Nursing mothers should not breastfeed while taking Genvoya.
Most serious: exacerbations of hepatitis B,
One tablet (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate) once daily, with a meal.
Other: diarrhea, nausea, rash, headache, abdominal pain, vomiting
Other: nausea, diarrhea
changes in body fat or immune system, increased risk of heart attack Other: trouble sleeping, headache, fatigue
build-up of lactic acid in blood, Immune Reconstitution Syndrome, renal impairment, bone loss, possible fat redistribution Other: gastrointestinal upset, fatigue, headache
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DRUGS THAT TREAT HIV-RELATED CONDITIONS Medication AMBISOME, AMPHOTEC, ABELCET, AMPHOCIN
traditional dosage
No more than 1.5 mg per kg of body weight, administered intravenously, once daily
what it treats , precautions , and recommendations w h at i t d o e s :
side effects
Treats fungal infections, including cryptococcal meningitis, which are more common in people with HIV w h a t t o k n o w : Individuals who cannot normally take traditional amphotericin B because it causes damage to their kidneys may be able to take the formulations in AmBisome, Abelcet, or Amphotec.
Most serious: allergic reaction, kidney problems, rash, irregular heartbeat, muscle cramps or pain, weakness, bleeding, hearing loss, blurred vision, hepatitis
w h at i t d o e s :
generic name:
Other: fever, shaking, chills, weight loss, nausea, headache, jaundice
Amphotericin B m a k e r : Astellas, Alkopharma, Sigma-Tau, Pfizer
ANDROGEL generic name:
Testosterone Gel m a k e r : AbbVie
AXIRON generic name:
Testosterone Topical Solution m a k e r : Lilly
BACTRIM, SEPTRA, SULFATRIM
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; stomach area (abdomen); or shoulders, upper arms, and stomach area; 1.62 percent only to shoulders and upper arms.
Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50 w h a t t o k n o w : Apply at same time every day, after bathing or showering, to clean, dry skin. Wash hands immediately after applying. Cover the application area with clothing after the gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your 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.
Most serious: enlarged prostate, possible increased risk of prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body
30, 60, 90, or 120 mg, as determined by your physician, and with frequency determined by physician. Apply only under the arms.
w h at i t d o e s :
Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50 w h at t o k n o w : Wash hands immediately after applying. Cover the application area with clothing after the solution dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your 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. Should not be used if you have breast cancer, or have or might have prostate cancer. Also tell your provider what other medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.
Most serious: enlarged prostate, possible increased risk of prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body
w h at i t d o e s : Treats and helps prevent recurrence of Pneumocystis pneumonia in HIV-positive patients; also used on other bacterial infections what to know: Take at the same time every day. Try not to miss a dose. Consult with doctor if pregnant, as there is chance of fetal damage.
Most serious: skin rash, joint or muscle aches, sore throat or fever, unusual bleeding or bruising
w h at i t d o e s :
Most serious: worsening of hepatitis B after discontinuation of treatment, other liver problems, buildup of lactic acid in the blood
400 mg (two or four tablets) three times daily
generic name:
Sulfamethoxazole/ Trimethoprim m a k e r : Various (see HIVPlusmag.com)
BARACLUDE generic name:
Entecavir m a k e r : Bristol-Myers Squibb
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
32 | JULY / AUGUST 2016
Treats chronic hepatitis B. May also help inhibit HIV replication, although this use has not been studied w h at t o k n o w : People with HIV should be receiving antiretroviral treatment for that as well, as resistance to anti-HIV drugs may develop otherwise. May affect concentration of drugs that reduce kidney function or vice versa. Those with decreased kidney function may need to reduce dosage.
Other: Increased prostate-specific antigens, mood swings, high blood pressure, increased red blood cell count, skin irritation, more frequent or longer-lasting erections
Other: Increased prostate-specific antigens, increased red blood cell count, skin irritation or redness, headache, diarrhea, vomiting, more frequent or longer-lasting erections
Other: dizziness, nausea, vomiting, diarrhea, loss of appetite, fatigue, headache, low blood sodium
Other: headache, fatigue, dizziness, nausea
Medication BIAXIN generic name:
Clarithromycin m a k e r : AbbVie
CRESEMBA generic name:
isavuconazonium sulfate m a k e r : Astellas
CYTOVENE-IV, VITRASERT generic name:
Ganciclovir Roche Laboratories (Cytovene-IV), Pharmaforce (generic); Bausch and Lomb (Vitrasert)
maker:
DAUNOXOME generic name:
Daunorubicin Liposomal m a k e r : Galen
DIFLUCAN generic name:
Fluconazole Pfizer
traditional dosage
DOXIL Doxorubicin, Liposomal m a k e r : Janssen
EGRIFTA generic name:
Tesamorelin m a k e r : EMD Serono
side effects
w h at i t d o e s : Fights bacterial infections, especially Mycobacterium avium complex (MAC) w h at t o k n o w : There have been life-threatening interactions with Colcrys and serious interactions with Altacor, Altoprev, Mevacor, Zocor, Lipitor, and blood pressure drugs. Use caution when taking with Viagra or Quetiapine. Increased exposure to Quetiapine toxicities including drowsiness, hypotension, and neuroleptic malignant syndrome (which can be fatal).
Most serious: abdominal pain, fever, nausea, vomiting, bleeding or bruising, diarrhea, colitis, liver failure, hepatitis
Initial “loading” dose of 372 mg every eight hours for six doses, through intravenous infusion or two 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.
w h at i t d o e s : Treats rare fungal infections invasive aspergillosis and invasive mucormycosis, which are more common in people with HIV w h a t t o k n o w : Do not take with Norvir, the antiseizure medicine carbamazepine, the tuberculosis drug rifampin, Saint-John’s-wort, or long-acting barbiturates.
Most serious: liver problems, infusion reactions, severe allergic and skin reactions
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
w h at i t d o e s : Treats the eye infection cytomegalovirus retinitis in transplant recipients and people with weakened immune systems, such as those with HIV w h at t o k n o w : Do not take with blood dyscrasia-causing medications, bone marrow depressants, radiation therapy, nephrotoxic medications, or Retrovir. Dosage may need adjustment if you have kidney problems or take Videx or Videx EC. Use caution if you take other HIV medications containing zidovudine or didanosine.
Most serious: blood disorders, black or tarry stools, cough, sore throat, fever or chills, pain, painful urination, unusual bleeding, unusual tiredness or weakness, seeing flashes, spots, or partial veil
w h at i t d o e s :
500 mg, 2 or 3 times daily, depending on the infection. Available in immediate release tablets, extended release tablets, and granules
Other: milder diarrhea, headache, nausea and vomiting, change in taste
Other: nausea, vomiting, diarrhea, headache, abnormal liver blood tests, low potassium levels, constipation, shortness of breath, coughing, tissue swelling
Other: abdominal pain, changes in behavior, diarrhea, fever, headache, increased sweating, loss of appetite, vomiting, weight loss
Injected intravenously at a strength of 40 mg per square meter of body surface area every two weeks
Treats advanced HIV-related Kaposi’s sarcoma Do not use if you have less than advanced KS. You should have regular blood counts on Daunoxome.
