HIV Plus Issue 119 July/August 2017

BECAUSE YOU’RE MORE THAN YOUR STATUS

OUR 5TH ANNUAL HIV & HEP C TREATMENT GUIDE

MR. MAJORS HE WENT FROM BASKETBALL TO BEYONCÉ VIDEOS. NOW ACTOR DEMARCO MAJORS IS OPENING UP ABOUT HIS BIGGEST LIFE CHANGE.

JULY/AUGUST 2017 www.hivplusmag.com

YOU MATTER AND SO DOES YOUR HEALTH That’s why starting and staying on HIV-1 treatment is so important.

WHAT IS DESCOVY®?

DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. 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 DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health.

What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • 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 DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being

more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• 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 DESCOVY 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 DESCOVY? • 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 over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY 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 DESCOVY with all of your other medicines.

• If you are pregnant or plan to become pregnant.

It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • 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 DESCOVY, including important warnings, on the following page.

Ask your healthcare provider if an HIV-1 treatment that contains DESCOVY® is right for you.

IMPORTANT FACTS This is only a brief summary of important information about DESCOVY and does not replace talking to your healthcare provider about your condition and your treatment. ®

(des-KOH-vee) MOST IMPORTANT INFORMATION ABOUT DESCOVY

POSSIBLE SIDE EFFECTS OF DESCOVY

DESCOVY may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

DESCOVY can cause serious side effects, including: • Those in the “Most Important Information About DESCOVY” section.

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• Bone problems.

The most common side effect of DESCOVY is nausea.

These are not all the possible side effects of DESCOVY. Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with DESCOVY.

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years of age and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

• DESCOVY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.

BEFORE TAKING DESCOVY Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection.

• Have any other medical condition.

• Are pregnant or plan to become pregnant.

• 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 DESCOVY.

GET MORE INFORMATION • This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more.

• Go to DESCOVY.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit DESCOVY.com for program information.

HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines.

• Take DESCOVY with or without food.

DESCOVY, the DESCOVY Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. DVYC0057 05/17

IN THIS ISSUE

J U LY/A U G U S T 2 0 1 7

ON THE COVER 40 Double Major

Former pro basketball player DEMARCO MAJORS left the court for Hollywood.

But his biggest challenge started when he learned he was living with HIV.

FEATURES

14 Our Annual HIV & Hep C Treatment Guide

Full deets on every HIV drug.

Treating Hep C and other comorbidities.

TREATMENT/TASP 6 HIV Made Me Fat

New study: obesity and HIV-related fat gain.

7 Reservoir Dogs

A new drug targets HIV reservoirs.

8 Left Behind

Gay and bi black men aren’t getting antiretroviral treatment.

9 Ring Around the Rosy

New ring prevents pregnancy and HIV.

9 Switcheroo

Switching to generic saves money without messing up treatment.

RESISTANCE 39 Warrior Calls

Dealing with HIV often means battling drug resistance. He’s up for the challenge.

DAILY DOSE 51 Unlucky in Love

Having HIV doesn’t mean I did something wrong, I just wasn’t a lucky lady.

CHILL 52 Your First Time

How to disclose you’re poz on a first date.

BACK TALK 56 A Woman of Influence

Anne-christine d’Adesky looks back at ’90s AIDS activism in Pox Lover.

ON THE COVER AND THIS PAGE: D E MARCO MAJORS PHOTOGRAPHED IN LOS ANGELES BY PHIL KNOTT. STYLED BY THOMAS VAN HORN.

HIVPLUSMAG.COM

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editor in chief DIANE ANDERSON-MINSHALL • svp, group publisher JOE VALENTINO art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL managing editor SAVAS ABADSIDIS editors at large TYLER CURRY, KATIE PEOPLES associate editor DAVID ARTAVIA assistant editors DESIREE GUERRERO, RAHEL NEIRENE contributing editors KHAFRE ABIF, MARK S. KING, ZACHARY ZANE mental health editor GARY MCCLAIN contributing writers ALEX GARNER, MARY LADD, SHYRONN JONES creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producer MICHAEL LUONG front end developer MAYRA URRUTIA senior drupal developer NICHOLAS ALIPAZ, SR. traffic manager KEVIN BISSADA manager, digital media LAURA VILLELA director of integrated marketing BRANDON GRANT senior manager, integrated marketing JAMIE TREDWELL managers, integrated marketing GRETA LIBBEY, CASEY NOBLE, RYAN WEAVER events manager JOHN O’MALLEY junior designer TEDDY SHAFFER senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN director of social and branded content LEVI CHAMBERS branded content producer LENNY GERARD editor, social media DANIEL REYNOLDS senior fulfillment manager ARGUS GALINDO operations director KIRK PACHECO office manager HEIDI MEDINA production services GVM MEDIA SOLUTIONS, LLC HERE MEDIA chairman STEPHEN P. JARCHOW ceo PAUL COLICHMAN cfo/coo TONY SHYNGLE managing directors LUCAS GRINDLEY, JOHN MONGIARDO executive vice presidents JOE LANDRY, BERNARD ROOK senior vice presidents GREG BROSSIA, CHRISTIN DENNIS, JOE VALENTINO vice presidents ERIC BUI, STEVEN CAPONE ADVERTISING & SUBSCRIPTIONS Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES 43430 E. Florida Ave. #F PMB 330, Hemet, CA 92544 • Phone (951) 927-8727 • Email support@retrogradecommunications.com or editor@HIVPlusMag.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 Argus.Galindo@heremedia.com.

Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc. Plus is a registered trademark of Here Media Inc. Entire contents © 2017 by Here Publishing Inc. All rights reserved. Printed in the USA.

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JULY / AUGUST 2017

50 years

on of award-winning HIV coverage.

EDITOR’S LETTER IT’S A SUNDAY morning before

ON THE WEB

While this issue details every single FDA-approved med for HIV and hep C, there’s even more online. Some of the medication related resources not to miss: E How to Make Sure Your Drugs Aren’t Fake bit.ly/BadDrgs E How HIV Meds Make it to Market bit.ly/Lab2Mrkt E The Truth about 15 Alternative Treatments for HIV-Positive People bit.ly/AltHIVTrtmnt E How Pharma Companies Can Help Pay for Your Meds bit.ly/HIVRXPay E More Ways to Pay for Meds Now bit.ly/Pay4HIVMeds E HIV Side Effects and the Meds that Treat Them bit.ly/HIVsideFX

BECAUSE YOU’RE MORE THAN YOUR STATUS

HE WENT FROM BASKETBALL TO BEYONCÉ VIDEOS. NOW ACTOR DEMARCO MAJORS IS OPENING UP ABOUT HIS BIGGEST LIFE CHANGE

OUR 5TH ANNUAL HIV & HEP C TREATMENT GUIDE

JULY/AUGUST2017 www.hivplusmag.com

SHUTTERSTOCK

WHICH IS YOUR FAVORITE COVER? So many good photos, so many choices! Here’s just one of the great cover images we had to chose from. Did we pick the right one? Email us at editor@HIVPlusMag.com.

we go to press, and a Google alert pops up in my Slack: “Top sports star investigated by cops over allegations he infected ex-lover with HIV.” It’s from the conservative British tabloid, The Sun, a dubious publication that talks about female celebs with headlines like, “Tam is a Man Eater.”

I know to generally ignore them.

But the fact that this anonymous gossip item is a headline that will reach millions of readers, is a reminder that coming out as poz can still be tough as hell. In addition, HIV criminalization continues to do serious damage and the way the media talks about HIV (e.g. his “infected ex-lover”) influences how both HIV-negative and positive people view the virus.

Two handsome men in this issue of Plus—our magnificent cover star, DeMarco Majors, and our resistance warrior, Jorge Diaz—reminded me of those things as well. For Majors, this interview is the first time he’s publicly spoken about being HIV-positive, something he’s been struggling with for a while.

Majors was one of the first out gay pro men’s basketball players. He played internationally and in the American Basketball Association. (John Amaechi, then retired, and Jason Collins, not yet retired, were the first out gay NBA players). Later, Logo’s reality show, Shirts & Skins, followed Majors and his Rock Dogs b-ball team as they trained to go for the gold at the 2006 Gay Games.

Reality TV gave way to acting and modeling. (He was the nearly-naked star at his first New York Fashion Week, and the cover shoot he did for us was so awesome, we could barely pick a cover!) Up next, a film he’s writing and directing. Majors felt he had a lot to lose—but more to gain—in sharing his story about growing up in poverty, facing addiction and sexual assault, and living with HIV. Another gay man of color, Jorge Diaz, the son of Latino immigrants, was afraid to disclose his HIV status when he was diagnosed at 21. Fear of rejection, shame, and stigma held him back—and led to treatment failure and medication resistance. But today, he’s a warrior, not just with his treatment regime, but also in the community. The one-time go-go dancer turned his master’s degree from the University of California Los Angeles into a career. He now helps other Latinos deal with HIV from a “whole person” perspective at Bienestar. What got him through? His mom, who has been his champion since he came out to her a year after his diagnosis and 7 months after his first treatment failed.

This is also our annual treatment guide, in which we list available HIV and hepatitis C treatments, detailing the dosages, usages, contraindications, and side effects so you—and your doctor—can determine the treatment that works best for you.

Getting on treatment is tough, but finding a way to adhere to that treatment can be tougher. To do it right, you need to process your emotions and find someone who can help you. Fear of rejection is often worse than the reality. If you can’t rely on an extended family like Diaz, remember that guys like him are ready to talk. You’re more than your viral load, your monthly lab tests, or your diagnosis. You’re the same great person, with a virus and a new medication regime. If you don’t know that yet, please seek out a counselor (many clinics offer free or sliding scale therapy), a local HIV support group (find anonymous groups through ProjectInform.org), peer-to-peer online support (try Therapy Tribe), or 24-hour HIV Nightline’s toll-free line (800-628-9240). Nightline talks to about 15,000 people a year, and you can call for any reason related to HIV, AIDS, unsafe sexual encounters, and more.

Be safe, be well, be happy.

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

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treatment / tasp

DOES THIS HIV MAKE ME LOOK FAT?

New study explains why you may have difficulty losing weight.

Obesity is characterized by an excess of fatty tissue, which makes it similar to lipohypertrophy, an HIVrelated fat build-up that’s the leading cause of the buffalo hump in the upper back, but can also cause fat to accumulate in other areas of your body, like your neck.

Ironically, this excess accumulation of fat can coexist with another HIV-related condition, lipoatrophy, in which fat loss occurs in the face or limbs. Also known as wasting, lipoatrophy is indelibly etched into our communal subconscious by images of people living with AIDS in the 1980s.

Lipohypertrophy has been linked to HIV itself as well as the drugs used to treat the virus. Adding to the complexity, Dr. Jordan E. Lake, an infectious disease specialist with McGovern Medical School of University of Texas Health Science Center at Houston, tells Plus,

people with HIV can experience obesity at the same time as lipohypertrophy or lipoatrophy. (Yes, you can have a gaunt face, beer belly, and buffalo hump all at once.)

“As the obesity epidemic overlaps with the HIV epidemic,” Lake says, “it is becoming harder to isolate what component of central weight gain is [obesity] and what is lipohypertrophy. The take home point is that increased visceral fat through whatever mechanism has detrimental metabolic effects.”

CONTINUED ON PAGE 13

SHUTTERSTOCK

BY JACO B A N D E R S O N - M I N S H A L L

New drug uncovers and treats HIV reservoirs, previously the biggest barrier to a cure.

potential to induce a functional cure.

Past cure research had been hampered by the difficulty in locating, “waking,” and treating the virus hiding in reservoirs, especially in people whose HIV is undetectable. That makes this discovery truly groundbreaking.

“Currently-approved drugs can effectively reduce and control the replication of the HIV virus in humans, allowing many patients to live with chronic treatment,” Dr. Jean-Marc Steens, chief medical officer at Abivax, said in a statement. “But no drugs have been able to eradicate the virus in humans because it evades therapy by hiding in ... HIV reservoirs.”

During the trial, 30 HIV-positive people in Spain, Belgium, and France were randomly placed in two groups.

In addition to their current antiretro-

“a gene expression signature of 103 upregulated genes that are specific for latently infected cells.” The protein CD32a was the most apparent in HIV reservoir cells but had “no detectable expression in bystander cells.”

With this knowledge, a team under Dr. Bonaventura Clotet—director of the IrsiCaixa AIDS Research Institute, sought to determine if ABX464 influenced the size of HIV reservoirs.

Half of participants saw the amount of HIV DNA reduce by over 25 percent.

“These results in [HIV-positive people] are a first and very important step in supporting the hypothesis that ABX464 could impact the HIV reservoir,” noted Steens.

No negative health impacts were reported when participants returned to their normal HIV treatment.

FOR THE FIRST time, scientists have reduced HIV reservoirs, thanks to a tiny antiviral molecule, ABX464, patented by the biotech company Abivax.

A first-in-class oral treatment, ABX464 recently finished Phase II clinical trials, where it dramatically reduced HIV reservoirs, furthering its

viral treatment, the majority received ABX464 for 28 days, while a smaller control group received a placebo.

Researchers measured viral DNA, using a biomarker for determining the presence of HIV reservoirs, which itself was just discovered earlier this year; as reported in the journal Nature. French researchers found

“We are excited to see this unique finding and are looking forward to further studying ABX464, as we would like to determine, through additional clinical trials, whether we can further increase the magnitude of the effect on reducing HIV reservoirs to the lowest possible level,” said Clotet.— DAV I D A R TAV I A

SERGEI ANUSHO

NO MORE PEEK A BOO

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treatment / tasp

FALLING BEHIND It’s time for us to get real. We are not doing enough to help black men who have sex with men and are living with HIV. If you don’t believe me, just look at the data.

Last February, the Centers for Disease Control and Prevention released a report predicting that one out of every two gay, bisexual, or same-gender loving black men will become HIV-positive in their lifetime­— unless we do something about it.

Even worse, those black men who do become HIV-positive aren’t getting into care and onto antiretroviral medication, and thus are more likely to experience negative health outcomes.