Most serious: suppression of the bone marrow’s production of blood cells and platelets;
Doses vary based on targeted infection. Available as tablets, a powder to be mixed with water and taken orally, or an injection formula
w h at i t d o e s :
Treats many types of fungal infections, including AIDSrelated Candida oral, esophageal, urinary, or vaginal yeast infections w h at t o k n o w : Do not take with Quinaglute, Quinidex, Hismanal, Propulsid, Orap, or erythromycin. Use with caution with antidiabetic agents, anticonvulsants, blood pressure medications, immunosuppressive drugs, protease inhibitors, blood thinners, and vitamin A nutritional supplements. Use with caution if pregnant (possible miscarriage risk) or if you have heart problems or kidney dysfunction. Do not take if you have sugar intolerance.
Most serious: liver problems, potentially severe allergic reaction, seizures
For AIDS-related Kaposi’s sarcoma, 20 mg per square meter of body surface, every three weeks by intravenous infusion
w h at i t d o e s : Treats Kaposi’s sarcoma in patients who cannot tolerate other medicines or whose disease is advanced w h a t t o k n o w : Dose may need to be adjusted if you have liver problems.
Most serious: congestive heart failure, decrease in blood cells, secondary oral cancers
w h at i t d o e s :
Most serious: severe allergic reaction or fluid retention, injection site reactions, or increase in glucose intolerance/diabetes
maker:
generic name:
what it treats , precautions , and recommendations
2 mg injected subcutaneously (just below the skin), once daily
w h at t o k n o w :
Other: back pain, flushing, chest tightness
Helps reduce HIV-related excess belly fat by encouraging the body to produce natural growth hormones that reduce fat w h at t o k n o w : Do not take if you have or had issues involving your pituitary gland, if you have active cancer, or if you are pregnant or breastfeeding.
Other: rash, nausea, headache, vomiting, diarrhea, dizziness
Other: tingling or burning, swelling, blisters, mouth sores, fever, nerve damage and more (see HIVPlusMag.com)
Other: pain, swelling, muscle soreness, tingling, numbness and pricking, nausea, vomiting, rash, itching
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DRUGS THAT TREAT HIV-RELATED CONDITIONS Medication EPOGEN, PROCRIT generic name:
Epoetin
Alfa maker:
Amgen (Epogen); Janssen (Procrit)
ERAXIS generic name:
Anidulafungin m a k e r : Pfizer
ETOPOPHOS generic name: maker:
Etoposide Bristol-Myers
traditional dosage
what it treats , precautions , and recommendations
side effects
100 Units per kilogram of body weight, three times a week, given intravenously. Singledose vials: 2000, 3000, 4000, and 10,000 Units/1 mL. Multidose vials containing benzyl alcohol: 20,000 Units/2 mL and 20,000 Units/1 mL
w h at i t d o e s :
Treats anemia that results as a side effect of Retrovir Do not take if you have uncontrolled high blood pressure. Iron supplements may be needed for patients who undergo blood transfusions. Talk to your doctor if you have cancer, as there is an increased risk of tumor progression or shortened survival.
Most serious: high blood pressure, seizures, development of antibodies against the drug, severe allergic reactions
For esophageal candidiasis, 100 mg by injection the first day, ollowed 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
w h at i t d o e s :
Treats esophageal candidiasis, candidemia, and other Candida infections w h at t o k n o w : Effects on women who are pregnant or breastfeeding have not been studied, so discuss possibility of pregnancy with your doctor.
Most serious: abnormal liver function, anaphylactic shock
Dosages vary for small cell lung cancer and testicular cancer, used in combination with other chemotherapeutic agents
w h at i t d o e s : Treats various types of cancer; being tested for treatment of non-Hodgkin’s lymphoma and Kaposi’s sarcoma w h at t o k n o w : High-dose cyclosporine and drugs such as levamisole hydrochlor can cause interactions. Use of a live virus vaccine could be complicated by weakened immune mechanisms. Do not deliver by bolus intravenous injection.
Most serious: severe allergic reaction, alopecia (hair loss), chills or fever, nausea, constipation, abdominal pain. May cause infertility or lack of menstruation in women, who are advised to use contraception for at least six months after final dose
Squibb
w h at t o k n o w :
Other: joint, muscle, or bone pain, fever, cough, rash, nausea, vomiting, soreness of mouth, itching, headache, pain at injection site
Other: nausea, diarrhea, vomiting
Other: rash, unusual tiredness
FAMVIR generic name:
500 mg in tablets twice daily for seven days; tablets come in 125, 250, or 500 mg strengths
w h at i t d o e s :
Treats recurrent episodes of orolabial herpes (cold sores) or genital herpes w h at t o k n o w : Dosage may need to be reduced for patients with kidney 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.
Most serious: acute kidney failure
Initial dose is 40 mg of gel, applied to the thighs once daily, in the morning; amount may be adjusted by your physician
w h at i t d o e s :
Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50 w h at t o k n o w : Apply at same time every day, after bathing or showering, to clean, dry skin. Wash hands immediately after applying. Cover the application area with clothing after the gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your 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.
Most serious: enlarged prostate, possible increased risk of prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body
w h at i t d o e s :
Most serious: impairment of kidney function, electrolyte abnormalities, seizures, anemia
Famciclovir m a k e r : Novartis
FORTESTA generic name:
Testosterone gel m a k e r : Endo Pharmaceuticals
FOSCAVIR generic name:
Sodium m a k e r : Hospira
Foscarnet
Initial dose of Foscavir, a liquid solution, is an intravenous infusion of 90 mg per kilogram of weight every 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 frequency
34 | JULY / AUGUST 2016
Treats CMV retinitis May be used in combination with ganciclovir drugs in patients who have relapsed after treatment with either drug by itself, but no other drug should be delivered in the same infusion. Use with caution with intravenous pentamadine. w h at t o k n o w :
Other: headache, nausea, skin or subcutaneous tissue disorders, heart palpitations
Other: increased prostate-specific antigens, skin redness or irritation, abnormal dreams
Other: headache, nausea, vomiting, diarrhea, fever
Medication FULYZAQ generic name:
Crofelemer m a k e r : Salix
GAMIMUNE N, GAMUNEX, GAMMAGARD, GAMUNEX-C
traditional dosage
One 125 mg delayed-release tablet, twice daily, with or without food. Tablets should be swallowed whole and not crushed or chewed
what it treats , precautions , and recommendations w h at i t d o e s :
side effects
Relieves diarrhea that is a side effect of antiretro-
viral drugs w h at t o k n o w : Patients should be tested to make sure the diarrhea is not caused by an infection or gastrointestinal disease.
Most serious: upper respiratory tract infection, bronchitis, Other: cough, flatulence, and increased levels of the liver enzyme bilirubin
w h at i t d o e s : Treats primary humoral immunodeficiency and bacterial infection, primarily in children and teens with HIV. w h at t o k n o w : May interfere with immune response to live-virus vaccines for measles, mumps, or rubella.
Most serious: depression, suicidal behavior, severe pain, difficulty breathing, vision problems, high fever, bleeding, bruising
w h at i t d o e s :
Treats chronic hepatitis B infection Do not take with Viread, Atripla, Truvada, Complera, or Stribild. Use caution when taking with other NRTIs or drugs that affect kidney function or are eliminated by the kidneys.
Most serious: worsening of hepatitis B, kidney malfunction, buildup of lactic acid in the blood
30 million international units (IUs) 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
w h at i t d o e s : Treats AIDS-related Kaposi’s sarcoma and hepatitis infection, especially hepatitis C w h at t o k n o w : Use caution if taken with Retrovir, theophylline, or Tyzeka. Do not take if you have autoimmune hepatitis, decompensated liver disease, thalassemia major, sickle-cell anemia, or problems with creatinine clearance. Use with caution if you have history of cardiovascular or cerebrovascular diseases.
Most serious: depression, suicidal thoughts, severe flu-like symptoms, increased risk of life-threatening liver disease
Varies, but usually starts with one 2.5-mg capsule taken twice daily, before lunch and dinner. Also available in 5-mg or 10-mg capsules. Take the capsules whole; do not crush or chew
w h at i t d o e s :
Marinol is a cannabinoid, a man-made form of cannabis, which is used to stimulate the appetite of people living with HIV. w h a t t o k n o w : Can interact dangerously with alcohol, Valium, Librium, Seconal, Xanax, or Nembutal. Do not smoke marijuana, as this can cause an overdose. Can become habit-forming.
Most serious: amnesia, confusion, delusions, mood changes, hallucinations, depression, nervousness, anxiety, rapid heartbeat
w h at i t d o e s :
Treats appetite loss, severe malnutrition, or unexplained, significant weight loss w h at t o k n o w : May decrease effectiveness of Crixivan. If you have a history of blood clots, check with your doctor before taking.
Most serious: Cushing’s syndrome, development or worsening of diabetes
w h at i t d o e s :
Most serious: Cushing’s syndrome, diabetes
300 to 600 mg per kg of body weight, every three to four weeks, administered intravenously
Other: headache, nausea, diarrhea, chills, fatigue
generic name:
Immune Globulin m a k e r : Bayer Biological, Talecris Biotherapeutics, Baxter Healthcare, Grifols Therapeutics
HEPSERA generic name:
One 10 mg tablet daily
w h at t o k n o w :
Adefovir
Dipivoxil m a k e r : Gilead
INTRON A g e n e r i c n a m e : Interferon Alfa-2B m a k e r : Schering
MARINOL generic name: maker:
Dronabinol
AbbVie
MEGACE ES generic name:
625 mg (one teaspoon), once daily
Megestrol
Acetate m a k e r : Strativa
MEGACE ORAL SUSPENSION generic name:
Megestrol
Acetate maker:
800 mg, once daily
Treats severe malnutrition, appetite loss, or signif-
icant weight loss w h at t o k n o w :
No significant interactions discovered to date. If you have a history of blood clots, check with your doctor before taking.
Other: weakness, headache, abdominal pain, nausea, diarrhea, indigestion, gas
Other: difficulty sleeping, nervousness, muscle pain or numbness, blood in urine or stools, painful or difficult urination, chest pain, fever, chills, unusual bleeding or bruising, suicidal or homicidal thoughts
Other: clumsiness, dizziness, drowsiness, euphoria, trouble thinking, nausea, vomiting
Other: decreased sexual desire or performance, flatulence, rash, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding
Other: decreased libido, flatulence, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding
Bristol-Myers
Squibb
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DRUGS THAT TREAT HIV-RELATED CONDITIONS Medication MEPRON generic name:
Atovaquone m a k e r : GlaxoSmithKline
MYCOBUTIN generic name:
Rifabutin Pfizer (Mycobutin); Lupin Ltd. (generic)
maker:
NEBUPENT
traditional dosage
w h at
i t d o e s : Helps prevent and treat mild to moderate Pneumocystis pneumonia in patients who cannot tolerate other drugs w h at t o k n o w : Taking rifampin (Rifadin), consider alternatives, as it reduces the amount of Mepron in the body
Most serious: rash, diarrhea, nausea
300 mg in capsules, once daily. If prone to nausea or vomiting, split into two doses daily, with food
w h at i t d o e s :
Helps prevent disseminated Mycobacterium avium complex (MAC) disease w h at t o k n o w : Do not use with Rescriptor or Norvir. May reduce effectiveness of Sporanox, Biaxin, Fortovase, and Invirase as well as oral contraceptives. Cut dose in half if also taking Crixivan or Viracept. Do not take if you have active tuberculosis.
Most serious: neutropenia (lowered white blood cell count)
300 mg every four weeks, via oral inhalation
w h at i t d o e s : Helps prevent Pneumocystis pneumonia in patients with a history of the disease or low T-cell counts w h at t o k n o w : Use with caution with aminoglycosides (a class of antibiotics), amphotericin B (an antifungal drug marketed under various brand names), Platinol, Foscavir, or Vancocin. If breast-feeding, take only if doctor determines benefits outweigh risks.
Most serious: acute pancreatitis
w h at i t d o e s :
Pentamidine Isethionate m a k e r : APP Pharmaceuticals
generic name: maker:
Alitretinoin
Eisai
RADIESSE generic name:
Calcium Hydroxylapatite m a k e r : Merz Aesthetics
RIFADIN, RIFADIN IV generic name: maker:
Rifampin Sanoifi-Aventis
ROFERON-A generic name:
Interferon
Alfa-2 maker:
generic name:
Injectable Poly-L-Lactic Acid m a k e r : Dermik Laboratories
Other: rash, gastrointestinal disorders, flulike symptoms, rare chance of eosinophilla (increased white blood cell count)
Other: night sweats, anemia, bronchitis, nonspecific herpes, herpes zoster, nonspecific influenza, oral Candida, pharyngitis, sinusitis, headache, chest pain, cough, wheezing
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
Provides topical treatment for Kaposi sarcoma lesions Avoid using with products that contain DEET, a common ingredient of insect repellents. Minimize skin’s exposure to sun.
Most serious: toxic skin reactions
Varies; the drug is available in single-use vials with 0.3, 1, or 1.3 milliliters of calcium hydroxylapatite suspended in a water-based gel. It is injected into the skin, and results can last up to a year. Injectible implant for use in hands.
w h at i t d o e s : Treats facial fat loss (lipoatrophy) and stimulates the body’s collagen production to combat HIV-related facial wasting w h at t o k n o w : Users of blood thinners or aspirin may have bleeding or bruising at the injection site. For 24 hours after treatment, avoid significant movement, massage, sun exposure, or makeup use.
Most serious: prolonged swelling, irritation, redness, swelling, itching, burning, or tenderness at the injection site may occur, but typically resolve shortly after treatment
10 mg per kg of body weight, once daily, orally in capsule form (Rifadin) or intravenously (Rifadin IV). Daily dosage should not exceed 600 milligrams. Oral dosage should be one hour before or two hours after a meal with water
w h at i t d o e s :
Helps prevent or treat infections caused by a certain type of bacterium, including the one that causes tuberculosis w h a t t o k n o w : Do not take if taking Reyataz, Prezista, Lexiva, Fortovase, Invirase, or Aptivus. Dosage of anticoagulant drugs should be adjusted. Use with caution if you have diabetes. Switch to nonhormonal contraceptives.