“Blacks continue to be less likely to be prescribed [antiretroviral] treatment,” according to a new study published in the Journal of Infectious Diseases.

Brooke E. Hoots from the University of North Carolina, Chapel Hill, and her colleagues at CDC’s National HIV Behavioral Surveillance Study Group, wrote that the difference in ART use, “persisted even after controlling for other predictors of lower access, namely, less education, lower income, and lack of health insurance.”

The researchers found that the proportion of newly diagnosed HIV-positive men in the U.S. who were able to start ART because of proper access to care increased between 2008 8

JULY / AUGUST 2017

and 2014. However, those rates were 9 percent lower among black gay and bi men compared to their white counterparts. Why the disparity?

“The issues involved are often as much societal as medical,” the authors concluded, pointing to a lack of access “to housing and education, employment and adequate income, substance use and mental health services, and other social determinants of health.”

Discrimination, poverty, stigma, and a lack of access to healthcare affect the overwhelming number of the African-Americans who accounted for 45 percent of all HIV diagnoses in 2015, according to the CDC. “How health systems can be improved and linked to communities of need without addressing these overarching issues remains a massive challenge for investigators and implementers alike,” the researchers said.

As reported by Michael Carter on NAM’s AIDSMap, the proportion of people linked to care within three months of diagnosis increased from 79 percent in 2008 to 87 percent in 2014. However, linkage to care was more likely among people with higher levels of education and health insurance.

Higher rates of ART use were observed among white people, older age groups, better educated gay and bi men, and those with health insurance. There were also regional disparities, with people in Southern states having the lowest level of ART use.

In 2014, the scientists found 90 percent of those with insurance were on ART. However, men living in the South were less likely to be insured because fewer Southern states have expanded Medicaid coverage under the Affordable Care Act. (This doesn’t bode well for other areas now that the ACA is under attack by Republicans.)

After reviewing the data, researchers argued that understanding the racial differences in ART access and use should be the next research priority. Furthermore, they concluded that innovative programs and community outreach were needed to bridge the gap. — DA

SHUTTERSTOCK

The number of poz guys on antiretroviral therapy is increasing, just not for black men.

switching

ONE WAY TO SAVE SOME CASH Spend less on your meds and maybe take a vacation for once.

Switching from branded Atripla to regimens that include at least one generic drug is a big cost saver and doesn’t compromise efficacy—at least in England. That’s according to research by Dr. Hardeep Kang and her team at U.K.’s Blackpool Teaching Hospitals NHS Foundation Trust. Presented at the the 23rd Annual Conference of the British HIV Association, the study followed 86 people who switched from a once-a-day Atripla, to a multi-pill combination of tenofovir, generic efavirenz, and generic lamivudine.

Participants who switched to generics maintained their undetectable viral loads, only one person discontinued the new regimen because of pill burden, and it all led to an annual cost savings over $200,000.

Atripla combines efavirenz, emtricitabine, and tenofovir in a single daily pill. Its potency, convenience, and relative safety meant it was once the preferred drug for first-line HIV therapy. Though supplanted by newer combo medications, it’s still taken by many people. Kang admitted that switching to generics did have challenges, especially after pharmacy stock delays for a specific generic medication forced the study to switch participants to other generics.

“This meant that patients were receiving pills of differing appearance,” she said, “increasing the potential for confusion about which pills had been taken.”

Despite that, Kang’s team concluded that the option was a viable cost-saving medication switch that worked well and users reported the burden of taking extra pills wasn’t an issue.—SAVAS ABADSIDIS

TWO RING CIRCUS

SHUTTERSTOCK

A new vaginal ring is both an anti-HIV drug and a contraceptive.

A new vaginal ring containing both the antiretroviral drug, dapivirine, and a hormonal contraceptive, levonorgestrel, could give women a single pre-exposure prophylaxis that shields them from both HIV and unintended pregnancy.

Microbicide Trials Network, an international collaboration of clinical trials that is funded by The National Institutes of Health, is overseeing this Phase I trial, after two larger trials— ASPIRE and The Ring Study—verified the durability of monthly dapavirine rings.

The newest study is testing whether the ring will be able to provide a three-month supply of the two drugs. It will be conducted at MageeWomens Hospital of the University of Pittsburgh School of Medicine and the University of Alabama at Birmingham.

It wasn’t until women who participated in previous ring trials expressed a need for a dual-purpose prophylaxis that researchers reportedly embraced the idea.

Both previous studies involved women wearing a vaginal ring for four weeks at a time. When used correctly, NAM’s AIDSMap reported such rings to be 75 to 92 percent effective in preventing HIV among women.

However, at last year’s International AIDS Conference, ASPIRE researchers acknowledged more dubious results, reducing HIV transmission by 56 percent in women 22 to 26, and 51 percent for women over 27, but having zero effect for women 18 to 21.

Researchers argued the problem was adherence, and have pressed on.

That’s because the ring symbolizes the first long-lasting, easy-to-use, HIV prevention women can discreetly employ. That is particularly important in situations—or parts of the world— where women may

not have sexual autonomy or the ability to insist their partner uses protection.

If all goes well, Dr. Sharon L. Achilles, director of the University of Pittsburgh Center for Family Planning Research told reporters, the study will determine whether a duo-purpose ring could last “longer—for up to three months—as it was intended.”

Results are expected mid-2018. “This study is a critical first step on a pathway that we hope will ultimately enable us to provide women with an easy-to-use product that can provide safe and effective, long-acting protection against both HIV and unintended pregnancy,” Achilles concluded.—DA HIVPLUSMAG.COM

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we stay Sure HIV treatment = Prevention #PlaySure

BE Sure, Play Sure, Stay Sure.

If you’re HIV positive, starting and staying on treatment can keep your viral load undetectable. Treatment keeps you healthy and makes it nearly impossible to pass HIV to your partner. Condoms offer additional protection against HIV and other STIs.

STAY SURE: Call 311 or visit nyc.gov/health/staysure to learn more about services that can help you get and stay on treatment.

CONTINUED FROM PAGE 6

Lake is the lead author of a new study published recently in Clinical Infectious Diseases, in which researchers from 12 universities raise concerns, noting that overweight or obese HIV-positive people have more than a 67 percent chance of having other health problems, including “detrimental effects on muscle,” osteoarthritis, neurocognitive dysfunction, cardiovascular disease, and diabetes.

In addition, the report notes, “Body fat changes are stigmatizing and may impact self-esteem, affect ART adherence, lead to depression, and decrease quality of life.”

The researchers recommend doctors monitor HIV-positive patients’s weight, as “prevention and early intervention are likely more effective than reversing fat accumulation.”

Indeed, there aren’t that many (successful) treatments for obesity. The first involves “structured exercise with or without dietary intervention.” There are also a handful of pharmaceutical options, although some, like orlistat (Alli, Xenical) and naltrexone/bupropion (Contrave) aren’t recommended for people on antiretroviral medications (orlistat is particularly dangerous as it can cause ART to fail).

The study notes bariatric weight loss

surgery “is the most effective treatment for obesity, resulting in an average 60-70 percent loss of excess body weight,” but these surgeries have mixed reviews when it comes to people with HIV, and should only be considered after “serious attempts at lifestyle changes.”