Most serious: gastrointestinal distress, changes in liver function, headache, drowsiness, dizziness, menstrual irregularities, jaundice, darkened urine
3 million IUs per square meter of body surface, subcutaneously or intramuscularly, three times a week
w h at i t d o e s :
Treats chronic hepatitis C* Use caution if taken with Retrovir and similar antiHIV drugs; theophylline, marketed under various names to treat breathing problems; or Tyzeka. (*For other, newer HCV drugs, see pg. 40)
Most serious: depression, suicidal behavior, pain, breathing and vision problems, fever, bleeding or bruising
w h at i t d o e s :
Most serious: bruising, edema, hematoma, injection site reactions
Roche
SCULPTRA
side effects
500 mg in tablets twice daily for seven days; tablets come in 125, 250, or 500 mg strengths
generic name:
PANRETIN GEL
what it treats , precautions , and recommendations
Amount and frequency varies by patient; delivered by subcutaneous injection
36 | JULY / AUGUST 2016
w h at t o k n o w :
w h at t o k n o w :
Helps restore or correct signs of facial fat loss
(lipoatrophy) w h at t o k n o w :
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.
Other: loss of appetite, fever, joint pain
Other: flu-like symptoms, sleep disturbances, headache, thyroid problems, fatigue
Medication SEROSTIM generic name: maker:
Somatropin EMD Serono
traditional dosage
0.1 mg per kilogram of body weight daily (up to 6 mg), injected subcutaneously at bedtime
what it treats , precautions , and recommendations w h at i t d o e s :
side effects
Treats wasting (HIV-related weight loss)
w h at t o k n o w : Do not use if you have acute critical illness following
open heart or abdominal surgery, multiple accidental trauma, or acute respiratory failure. Do not use if you have neoplasia.
Most serious: glucose intolerance, musculoskeletal discomfort, carpal tunnel syndrome, Other: swelling of the hands and feet
SPORANOX generic name:
Itraconazole m a k e r : Janssen
TAXOL g e n e r i c n a m e : Paclitaxel maker:
Bristol-Myers Squibb (name brand); Teva Parenteral Medicines (generic)
TESTIM g e n e r i c n a m e : Testoster-
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
w h at i t d o e s :
Treats fungal infections such as oral candidiasis, also known as thrush w h a t t o k n o w : Do not take with D.H.E. 45, Migranal, Germinal, Hydergine, Ergotrate, Bellergal-S, Cafergot, Ergomar, Wigraine, Methergine, Sansert, Altocor, Altoprev, Mevacor, Zocor, Halcion, methadone, felodipine. Use caution if you have heart, lung, or kidney disease, or take protease inhibitors. Do not take capsules if you have heart failure.
Most serious: liver failure, neuropathy, hearing loss
135 mg per square meter of body surface, intravenously over three hours every three weeks, or 100 mg per square meter of body surface, intravenously over three hours every two weeks
w h at i t d o e s :
Provides second-line treatment for Kaposi’s sarcoma Use caution when taking with Versed, Buspar, Vansar, Plendil, Altocor, Altoprev, Mevacor, Zocor, Relpax, Revatio, Viagra, Halcion, Reyataz, Biaxin, Crixivan, Sporanox, Feoris, Nizoral, Serzone, Viracept, Norvir, and several other drugs. (See HIVPlusMag. com for others.)
Most serious: bone marrow disorders
50 mg in premeasured tube, applied to upper arms and shoulders, once daily
w h at i t d o e s :
Treats low testosterone in adult men, which can be a complication of HIV, especially for men over 50 w h at t o k n o w : Apply at same time every day, after bathing or showering, to clean, dry skin. Wash hands immediately after applying. Cover the application area with clothing after the gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your 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.
Most serious: Enlarged prostate, possible increased risk of prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body
w h at i t d o e s :
Most serious: buildup of lactic acid in body, severe liver problems, muscle pain or weakness, nerve problems, flare-up of hepatitis B after discontinuation
one Gel maker:
Endo Pharmaceuticals
TYZEKA generic name: maker:
Telbivudine Idenix/Novartis
One 600-mg tablet, once daily, or 30 milliliters of oral solution for patients who have difficulty swallowing tablets
w h at t o k n o w :
Treats hepatitis B Do not take with Pegasys. If using oral solution, close bottle and clean dosing cup immediately after dosing, keep cup dry between uses, and do not use for anything else. w h at t o k n o w :
Other: nausea, diarrhea, vomiting, fever, respiratory disorders, rash, headache
Other: tiredness, weakness, shortness of breath, nausea, vomiting, diarrhea, unusual bleeding or bruising, joint pain or numbness, hair loss
Other: Skin irritation at application site, increased red blood cell count
Other: diarrhea, abdominal pain or swelling, cough, headache, dizziness, sore throat, fever
VALCYTE generic name:
Two 450 mg tablets, twice daily, for 21 days, then two tablets once daily
Valganciclovir Genentech
maker:
VFEND generic name:
Voriconazole Pfizer
maker:
For esophageal candidiasis, 200 mg in tablets or oral solution, every 12 hours, at least an hour before or 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
w h at i t d o e s :
Treats the eye infection cytomegalovirus retinitis Use with caution if also taking Retrovir, Benemid, CellCept, Myfortic, or Videx. Since Valcyte can cause seizures, do not drive until you know how the medication affects you.
Most serious: anemia, fertility impairment, fetal abnormalities, kidney failure
w h at i t d o e s :
Most serious: severe liver problems, heart arrhythmias, visual disturbances
w h at t o k n o w :
Treats fungal infections, such as esophageal
candidiasis w h at t o k n o w :
Do not use with Atripla or high-dose Norvir; use with caution with low-dose Norvir. Do not use with Saint-John’s-wort, ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, quinidine, or rifabutin. Use with caution in patients with heart arrhythmias.
Other: diarrhea, vomiting, fever, tremors, and seizures
Other: fever, nausea, rash, vomiting, chills, headache
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DRUGS THAT TREAT HIV-RELATED CONDITIONS Medication VISTIDE generic name: maker:
Cidofovir
Gilead
ZITHROMAX generic n a m e : Azithromycin maker:
Pfizer (Zithromax); various others (generic)
ZOVIRAX g e n e r i c n a m e : Acyclovir maker:
GlaxoSmithKline
traditional dosage
what it treats , precautions , and recommendations w h at i t d o e s :
side effects
Varies; the drug is available in single-use vials with 0.3, 1, or 1.3 milliliters of calcium hydroxylapatite suspended in a water-based gel. Delivered by intravenous infusion, the initial dose depends on the patient’s weight, gender, and how well the kidneys clear creatinine from the blood. Maintenance dose is 5 mg per kilogram of body weight, by infusion, once every two weeks. It is injected into the skin, and results can last up to a year. Injectible implant for use in hands.
Treats CMV retinitis The antigout drug probenecid (brand name Benemid or 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.
Most serious: kidney toxicity, decreased interocular pressure
For treatment of Mycobacterium avium complex, one 600 mg tablet daily, with 15 mg of Myambutol; for prevention, two 600 mg tablets, once weekly, which may be combined with Mycobutin
w h at i t d o e s :
Most serious: irregular heart activity, in rare cases fatal; liver enzyme abnormalities and other liver problems, severe diarrhea, hearing impairment
Dosage varies depending on type of infection; available in capsules, tablets, oral suspension, topical cream, and as intravenous injectable
w h at t o k n o w :
Treats and helps prevent Mycobacterium avium
complex w h a t t o k n o w : When this drug is used with Viracept, which can increase concentrations of Zithromax, the patient should be monitored closely for known side effects of Zithromax, such as liver enzyme abnormalities and hearing impairment.
w h at i t d o e s :
Treats and controls herpes viral infections, like shingles, genital warts, and chicken pox w h at t o k n o w : Use with caution with Retrovir, antifungal agents, Benemid, interferon, intrathecal methotrexate, and drugs that can cause kidney toxicity. Drink plenty of fluids while taking the drug.
Other: nausea, vomiting, fever
Other: nausea, vomiting, mild to moderate diarrhea, abdominal pain
Most serious: severe allergic reaction, blood and liver disorders, hepatitis, peripheral edema (blood clotting leading to swelling of the legs or arms), gastrointestinal upset, nausea, alopecia (hair loss), jaundice, seizures, confusion, hallucination Other: headache, visual impairment, tremors, rash or stinging skin with topical ointment
38 | JULY / AUGUST 2016
black market hiv drugs
a matter of life and death , here are five ways to make sure your drugs are actually safe .
1 Although getting your meds from a major retailer doesn’t come with a money-back guarantee, chances are higher that the small new pharmacy advertising rock bottom prices may have drugs that come from dubious sources. Unless you can thoroughly vet your pharmacy, stick with larger or chain stores, well-known small pharmacies, or HIV specialty pharmacies. If you shop online, protect yourself by visiting only establishments verified by the National Association of Boards of Pharmacy (NABP.net). 2 Be wary of Internet pharmacies, especially if they claim to be Canadian. In 2005, the U.S. Food and Drug Administration found that 85 percent of the online pharmacies claiming to be from Canada were actually located someplace else on the globe. 3 Check your medication before taking them. Use Plus magazine’s Treatment Guide or Drugs.com to look up the name of your meds and compare the photo of the pill to what’s in your RX bottle. Don’t take them if they don’t look the same. (Note: You may not be able to return medications after leaving the pharmacy.) 4 Report any adverse reactions—especially if they aren’t on the list of known side effects—and show questionable meds to your doctor or a reputable pharmacist. 5 Remember, you get what you pay for. If something seems too good to be true, it probably is. So weigh your risks carefully. It’s one thing to to hope that the generic Rogaine you found on Amazon will actually prevent hair loss; it’s quite another to play Russian roulette with your life-saving HIV or HVC meds. — j a c o b a n d e r s o n - m i n s h a l l
SHUTTERSTOCK
H I V D R U G S A R E B I G B U S I N E SS —and not just to the companies that manufacture them and the pharmacies that sell them. They are also a growing portion of the drugs flooding the black market, generally stolen or counterfeit medications. It’s tempting to buy the drugs marketed online at a fraction of what you’re paying for them. As long as you get the drugs you need, you might not care if you buy them from “legitimate” sources or a cutrate online pharmacy in China selling them for a fraction of the price. Unfortunately, as an AARP investigation recently discovered, many of these drugs are not actually the product of drug heists or patent-breaking knock-offs. Instead, many contain the wrong dosages or none of the stated medication at all. Worse, the AARP Bulletin found that many drugs they tested were “full of dangerous contaminants, including heavy metals, rat poison, and even toxic highway paint.” So how do you protect yourself? Here are some helpful tips.
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The 2016 Hepatitis C Treatment Guide W E LC O M E TO P LU S magazine’s first hepatitis C (HCV) treatment guide. The U.S. Centers for Disease Control and Prevention reports approximately 25 percent of all HIV-positive people also have hep C (HCV), but many don’t know it or aren’t getting treatment. Fortunately, there’s never been a better time to start treatment for hepatitis C, because new (and better) medications are now available—including some that provide what is essentially a cure for 90 percent of users. With that in mind, below you’ll find our comprehensive guide to hep C drugs, their side effects, and whether they’ll interact with your HIV therapy or other medications. Getting a prescription for HCV drugs usually requires genetic testing to determine which genotype of the virus you have. Talk with your doctor before starting or changing any medications.
INTERFERONS
The oldest class of drug used to fight HVC does so two ways: it makes the hep C virus more visible to the immune system and it directly suppresses formation of new virus particles in the liver.
Medication PEGASYS generic name:
traditional dosage
drug interactions , precautions , and recommendations
side effects
180 micrograms, once weekly, by subcutaneous injection
Do not take if you have autoimmune hepatitis or liver problems. Do not take with Copegus or Rebetol if you are pregnant or if you or your partner plan to become pregnant. Avoid taking Videx. Use with caution if taking Tyzeka, Theo-24, Elixophyllin, Uniphyl, Theolair, Azasan, Imuran, warfarin (Coumadin and Jantoven), phenytoin (Dilantin, Phenytek, Dilantin-125, and Cerebyx), or methadone.
Most serious: severe eye, blood, liver, nerve, thyroid, or lung problems; stroke, heart attack, pancreatitis, severe infections, suppression of bone marrow function, colitis, high blood sugar or diabetes, allergic reaction, growth inhibition in pediatric patients. Plus: neuropsychiatric reactions including suicide, homicidal ideation, relapse of drug addiction, and drug overdose
Peginterferon Alfa-2A m a k e r : Genentech
Other: flu-like symptoms, tiredness, weakness, stomach problems, loss of appetite, skin reactions, tongue discoloration, hair thinning, insomnia
generic name:
Peginterferon Alfa-2B Merck
maker:
1.5 micrograms per kilogram of body weight, once weekly, by subcutaneous injection; other doses no longer being manufactured
40 | JULY / AUGUST 2016
Use with caution with drugs metabolized by CYP2C8/9 or CYP2D6. Monitor for toxicities when used with NRTIs. Do not take if you have autoimmune hepatitis or certain other liver problems.
Most serious: severe eye, blood, liver, nerve, thyroid, or lung problems, pancreatitis, colitis, high blood sugar or diabetes, allergic reaction Other: flu-like symptoms, tiredness, appetite problems, skin reactions, hair thinning
SHUTTERSTOCK
PEGINTRON
S3/4A PROTEASE INHIBITOR
This class of drugs fight HCV by inhibiting the NS3-4A enzyme, an essential element in the virus’s replication.
Medication OLYSIO generic name:
Simeprevir Janssen
maker:
traditional dosage
drug interactions , precautions , and recommendations
side effects
150 mg capsule, once daily, with food, in combination with ribivarin (marketed under brand names Copegus, Rebetol, and others) and Pegasys. Has also been approved for use in combination with the hepatitis C drug, Sovaldi
Do not take if you or partner are pregnant or plan to be, as birth defects or fetal death can result. Avoid using Prezista, any cobicistat-containing product (Tybost, Prexcobix, Stribild), Rescriptor, Intelence, Viramune, or any HIV protease inhibitor—with or without ritonavir (Novir). Use with caution if taking Tegretol, Mycobutin, Rifadin, Saint-John’s-wort, Norvir, Kaletra, Biaxin, cimetidine, antifungal meds, grapefruit juice, Sovaldi; antibiotics like Priftin, Ketek, erythromycin; the corticosteroid dexamethasone (Maxidex, Ozurdex, and Baycadron); amiodarone (Cordarone, Nexterone, and Pacerone); generic cisapride; or some anticonvulsants.