There are even fewer treatments for those dealing with lipohypertrophy, Lake says. In fact, “Egrifta [tesamorelin] is the only FDAapproved pharmacologic therapy to reduce visceral fat in HIV-infected persons.”

Although many have turned to liposuction to deal with HIV-related fat deposits, Lake says, “These are separate issues. Liposuction doesn’t improve the health of the fat, and is used for cosmetic purposes only. You can only remove subcutaneous fat—fat under the skin—with liposuction. Fat in different parts of the body behaves differently. The ‘buffalo hump,’ for example, isn’t as metabolically active as abdominal visceral fat— fat around and in the organs of the body.”

That can make it harder to remove through liposuction.

But, Lake adds, stimulating the visceral depot to reduce its size, which is what tesamorelin does, “has clear metabolic and inflammatory benefits.”

As does losing weight.

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LEDBUG

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JULY / AUGUST 2017

our 5th annual hiv treatment guide For 2017, Plus has put together our most up-to-date and comprehensive look at the medications approved by the Food and Drug Administration for the treatment of HIV and opportunistic infections in this easy to pull out section. research by mary r. ladd

Editor’s note: This info was culled from the National Institutes of Health’s drug database, the FDA, and individual pharmaceutical companies.

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PROTEASE INHIBITORS

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

traditional dosage

drug interactions, precautions, and recommendations

side effects

APTIVUS

500 mg (two 250 mg capsules or 5 ml of oral solution) with 200 mg (two 100 mg capsules/tablets or 2.5 ml of solution) of Norvir, twice daily. If taken with Norvir capsules or solution, may be taken with or without meals; if taken with Norvir tablets, must be taken with meals.

For treatment-experienced patients, in combination with at least two other anti-HIV drugs. Do not use with other protease inhibitors.

Do not take with Rifadin, ergot derivatives (Dihydroergotamine, ergonovine, ergotamine, methylergonovine), St. John’s Wort, Versed, Latuda, Cisapride, Revatio, Uroxatral, Altoprev, Mevacor, Orap, Zocor, Halcion, or certain anti-arrhythmic drugs (Amiodarone, bepridil, flecainide, propafenone, quinidine). 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 and hyperglycemia other: diarrhea, nausea, fever, vomiting, tiredness, headache, stomach pain, rash, increased sun sensitivity, increased blood fat (lipid) levels, changes in body fat

CRIXIVAN

800 mg, taken every eight hours, with water or other 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, Latuda, Orap, Cordarone, Hismanal, Halcion, Xanax, Revatio, Uroxatral, Rifadin, Rimactane, Rifamate, Rifater, St. John’s Wort, Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate, Methergine, or Reyataz.

Use with caution with Viagra, Cialis, Levitra, Lipitor, Seroquel, Crixivan, 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 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

INVIRASE

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 CYP3A substrates (dapsone, disopyramide, quinine), Aptivus-Norvir combination, Uroxatral, Cordarone, Vascor, Cisapride, Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot medications (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, St. John’s Wort, Trazodone, garlic capsules, fusidic acid products, or drugs that both increase saquinavir plasma concentrations. Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Rescriptor, Viramune, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Seroquel, hormonal contraceptives, certain sedatives and hypnotics, certain calcium channel blockers, certain antibiotics and antifungals, some antipsychotics or antidepressants, proton pump inhibitors. Do not use if you have complete atrioventricular block without implanted pacemakers, or are at high risk of complete AV block; have severe liver problems, low potassium or low magnesium, Long QT Syndrome, refractory hypokalemia or hypomagnesemia.

Use caution if you have other heart or liver problems, hemophilia, or diabetes.

most serious: worsening of heart and or liver problems; increased bleeding with hemophilia; diabetes or high blood sugar, elevated cholesterol or triglycerides; or changes in body fat, immune system, or heart rhythm other: nausea, vomiting, diarrhea, fatigue, dizziness, fainting, abdominal pain

KALETRA

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: it should be taken with food.

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, St. John’s Wort, dihydroergotamine (D.H.E. 45 and others), ergonovine (Ergotrate), methylergonovine (Methergine), or ergot-containing medicines, including ergotamine (Cafergot and others). Use with caution with Viagra, Cialis, Levitra, Adcirca, 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, methadone, birth control pills, or contraceptive patches containing estrogen.

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

generic name: Tipranavir maker: Boehringer Ingelheim

generic name: Indinavir maker: Merck

generic name: Saquinavir mesylate maker: Hoffmann-La Roche

generic name: Lopinavir and ritonavir maker: AbbVie

16

JULY / AUGUST 2017

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

LEXIVA

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 twice daily, sometimes paired with Norvir. 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, St. 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 StevensJohnson syndrome, new or worsened diabetes, redistribution of body fat, elevated cholesterol, anemia, spontaneous bleeding, kidney stones other: diarrhea, rash, nausea, vomiting, headache

NORVIR

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), St. 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 drug 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 other: rash, abdominal pain, diarrhea, feeling weak or tired, headache, nausea, vomiting, changes in taste, loss of appetite, dizziness, tingling feeling or numbness (on hands, feet, or around the lips)

PREZISTA

One 800 mg tablet with one 100 mg Norvir capsule, once daily, with food; or one 600 mg tablet with one 100 mg Norvir tablet or capsule taken twice daily, with food for those with drug resistance.

Do not take with Uroxatral, Victrelis, D.H.E. 45, Embolex, Migranal, Cafergot, Ergomar, methylergonovine, Propulsid, Orap, oral midazolam, Halcion, St. John’s Wort, Mevacor, Altoprev, Advicor, Zocor, Simcor, Vytorin, Rifadin, Rifater, Rifamate, Rimactane, Revatio (when used to treat pulmonary arterial hypertension), Crixivan, Kaletra, Invirase, Eliquis, Pradaxa, Xarelto, Vfend, Priftin, dexamethasone, Olysio, Afinator, Serevent, Stendra, or Incivek. Colchicine (Colycris, Mitigare) is contraindicated in patients with liver or kidney problems. Use caution if taking Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Seroquel, Col-Probenecid, Coartem, or Riamet. May reduce birth control pills’s 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 other: diarrhea, nausea, mild rash, headache, stomach pain, vomiting

REYATAZ

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. Take at the same time every day.

Do not take with Versed, Halcion, Cafergot, Migranal, D.H.E. 45, Methergine, other ergot medicines, Orap, Camptosar, Crixivan, Mevacor, Zocor, Uroxatral, Revatio, Rimactane, Rifadin, Rifater, Rifamate, St. 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, diabetes, kidney stones, worsening liver disease, increased bleeding problems, gallbladder disorders, changes in body fat, immune system, or heart rhythm other: nausea, headache, stomach pain, vomiting, diarrhea, depression, fever, dizziness, trouble sleeping, muscle pain, numbness, tingling, or burning of hands or feet

VIRACEPT

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.