Most serious: severe rash, fetal damage, liver failure, dangerously slow heart rate Other: milder rash, itching, sensitivity to light, nausea
COMBINATION DRUGS
Helping to prevent the replication of HCV, drugs in this class combine two or more medications that use different methods to attack the virus.
Medication HARVONI generic name:
Ledipasvir
and Sofosbuvir m a k e r : Gilead
TECHNIVIE generic names:
Ombitasvir, Paritaprevir, and Ritonavir m a k e r : Abbvie
VIEKIRA PAK generic names:
Ombitasvir, Paritaprevir, and Ritonavir tablets packaged with Dasabuvir tablets m a k e r : AbbVie
ZEPATIER generic names:
and Grazoprevir m a k e r : Merck
Elbasvir
traditional dosage
drug interactions , precautions , and recommendations
side effects
One tablet daily, containing 90 mg of ledipasvir and 400 mg of sofosbuvir. Treatment duration 12 or 24 weeks. Doesn’t need to be taken with ribavarin or interferon. (Harvoni combines a NS5A inhibitor and a nucleotide NS5B polymerase inhibitor.)
Do not use with Saint-John’s-wort, Cordarone, Crestor, Mycobutin, Rifadin, Olysio, anticonvulsant drugs, or the HIV drugs Aptivus, Norvir, or Stribild. Use with caution with drugs that contain tenofovir, such as Viread, Truvada, and Atripla. Leave at least four hours between Harvoni and antacid consumption. Use with caution if pregnant or breast-feeding; and when taking another direct acting hep C antiviral. Do not take other products with Sovaldi (sofosbuvir) in them. If taken with ribavirin (Copegus, Rebetol), all ribavirin warnings and contraindications apply.
Most serious: skin rashes, sometimes with swelling and blisters occuring
Two tablets taken orally, once daily with food; used commonly with ribavirin (Copegus, Virazole, and Ribasphere). (Technivie is a combo of a NS5A Inhibitor, a NS3/4A Protease Inhibitor, and a CYP3A Inhibitor.)
Do not take if you have cirrhosis, nor in combination with Colchicine, Alfuzosin HCI, Carbamazepine, phenytoin, phenobarbital, Rifampin, or Ergot derivatives. Discontinue medications with ethinyl estradiol (estrogen) prior to starting. If taken along with ribavirin (Copegus, Rebetol) all ribavirin warnings and contraindications apply.
Most serious: liver failure
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 food, for 12 weeks. For patients with HCV genotype 1a and cirrhosis, ribivarin should be added. (Viekira Pak combines a NS5A inhibitor, a NS3/4A protease inhibitor, and a non-nucleoside NS5B polymerase inhibitor.)
Do not take with Uroxatral, Carbatrol, Epitol, Equetro, Tegretol, Sustiva, Atripla, Cafergot, Complera, Kaletra, Migergot, Ergomar, Ergostat, Edurant, Medihaler, Wigraine, Wigrettes, D.H.E. 45, Migranal, Ergotrate, Methergine, ethinyl estradiol-containing medicines, Lopid, Advicor, Altoprev, Mevacor, oral midazolam, Norvirboosted Prezista, Sustiva, Dilantin, Phenytek, Luminal, Orap, Zocor, Vytorin, Simcor, Viagra, Cialis, Saint-John’s-wort, Halcion, Rifadin, Rifamate, Rifater, Rimactane, or Revatio when taken for pulmonary artery hypertension. Do not take if you have liver cirrhosis or have had a severe skin rash after taking ritonavir (Norvir). Use with caution if you have other liver problems or have had a liver transplant and take the medicines Prograf, Gengraf, Neoral, or Sandimmune. If taken with ribavirin (brand names Copegus, Rebetol) all ribavirin warnings and contraindications apply.
Most serious: liver damage or liver failure, hypersensitivity
One tablet daily containing 50 mg elbasvir and 100 mg grazoprevir. For use with or without ribavirin. (Combines a NS5A inhibitor and NS3/4A protease inhibitor.)
Co-administration with CYP3A inhibitors is not recommended. May increase concentrations of statins. If taken along with ribavirin (Copegus, Rebetol) all ribavirin warnings and contraindications apply.
Most serious: elevation of liver enzymes
Other: fatigue, headache
Other: asthenia, fatigue, nausea, and insomnia
Other: nausea, itching, sleep problems
Other: fatigue, headache, nausea, anemia
Editor’s note: This information has been culled from the National Institutes of Health, the Food and Drug Administration and individual pharmaceutical companies.
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NUCLEOSIDE ANALOGS
Often used in combination with Pegasys or PegIntron, these drugs inhibit RNA replication of the hepatitis C virus
Medication COPEGUS generic name: maker:
Ribivarin
Roche
REBETOL generic name: maker:
Ribivarin Schering, Merck
traditional dosage
drug interactions , precautions , and recommendations
side effects
800 to 1,200 mg daily, depending on patient’s weight, taken twice daily in 200 mg capsules, with food
Do not use if you have cirrhosis or will be having a liver transplant; or if you take Videx or Videx EC. Use caution when taking with NRTIs like Combivir, Epivir, Epzicom, Retrovir, Trizivir, as drug interactions could lead to toxicity. Do not take if you have certain blood disorders, such as thalassemia major or sickle-cell anemia, or certain types of hepatitis. Do not take if you are pregnant or if you or your partner plan to become pregnant.
Most serious: Stunted growth among patients under 17; severe eye, blood, lung, or liver problems; pancreatitis; skin reactions (some fatal); depression or suicidal thoughts; high blood sugar or diabetes; fetal death or birth defects.
Do not take if you use Videx or Videx EC; have cirrhosis or will be having a liver transplant; have autoimmune hepatitis, certain blood disorders, or severe kidney disease; or if you are pregnant or if you or your partner plan to become pregnant. Use caution when taking with NRTIs such as Combivir, Epivir, Epzicom, Retrovir, or Trizivir.
Most serious: severe eye, lung, or blood problems; pancreatitis; severe depression, anorexia, homicidal or suicidal thoughts; fetal death, birth defects, or pediatric growth inhibition; skin problems (some fatal); anemia
800 to 1,400 mg daily, based on patient’s weight, by oral solution, taken with food. Capsule version no longer manufactured. Usually prescriped in combination with PegIntron.
Other: flu-like symptoms, tiredness and weakness, nausea and vomiting, loss of appetite, anemia, hair thinning, trouble sleeping
Other: dental problems caused by dry mouth, less serious mood changes, flu-like symptoms, headache, fever, stiffness
NUCLEOTIDE NS5B POLYMERASE INHIBITORS
This class of drugs mimics the NS5B enzyme; when incorporated into viral replication they cause RNA chain termination.
Medication SOVALDI generic name: maker:
Sofosbuvir
Gilead
traditional dosage
drug interactions , precautions , and recommendations
side effects
One 400 mg tablet, once daily, in combination with ribivarin (marketed under brand names Copegus, Rebetol, and others); with some types of hep C virus, peginterferon alfa (Pegasys) should be used
Do not take if you or partner are pregnant or plan to be, as birth defects or fetal death can result. Do not take with Aptivus, Olysio, Tegretol, Dilantin, Tileptal, Mycobutin, Rifadin, Priftin, Saint-John’s-wort, or drugs containing phenobarbital. Use caution taking Sovaldi with another direct acting hep C antiviral; avoid other sofosbuvir-containing medications like Harvoni. When taken along with ribavirin or peginterferon, all of their associated warnings and contraindications apply.