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, St. John’s Wort, Mevacor, Zocor, or Serevent. Use 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 Videx. May reduce effectiveness of birth control pills, so use alternative forms 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 or immune system other: diarrhea, nausea, rash

generic name: Fosamprenavir maker: ViiV Healthcare

generic name: Ritonavir maker: AbbVie

generic name: Darunavir maker: Janssen

generic name: Atazanavir maker: Bristol-Myers Squibb

generic name: Nelfinavir maker: ViiV Healthcare

HIVPLUSMAG.COM

17

ENTRY AND FUSION INHIBITORS

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

They are always taken with other HIV medications. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

FUZEON

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 other: pain and numbness in feet or legs, loss of sleep, depression, decreased appetite, sinus problems, enlarged lymph nodes, weight decrease, loss of strength, muscle pain, constipation, pancreas problems

REBETOL

800 to 1,400 mg daily, based on patient’s weight, by oral solution, taken with food. Capsule version no longer manufactured. Usually prescribed in combination with PegIntron.

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 other: dental problems caused by dry mouth, less serious mood changes, flu-like symptoms, headache, fever, stiffness, injection site reaction, neutropenia

SELZENTRY

300 mg twice daily; or 150 mg twice daily if taken with potent CYP3A inhibitors; or 600 mg twice daily if taken with potent CYP3A inducers.

Do not take St. John’s Wort, Prezista, Kaletra, Reyataz, Sustiva, Atripla, which may 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, or if you have low blood pressure or take medication to lower it.

most serious: heart or liver disorders, lowered blood pressure when standing, increased risk of cancer and infections, changes in immune system, severe rash, allergic reaction leading to hepatotoxicity other: cough, fever, dizziness, headache, lowered blood pressure, nausea, bladder irritation, upper respiratory infection

generic name: Enfuvirtide maker: Roche Laboratories (Fuzeon); Trimeris (Generic)

generic name: Ribivarin maker: Schering, Merck

generic name: Maraviroc maker: ViiV Healthcare

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

traditional dosage

drug interactions, precautions, and recommendations

side effects

ISENTRESS

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 other: headache, trouble sleeping, nausea, tiredness, weakness, stomach pain, dizziness, depression, suicidal thoughts and actions

TIVICAY

One 50 mg tablet, once daily for those new to integrase inhibitors or antiretroviral drugs; 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 if you have ever had an allergic reaction to a medicine that contains dolutegravir (Tivicay, Triumeq). Do not take with dofetilide (Tikosyn), oxcarbazepine, phenytoin, phenobarbital, carbamazepine, or St. John’s Wort. Do not take with etravirine (Intelence) without coadministration of ritonavir (Norvir) and either atazanavir (Reyataz), darunavir (Prezista), or lopinavir (or Kaletra a combination of ritonavir and lopinavir). Take two hours before or six hours after antacids, laxatives, or other medicines that contain aluminum, magnesium, sucralfate (Carafate), or buffered medications. Multivitamins, oral iron, or calcium supplements may be taken at the same time if taken with food. If you are starting or stopping the diabetes drug metformin at the same time as Tivicay, you 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 other: insomnia, nausea, headache

generic name: Raltegravir maker: Merck

generic name: Dolutegravir maker: GlaxoSmithKline

18

JULY / AUGUST 2017

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)

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

traditional dosage

drug interactions, precautions, and recommendations

side effects

COMBIVIR

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 (Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir, Atripla, Emtriva, Truvada). Use caution 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, flare-up of hepatitis B after discontinuation, or changes in body fat or immune system other: headache, nausea, fatigue, diarrhea, cough, stuffy nose, general discomfort

EMTRIVA

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.

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

EPIVIR

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. There is risk of severe liver decomposition if you take combination antiretroviral therapy and interferon alfa drugs for hepatitis C.

most serious: buildup of lactic acid, severe liver problems, changes in body fat, or immune system changes other: headache, nausea, malaise, fatigue, nasal problems, diarrhea, cough

EPZICOM

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 take Atripla, Combivir, Emtriva, Epivir, Trizivir, Truvada, Ziagen, methadone, or medicines used to treat hepatitis. If you have hep B, do not run out of or stop taking Epzicom without consulting your doctor. Your general health, blood tests, and liver functions should be monitored if you stop taking Epzicom.

Do not take if you have moderate to severe liver problems, or are breastfeeding.

most serious: severe allergic reactions, buildup of lactic acid in the blood, liver problems other: insomnia, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever

RETROVIR

600 mg a day, taken in divided doses, in tablets, capsule, or syrup. Can also be given as an intravenous infusion, 1 mg per kg of body weight, over one hour, every four hours.

Do not take with other medicines that contain the same active ingredients, including Combivir and Trizivir. Not recommended for use with hepatitis drugs (Copegus, Rebetol, RibaTab, 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 other: headache, malaise, nausea, anorexia, vomiting

TRIZIVIR

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

Do not take if you have certain liver problems or weigh less than 90 pounds. Take with caution if you have the gene variation 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, Atripla, Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Retrovir, Truvada, Zerit, Ziagen, or bone marrow suppressive or cytotoxic medicines.

most serious: severe or fatal allergic reactions, heart attack, buildup of lactic acid, liver disorders, blood problems, muscle weakness, body fat or immune system changes, hepatitis B flare-up other: nausea, vomiting, headache, weakness, diarrhea, fever or chills, depression, muscle and joint pain, skin rashes, cold symptoms, nervousness, ear, nose, and throat infections

generic name: Lamivudine and zidovudine maker: ViiV Healthcare (Combivir); Hetero Labs, Aurobindo, Teva Pharmaceuticals (Generic)

generic name: Emtricitabine maker: Gilead Sciences

generic name: Lamivudine or 3TC maker: ViiV Health

generic name: Abacavir sulfate and lamivudine maker: ViiV Healthcare

generic name: Zidovudine or AZT maker: ViiV Healthcare

generic name: Abacavir sulfate, lamivudine, and zidovudine maker: ViiV Healthcare

HIVPLUSMAG.COM

19

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)

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

traditional dosage

drug interactions, precautions, and recommendations

side effects

TRUVADA

For HIV Treatment: One tablet, containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate.

Once daily for adults and children weighing at least 17 kg, with or without food. Always used in combination with other HIV medications.

For HIV prevention: One tablet once daily taken orally with or without food. Must be paired with regular HIV tests and safer sex practices.

Do not take with Hepsera, Atripla, Combivir, Complera, Descovy, Emtriva, Epivir or Epivir-HBV, Epzicom, Genvoya, Stribild, Trizivir, or Viread. 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-up of hep B, kidney problems, thinning bones, changes in body fat, inflammation other: diarrhea, dizziness, nausea, vomiting, headache, fatigue, abnormal dreams, sleeping problems, rash, depression, pain, weakness, skin discoloration, headache, abdominal pain, weight loss

VIDEX EC

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 capsules whole; do not chew, break, crush, or dissolve. A powder form may be mixed with water for children.

Do not take with Lopurin or Zyloprim (used to treat gout and kidney stones), or hepatitis drugs (Copegus, Rebetol, RibaTab, Ribasphere).

Use caution with methadone, ganciclovir, or any drugs that may cause toxicity to the pancreas or nervous system. If also taking Viread, reduce Videx EC dose.

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

VIREAD

One 300 mg tablet, once daily with or without food. Adults unable to swallow tablets may take 7½ scoops of Viread oral powder. If you have kidney problems (CrCl<50ml/min) dose adjustments are recommended.

Viread is used in combination with other antivirals to treat HIV-1 infection. Also used to treat hepatitis B. (HIV testing recommended for HBV patients before starting Viread.)

Do not take Viread if you are taking other medicines that contain tenofovir disoproxil fumarate (Atripla, Complera, Truvada, Stribild), tenofovir alafenamide (Descovy, Genvoya, Odefsey), or adefovir (Hepsera). Dosages may need to be adjusted 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, or bones other: nausea, rash, diarrhea, headache, pain, depression, weakness

ZERIT

For individuals 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 zidovudine-containing drugs (Retrovir, Combivir Trizivir). Do not take with hydroxyurea (Droxia, Hydrea). Use caution with Videx EC, Adriamycin, Rubex, Copegus, Rebetol, Ribasphere, Virazole, Roferon-A, and Intron-A. Use 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 lactic acid in blood, serious liver problems, pancreatitis, changes in immune system or body fat, peripheral neuropathy other: headache, diarrhea, rash, nausea, vomiting

ZIAGEN

600 mg in tablets daily, administered as either 300 mg twice daily or 600 mg once daily.

Also available as an oral solution.

Individuals with mild liver impairment should take 200 mg twice daily.

Do not take if you have moderate to severe liver impairment. 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 the gene variation HLA-B*5701. Do not take if you are pregnant or plan on becoming pregnant; do not take if you breastfeed or plan on breastfeeding.

most serious: severe allergic reaction, buildup of lactic acid in blood, changes in body fat or immune system, severe liver problems, increased risk of heart attack especially with other risk factors (smoking, etc) other: shortness of breath, cough, sore throat, nausea, vomiting, fatigue, headache, diarrhea, stomach pain, rash, trouble sleeping, fever or chills, loss of appetite, tiredness, achiness

generic name: Emtricitabine and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Didanosine maker: Bristol-Myers Squibb

generic name: Tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Stavudine or D4T maker: Bristol-Myers Squibb

generic name: Abacavir maker: GlaxoSmithKline

20

JULY / AUGUST 2017

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

Help prevent replication of HIV; drugs in this class attack the same enzyme NRTIs do, but in a different way. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

EDURANT

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 other NNRTIs; antiseizure drugs (Luminal, Tegretol, Trileptal, Dilantin); antituberculosis medicines (Rifadin, Rimactane, Priftin); proton pump inhibitors (Nexium, Vimovo, Prevacid, Prilosec, Protonix, Aciphex); more than one dose of dexamethasone; or St. John’s Wort. Use caution with antifungals (Sporanox, Diflucan, Nizoral, Noxavil); Vfend taken orally; antibiotics (Mycobutin, Biaxin, and Ketek); methadone; or protease inhibitors. Take H2 blockers (Tagamet, Pepcid, Zantac)—or antacids containing aluminum, magnesium hydroxide, or calcium carbonate—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, severe skin rash and allergic reactions, and liver problems.

0ther: insomnia, headache, rash

INTELENCE

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. Tablet may also be dispersed in a full glass of water.

Do not take with other NNRTIs; Aptivus, Lexiva, or other protease inhibitors without ritonavir; epilepsy and seizure medicines (Tegretol, Carbatrol, Luminal, Dilantin, Phenytek); St. John’s Wort; or antibacterial drugs (Mycobutin, Rifadin, Rifater, Rifamate, Priftin). Use caution with Tivicay, Triumeq, Coartem, Sporanox, Diflucan, Nizoral, Noxavil, Vfend, dexamethasone, Neoral, Sandimmune, Prograf, Rapamune, or drugs that inhibit or induce the genetic features CYP3A, CYP2C9, and/or CYP2C19.

most serious: severe skin reactions such as StevensJohnson syndrome, changes in immune system or body fat other: changes in body shape, tingling or pain in the hands or feet, numbness

RESCRIPTOR

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, St. 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 other: headache, nausea, diarrhea, tiredness

SUSTIVA

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 (like Wigraine, Cafergot); Mepron or Paludrine. The following medicines may need to be replaced with others while taking Sustiva: Fortovase, Invirase, Biaxin, Carbatrol, Tegretol, Noxafil, Sporanox, and Reyataz. Change in doseage may be required of either Sustiva or these medicines: 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 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, skin reactions other: changes in immune system or body fat, dizziness, nausea, headache, insomnia, tiredness

VIRAMUNE

One 200 mg tablet daily for first 14 days, then one 200 mg twice daily. Also available in oral suspension; 100 mg tablet for children; or an extended-release formulation, for which dosage is one 200 mg tablet of immediaterelease Viramune once daily for 14 days, followed by one 400 mg tablet of Viramune XR once daily.

Do not take with St. John’s Wort, Sustiva, Atripla, Kaletra, Lexiva, Reyataz, Nizoral, Sporanox, Rifadin, Rifamate, Rifater, Victrelis, Incivek, or birth control pills. Tell your doctor if you’re 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 other: dizziness, nausea, vomiting, diarrhea, rash, sleep disturbances, drowsiness, trouble concentrating, unusual dreams

generic name: Rilpivirine maker: Janssen

generic name: Etravirine maker: Janssen

generic name: Delavirdine maker: ViiV Healthcare

generic name: Efavirenz maker: Bristol-Myers Squibb

generic name: Nevirapine maker: Boehringer Ingelheim

HIVPLUSMAG.COM

21

COMBINATION DRUGS

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

traditional dosage

drug interactions, precautions, and recommendations

side effects

ATRIPLA

One tablet, once daily on an empty stomach, preferably at bedtime (600 mg of efavirenz, 200 mg emtricitabine, and 300 mg of tenofovir disoproxil fumarate). Efavirenz is an NNRTI, the other components NRTIs.

Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, Trizivir), other HIV antiretroviral medications, drugs to treat seizures or tuberculosis, adefovir (Hespera), St John’s Wort, sofosbuvir/velpatasvir (Epclusa), or more than one dose of dexamethasone. Use caution with antidepressants, antifungals, antimalarials, birth control, blood thinner (warfarin), high blood pressure medication (calcium channel blockers), and 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-up, depression, bone thinning, changes in immune system other: dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, abnormal dreams, rash

COMPLERA

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

Rilpivirine is an NNRTI, the other components NRTIs. Complera is for those who are new to antiretroviral drugs and have viral loads of 100,000 copies/ml or less.; or as a replacement regimen for individuals with a viral load of 50 copies/ml or less and no resistance to any components.

Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, Trizivir), other antiretroviral medications, antiseizure or antituberculosis drugs, proton pump inhibitors (Kapidex, Dexilant), adefovir (Hespera), St John’s Wort, or more than one dose of dexamethasone. Use caution with 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-up, depression, bone thinning, changes in immune system other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, weight gain

EVOTAZ

One tablet (300 mg atazanavir and 150 mg cobicistat) once daily with food, in combination with other antiretroviral drugs.