Most serious: fetal damage Other: fatigue, headache, nausea, insomnia, anemia
NONSTRUCTURAL PROTEIN 5A (NS5A) REPLICATION COMPLEX INHIBITORS Inhibitors of NS5A block a protein essential for HCV to produce, thus stopping viral production at an early stage. Medication DAKLINZA g e n e r i c n a m e : Daclatasvir maker:
Squibb
Bristol-Myers
traditional dosage
drug interactions , precautions , and recommendations
side effects
1 60 mg tablet taken orally, once daily in combination with sofosbuvir (Sovaldi) with or without ribavirin (Rebetol, Copegus, Virazole, or Ribasphere). Also available in 30 mg and 90 mg doses.
Should not be taken with Rifadin (rifampin), Saint-John’s-wort, or anticonvulsants
Most serious: symptomatic bradycardia (abnormally slow heartbeat) in patients taking with Solvaldi, Harvoni or amiodarone (Cordarone, Nexterone, and Pacerone)
42 | JULY / AUGUST 2016
Other: headache, fatigue.
HOW ARE YOU GOING TO AFFORD THIS?
H I V M E D S A R E O F T E N E X P E N S I V E , so
can also help pay for your 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 for every state. Each state’s Maximum Qualifying Income (MQI, the most you can make and still qualify for help) is shown as a percentage of the federal poverty level as well. We also give you the dollar amount for a one-person household, and you can use their charts to go up from there. Most states start with the 2016 federal poverty level for one person ($11,880 plus $4,160 for each additional family member).
SHUTTERSTOCK
your first concern might be how to pay for it all. But don’t worry, whether or not you have insurance (even if your income is too high to qualify for Medicaid), there are still programs that can help. The Affordable Care Act requires insurers to provide prescription drug coverage and they must cover at least one drug in every class (including HIV meds). Furthermore, they have to count your co-pays towards a lifetime cap on out-ofpocket expenses. The ACA marketplace has also made coverage available to millions of previously uninsured Americans—especially in states that accepted Medicaid expansion. Find more information at Healthcare.gov. The federally created, state-managed AIDS Drug Assistance Program (ADAP)
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AIDS DRUG ASSISTANCE PROGRAM CONTACT INFORMATION ALABAMA
F LO R I DA
LO U I S I A N A
Website: bit.ly/ALadap Phone: (334) 206-5364 MQI: 300% or $35,640
Website: floridaADAP.org Phone: (850) 245-4334 MQI: 400% or $47,520
Website: hiv.dhh.louisiana.gov Phone: (504) 568-7474 MQI: 300% or $35,640
ALASKA
GEORGIA
MAINE
Website: bit.ly/ALASKAadap (907) 452-4222 MQI: 400% or $59,360
Website: bit.ly/GEORGIAadap Phone: (404) 657-3100 MQI: 300% or $35,640
Website: bit.ly/MEadap Phone: (207) 287-3747 MQI: 500% or $59,400
ARIZONA
H AWA I I
MARYLAND
Website: bit.ly/ARIZadap Phone: (800) 334-1540 MQI: 400% or $47,520
Website: bit.ly/HIadap1 Phone: (808) 586-4400 MQI: 400% or $54,680
Website: bit.ly/MDadap1 Phone: (800) 205-6308 MQI: 500% or $59,400
ARKANSAS
I DA H O
M A SS AC H U S E T T S
Website: bit.ly/ARadap Phone: (501) 661-2408 MQI: 400% or $47,520
Website: safesex.idaho.gov Phone: (208) 334-6527 MQI: 200% or $23,760
Website: bit.ly/MAadap1 Phone: (800) 228-2714 MQI: 500% or $59,400
CA L I FO R N I A
ILLINOIS
M I C H I GA N
Website: bit.ly/CAadap Phone: (916) 449-5900 MQI: 500% or $59,400
Website: bit.ly/ILLadap Phone: (217) 782-4977 MQI: 300% or $35,310
Website: michigan.gov/dap Phone: (888) 826-6565 MQI: 450% or $53,460
C O LO R A D O
INDIANA
M I N N E S OTA
Website: stdhivco.org Phone: (303) 692-2716 MQI: 500%, or $58,850
Website: bit.ly/indianaADAP Phone: (317) 233-7450 MQI: 300% or $35,640
Website: bit.ly/MNadap1 Phone: (800) 657-3761 MQI: 400% or $47,520
C O N N E CT I C U T
I OWA
M I SS I SS I P P I
Website: bit.ly/CTadap Phone: (800) 233-2503 MQI: 400% or $47,520
Website: bit.ly/IAadap1 Phone: (515) 281-0926 MQI: 200% or $23,760
Website: bit.ly/mississippiADAP Phone: (601) 576-7723 MQI: 300% or $35,640
D E L AWA R E
KANSAS
M I SS O U R I
Website: bit.ly/DEadap Phone: (302) 744-1050 MQI: 500% or $59,400
Website: bit.ly/KANadap Phone: (785) 368-8218 MQI: 300% or $35,640
Website: bit.ly/missouriADAP Phone: (866) 628-9891 MQI: 300% or $35,640
D I S T R I CT O F C O LU M B I A
KENTUCKY
M O N TA N A
Website: bit.ly/DCadap Phone: (202) 671-4900 MQI: 500% or $59,400
Website: bit.ly/kentuckyADAP Phone: (866) 510-0005 MQI: 400% or $47,520
Website: bit.ly/montanaADAP Phone: (406) 444-4744 MQI: 330% or $39,204
44 | JULY / AUGUST 2016
NEBRASKA
OKLAHOMA
VERMONT
Website: bit.ly/NEadap Phone: (402) 559-4673 MQI: 200% or $23,760
Website: bit.ly/OKADAP Phone: (405) 271-4636 MQI: 200% or $23,760
Website: bit.ly/vermontADAP Phone: (802) 863-7245 MQI: 500% or $59,400
N E VA DA
OREGON
VIRGINIA
Website: bit.ly/NVadap1 Phone: (775) 684-4247 MQI: 400% or $47,520
Website: bit.ly/ORadap1 Phone: (800) 805-2313 MQI: 500% or $59,400
Website: bit.ly/virginiaADAP Phone: (855) 362-0658 MQI: 400% or $47,520
NEW HAMPSHIRE
P E N N SY LVA N I A
WA S H I N GTO N
Website: bit.ly/NHadap1 Phone: (603) 271-4502 MQI: 400% or $47,520
Website: bit.ly/PAadap Phone: (877) 724-3258 MQI: 500% or $59,400
Website: bit.ly/WAadap1 Phone: (360) 236-3426 MQI: 400% or $47,520
NEW JERSEY
Website: bit.ly/newjerseyADAP Phone: (877) 613-4533 MQI: 500% or $59,400 NEW MEXICO
Website: nmhivguide.org Phone: (505) 827-2435 MQI: 400% or $47,520 N E W YO R K
Website: bit.ly/adapNewYork Phone: (800) 542-2437 MQI: 435% or $51,678 N O R T H CA R O L I N A
Website: bit.ly/adapNCar Phone: (877) 466-2232 MQI: 300% or $35,640 N O R T H DA KOTA
RHODE ISLAND
Website: bit.ly/RIadap1 Phone: (401) 462-3294 MQI: 400% or $47,520 S O U T H CA R O L I N A
Website: bit.ly/SCadap1 Phone: (800) 569-9954 MQI: 300% or $35,640 S O U T H DA KOTA
Website: bit.ly/SDakADAP Phone: (605) 773-3737 MQI: 300% or $35,640 T E N N E SS E E
Website: bit.ly/TNadap1 Phone: (615) 714-7500 MQI: 400% or $47,520
WEST VIRGINIA
Website: bit.ly/WestVAADAP Phone: (304) 558-2195 MQI: 400% or $47,520 WISCONSIN
Website: bit.ly/WIadap Phone: (800) 991-5532 MQI: 300% or $35,640 W YO M I N G
Website: bit.ly/WYadap Phone: (307) 777-5856 MQI: $40,050-$46,100, depending on county (new MQI released soon)
TEXAS
Website: ndhealth.gov/HIV Phone: (800) 472-2180 MQI: 300% or $35,640
Website: Unavailable Email: Rachel.Sanor@dshs.state.tx.us Phone: (800) 255-1090 MQI: 200% or $23,760
OHIO
U TA H
Website: bit.ly/OHadap Phone: (800) 777-4775 MQI: 300% or $35,640
Website: bit.ly/UTadap Phone: (801) 538-6197 MQI: 250% or $29,700
ADAP also covers Puerto Rico, Guam, the Virgin Islands, and Pacific Island Territories. Visit bit.ly/HHSadap for more information.