Atazanavir (Reyataz) is a protease inhibitor and cobicistat (Tybost) a boosting agent.

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 St John’s Wort.

Use with caution if you have heart, liver, or kidney problems; diabetes; hemophilia; or if you are pregnant, plan to become pregnant, or 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 other: nausea, yellowing of the skin or whites of the eyes

GENVOYA

One tablet (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide) once daily, with food. For those 12 or older who weigh at least 35 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least 6 months, with no previous virologic failure, and no drug resistance to the components of Genvoya.

Do not use with other HIV drugs containing tenofovir alafenamide (Odefsey, Descovy), the HBV drug Vemlidy, HIV drugs containing emtricitabine or tenofovir disoproxil fumarate (Atripla, Complera, Stribild, Emtriva, Truvada, Viread), drugs containing lamivudine (Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir), ritonavir or other drugs containing cobicistat (Evotaz, Prezcobix), Revatio, Hepsera, alfuzosin, rifampin, cisapride, lurasidone, pimozide, St John’s Wort, ergot derivatives (dihydroergotamine, ergotamine, methylergonovine), HMG-CoA Reductase inhibitors (lovastatin, simvastatin), anticonvulsants (carbamazepine, phenobarbital, phenytoin), or sedative hypnotics. Avoid if taking Quetiapine for schizophrenia. Not FDA approved for hepatitis B treatment. Not recommended if you have a creatinine clearance below 30 ml/minute.

most serious: buildup of lactic acid in blood; severe liver or kidney problems, which could lead to fatal renal failure; thinning bones; changes in immune system other: nausea, diarrhea

generic name: Efavirenz, emtricitabine, and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Emtricitabine, rilpivirine, and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Atazanavir and cobicistat maker: Bristol-Myers Squibb

generic name: Elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide maker: Gilead Sciences

22

JULY / AUGUST 2017

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

ODEFSEY

One tablet (200 mg of emtricitabine, 25 mg of rilpivirine, and 25 mg of tenofovir alafenamide), once daily, with a meal . Rilpivirine is an NNRTI, the other components NRTIs. Odefsey is for those new to antiretroviral drugs, who have a viral load of 100,000 copies/ml or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies/ml or less.

Do not take with medicines that contain lamivudine (Epivir, EpivirHBV, Epzicom, Combivir, Trizivir), other antiretroviral medications, antiseizure or antituberculosis medicine, proton pump inhibitors (Kapidex, Dexilant), adefovir (Hespera), St 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, hepatitis B flare-up, depression, changes in immune system other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, weight gain

PREZCOBIX

One tablet (800 mg of darunavir and 100 mg of cobicistat), once daily with food. Darunavir (Prezista) is a protease inhibitor and cobicistat (Tybost) a boosting agent.

Do not take with Eliquis, Pradaxa, Xarelto, Trileptal, Aptiom, Vfend, Priftin, dexamethasone, Olysio, Afinator, Serevent, Sustiva, Atripla, Intelence, Viramune, Stendra, Vitekta, Stribild, other protease inhibitors, Uroxatral, Propulsid, Propulsid Quicksolv, 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, St John’s Wort, or Halcion.

Use with caution with Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Seroquel, Coartem, or Riamet.

Colchicine Colcrys, Mitigare contraindicated in those with liver or kidney problems. Use with caution if you have liver or kidney problems, or if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed.

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, new or worsening kidney problems (when taken with certain other medicines) other: diarrhea, nausea, rash, headache, abdominal pain, vomiting

STRIBILD

One tablet (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate) once daily, with food. For those 12 or older, who weigh at least 35 kg, and are new to antiretroviral therapy; or as a replacment regimen for those virologically suppressed on their current regimen for at least 6 months, who have no previous virologic failures, and no drug resistance to Stribild components.

Do not use with other HIV drugs containing emtricitabine or tenofovir disoproxil fumarate (Atripla, Complera, Emtriva, Truvada, Viread), lamivudine, ritonavir (Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir), or tenofovir alafenamide (Genvoya, Odefsey, Descovy); the HBV drug Vemlidy; ritonavir or other drugs containing cobicistat (Evotaz, Prezcobix); or Revatio, Hepsera, alfuzosin, rifampin, cisapride, lurasidone, pimozide, St John’s Wort; ergot derivatives (dihydroergotamine, ergotamine, methylergonovine), HMG-CoA Reductase inhibitors (lovastatin, simvastatin), anticonvulsants (carbamazepine, phenobarbital, phenytoin); or with sedative hypnotics. Avoid if taking Quetiapine for schizophrenia or Ledipasvir for hepatitis C treatment. Not FDA approved for hepatitis B treatment. Not recommended if you have a creatinine clearance below 70 ml/minute.

most serious: buildup of lactic acid in blood; severe liver or kidney problems, which could lead to potentially fatal renal failure; thinning bones; changes in immune system other: nausea, diarrhea

TRIUMEQ

One tablet (50 mg of dolutegravir, 600 mg of abacavir, and 300 mg of lamivudine), once daily, with or without food. Dolutegravir (Tivicay) is an integrase strand transfer inhibitor, the other two components (Ziagen and Epivir), both NRTIs .

Do not take with Epzicom, Trizivir, Ziagen, Combivir, Epivir, EpivirHBV, Emtriva, Atripla, Complera, Stribild, Truvada, Tikosyn, Viramune, Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin, or St 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, changes in body fat or immune system, increased risk of heart attack other: trouble sleeping, headache, fatigue

generic name: Emtricitabine, rilpivirine, and tenofovir alafenamide maker: Gilead Sciences

generic name: Darunavir and cobicistat maker: Janssen

generic name: Elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Dolutegravir, abacavir sulfate, and lamivudine maker: ViiV Healthcare

HIVPLUSMAG.COM

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DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

AMBISOME, AMPHOTEC, ABELCET, AMPHOCIN

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

what it does: Treats fungal infections (including cryptococcal meningitis), which are more common in people with HIV. what to know: 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 other: fever, shaking, chills, weight loss, nausea, headache, jaundice

ANDROGEL

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, upper arms, and stomach area (abdomen); 1.62 percent only to shoulders and upper arms.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50. what to know: Apply at same time every day, after bathing or showering, to clean, dry skin. Wash hands immediately after applying. Cover application area with clothing after 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 doctor 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. Tell your provider the other drugs you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, 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 other: increased prostatespecific antigens, mood swings, high blood pressure, increased red blood cell count, skin irritation, more frequent or longer-lasting erections

AXIRON

30, 60, 90, or 120 mg, as determined by your physician, and with frequency determined by doctor. Apply only under the arms.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50 what to know: Wash hands immediately after applying. Cover 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 doctor about all your health conditions, especially difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Should not be used if you have breast or prostate cancer. Tell your provider the drugs you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, 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 other: increased prostatespecific antigens, increased red blood cell count, skin irritation or redness, headache, diarrhea, vomiting, more frequent or longer-lasting erections

BACTRIM, SEPTRA, SULFATRIM

400 mg (two or four tablets) three times daily.

what it does: Treats and helps prevent recurrence of Pneumocystis carinii pneumonia (PCP) 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 other: dizziness, nausea, vomiting, diarrhea, loss of appetite, fatigue, headache, low blood sodium

BARACLUDE

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.

what it does: Treats chronic hepatitis B. May also help inhibit HIV replication, although this use has not been confirmed. what to know: People with HIV should be on antiretroviral treatment as well, as resistance to 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.