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| 45
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. A B B OT T , A B B V I E
Abbviepaf.org (800) 222-6885 B R I S TO L - M Y E R S S Q U I B B
BMSpaf.org (800) 736-0003 BOEHRINGER INGELHEIM
bit.ly/BIpap (800) 556-8317 G E N E N T E C H ( I N C LU D E S H O F F M A N - L A R O C H E )
Genentech-Access.com/patients (866) 422-2377 GILEAD
bit.ly/GileadPAP (800) 226-2056 G L A XO S M I T H K L I N E
GSKforYou.com JA N SS E N
JanssenPrescriptionAssistance.com MERCK
MerckHelps.com VIIV
SHUTTERSTOCK
ViivHealthcareForYou.com
46 | JULY / AUGUST 2016
YOU CAN LIVE A HEALTHY LIFE WITH HIV. TREATMENT HELPS MAKE IT POSSIBLE.
Starting treatment means you’re protecting your health. Find out why it’s so important at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1857 03/15
D A I LY D O S E
WHY WE SHOULDN’T STOP TALKING ABOUT BEING ‘UNDETECTABLE’ TREATMENT AS PREVENTION IS NOT A SEXY TOPIC, BUT IT SHOULD BE. I T I S I M P OSS I B L E to have a modern conversation about HIV without having the term “undetectable” used, misused, and abused. Activists certainly have strong opinions on how the term—which refers to an HIVpositive person’s viral load once it becomes so low it is no longer detectable by current blood testing processes—should be used correctly. Some herald the term as a badge of honor worn by those who are compliant with treatment and open about their HIV status. Others scold the same group of people for using the term as an excuse to engage in unsafe sexual behavior. Neither oversimplified accolades nor mudslinging moral judgments should have a place in conversations about HIV stigma, prevention, and the goal of staying on medication. But many are still unclear about what being “undetectable” truly constitutes. For those who are still unsure: An HIV-positive person can achieve undetectable viral levels after undergoing antiretroviral therapy. A person’s viral load affects both their own health and the chance that they will transmit HIV. A study in The New England Journal of Medicine
48 | JULY / AUGUST 2016
showed early antiretroviral therapy reduced the likelihood of transmission by 96 percent. Once antiretroviral meds help a person achieve an undetectable viral load, it is possible to remain at this level, provided the person continues to take the medication as directed. An education on the specifics of HIV as it is today, including the meaning of being undetectable, should be mandatory reading. No matter how far removed you are from the HIV pandemic, you are still susceptible to the virus (especially if you think you aren’t). Casual conversation among our peers is the most effective method of education. But, as with many discussions concerning HIV, far too many of these debates devolve into blame games. Who loses? Everyone. A person with an undetectable viral load and a person who is HIV-negative both get tested regularly to make sure that they’re still safely in their category. Yet for some reason, discussing an undetectable status immediately gets bogged down by shame-mongering and moral accusations. Even using the term to describe your own HIV status opens you to ridicule and judgment. The following quote was taken from a response to a post asking how we can make progress in eliminating HIV stigma: “I’d like to hear more responsible discussion in our community about how dangerous and reckless it is to use the term ‘undetectable’ given the implications of treating ‘undetectable’ status as if it were really something different from being positive.” This claim may not have been made with malicious intent, but it does offer a clear demonstration of the difficulty of discussing HIV-related topics without subconsciously casting judgment. In fact, people who are undetectable should never stop talking about their status. At the gym, on the subway, and even at Sunday services (if that’s your sort of thing). A person discussing their undetectable status is a beautiful thing because it means they have been tested, are on treatment, and are open and honest about their HIV status. The idea that the term “undetectable” is used to lure unsuspecting prey into performing high-risk sexual acts with someone who is positive is both stigmatizing and ridiculous. This notion removes all responsibility from the other party when they have just been given the information they need to protect their own health. Far too often, our community mistakes silence as an admission of innocence. If no one asks a person’s HIV status, no one tells. Worse, some will assert their HIV-negative status even if it’s been months or even years since their last HIV test. Yet these proverbial question marks walk around every day, unscathed by denunciations associated with their bedtime behavior. They aren’t reduced to sweeping stereotypes of being sexual pariahs even though their pseudo-negative HIV status could possibly place a person at much greater risk than that of someone who is undetectable. Sometimes it might feel like nobody likes using condoms and everybody is a liar. But that doesn’t mean we have to muddle the value of an undetectable viral load and debase a group of people who are at least willing to be up front with their status. Sex acts don’t exist in two separate vacuums. If they did, it would be much easier to end transmission of the virus. So the conversation about what it will take to decrease stigma and increase testing must also exist without uninformed generalizations that could silence many before they even speak. In order for a conversation about HIV and HIV stigma to have substantive meaning, assumptions, accusations, and generalizations need to become “undetectable.”
SHUTTERSTOCK
BY TYLER CURRY
P ep + HIV treatment + Condoms
#PlaySure
BE HIV & STI Sure If you are HIV negative, PrEP is a daily pill that protects you from HIV. If you have HIV, treatment can keep your virus level undetectable and decreases the chance of passing HIV to your partners. Condoms add more protection against HIV and help prevent Sexually Transmitted Infections. PLAY SURE: Call 311 or visit nyc.gov/health to design the right HIV and STI prevention combination for you.
Bill de Blasio Mayor Mary T. Bassett, MD, MPH Commissioner
You want time for important things Š2015 Walgreen Co. All rights reserved.
97483-620-1015
Walgreens HIV-specialized pharmacies can coordinate your prescription refills so you can pick them all up on the same day. Plus, we can remind you about medication doses and refills. It’s our way of helping you simplify your busy life. To learn more, visit HIV.Walgreens.com.