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

BIAXIN

500 mg, 2 or 3 times daily, depending on infection.

Available in immediate release tablets, extended release tablets, and granules.

what it does: Fights bacterial infections, especially Mycobacterium avium complex (MAC). what to know: 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 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 other: headache, change in taste

generic name: Amphotericin B maker: Astellas, Alkopharma, Sigma-Tau, Pfizer

generic name: Testosterone gel maker: AbbVie

generic name: Testosterone topical solution maker: Lilly

generic name: Sulfamethoxazole/ trimethoprim maker: Various (see HIVPlusMag.com)

generic name: Entecavir maker: Bristol-Myers Squibb

generic name: Clarithromycin maker: AbbVie

24

JULY / AUGUST 2017

HIV TREATMENT CAN GET YOUR VIRAL LOAD SO LOW, IT’S UNDETECTABLE. GO FOR UNDETECTABLE.

There is no cure for HIV, but being undetectable helps protect your health. See how. Watch “The Goal of Undetectable” at HelpStopTheVirus.com © 2015 Gilead Sciences, Inc. All rights reserved. UNBC1853 03/15

DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

CRESEMBA

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.

what it does: Treats rare fungal infections, invasive aspergillosis and invasive mucormycosis, which are more common in people with HIV. what to know: Do not take with Norvir, the antiseizure medicine carbamazepine, the tuberculosis drug rifampin, St. John’s Wort, or long-acting barbiturates.

most serious: liver problems, infusion reactions, severe allergic and skin reactions other: nausea, vomiting, diarrhea, headache, abnormal liver blood tests, low potassium levels, constipation, shortness of breath, coughing, tissue swelling

CYTOVENE-IV, VITRASERT

For Cytovene-IV, dosages vary but should not exceed 6 mg per kg of body weight. Vitrasert, surgically implanted in the eye, consists of a 4.5 mg pellet of ganciclovir coated with polymers.

what it does: Treats the eye infection cytomegalovirus retinitis in transplant recipients and people with weakened immune systems. what to know: 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, tiredness, weakness, seeing flashes, spots, partial veil other: abdominal pain, changes in behavior, diarrhea, headache, increased sweating, loss of appetite, vomiting, weight loss

DAUNOXOME

Injected intravenously at a strength of 40 mg per square meter of body surface area every two weeks.

what it does: Treats advanced HIV-related Kaposi’s sarcoma what to know: 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 other: back pain, flushing, chest tightness

DIFLUCAN

Doses vary based on targeted infection. Available as tablets, powder to mix with water, or an injection formula.

what it does: Treats fungal infections, including AIDS-related Candida oral, esophageal, urinary, or vaginal yeast infections. what to know: 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. Use caution if pregnant (miscarriage risk) or you have heart or kidney problems. Do not take if you have sugar intolerance.

most serious: liver problems, potentially severe allergic reaction, seizures other: rash, nausea, headache, vomiting, diarrhea, dizziness, abdominal pain

DOXIL

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

what it does: Treats AIDS-related Kaposi’s sarcoma in patients who cannot tolerate other medicines or whose disease is advanced. what to know: Dose may need to be adjusted if you have liver problems. Do not use if you are pregnant or plan to be pregnant.

most serious: congestive heart failure, decrease in blood cells, secondary oral cancers, handfoot syndrome other: tingling or burning, swelling, blisters, mouth sores, fever, nerve damage, fatigue, vomiting, more (see HIVPlusMag.com)

EGRIFTA

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

what it does: Reduces HIV-related excess belly fat by encouraging the body to produce natural growth hormones. what to know: Do not take if you have or had pituitary gland issues, if you have active cancer, or if you are pregnant or breastfeeding.

most serious: severe allergic reaction, fluid retention, injection site reactions, increase in glucose intolerance, diabetes other: pain, swelling, muscle soreness, tingling, numbness and pricking, nausea, vomiting, rash, itching

EPOGEN, PROCRIT

100 units per kg body weight, three times a week, given intravenously. Single-dose vials: 2,000, 3,000, 4,000, and 10,000 units/1 ml. Multidose vials containing benzyl alcohol: 20,000 units/2 ml and 20,000 units/1 ml.

what it does: Treats anemia that results as a side effect of Retrovir. what to know: Do not take if you have uncontrolled high blood pressure or have had a type of anemia called pure red cell aplasia.

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 other: joint, muscle, or bone pain, fever, cough, rash, nausea, vomiting, soreness of mouth, itching, headache, pain at injection site

generic name: Isavuconazonium sulfate maker: Astellas

generic name: Ganciclovir maker: Roche Laboratories (Cytovene-IV), Bausch and Lomb (Vitrasert), Pharmaforce (generic)

generic name: Daunorubicin liposomal maker: Galen

generic name: Fluconazole maker: Pfizer

generic name: Doxorubicin, Liposomal maker: Janssen

generic name: Tesamorelin maker: EMD Serono and Theratechnologies

generic name: Epoetin Alfa maker: Amgen (Epogen), Janssen (Procrit)

26

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

ERAXIS

For esophageal candidiasis 100 mg by injection the first day, followed by 50 mg daily dose thereafter for 14 days; for candidemia and Candida infections, 200 mg by injection first day, followed by 100 mg daily dose. Eraxis comes as a powder that is mixed with sterile water for infusion.

what it does: Treats esophageal candidiasis, candidemia, and other Candida infections. what to know: Effects on women who are pregnant or breastfeeding have not been studied, discuss possibility of pregnancy with your doctor.

most serious: abnormal liver function, anaphylactic shock other: nausea, diarrhea, vomiting

ETOPOPHOS

Dosages vary for small cell lung cancer and testicular cancer, used in combination with other chemotherapeutic agents.

what it does: Treats various types of cancer; currently being tested for treatment of non-Hodgkinâ&#x20AC;&#x2122;s lymphoma and Kaposiâ&#x20AC;&#x2122;s sarcoma. what to know: 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. Women are advised to avoid pregnancy and take contraception for at least six months after final dose.

most serious: severe allergic reaction, hair loss, chills or fever, nausea, constipation, abdominal pain, infertility or lack of menstruation other: rash, unusual tiredness

FAMVIR

500 mg twice daily for seven days; tablets come in 125, 250, or 500 mg strengths.

what it does: Treats recurrent episodes of orolabial herpes (cold sores) or genital herpes. what to know: Dosage may need to be reduced for patients with kidney impairment. The gout drugs Benemid and Probalan may increase levels of Famvir in the body, so level should be monitored.

most serious: acute kidney failure other: headache, nausea, skin or subcutaneous tissue disorders, heart palpitations

FORTESTA

Initial dose is 40 mg of gel, applied to the thighs once daily, in the morning; amount may be adjusted by your physician.

Apply at same time every day, after bathing or showering, to clean, dry skin.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50. what to know: Wash hands immediately after applying. Cover the application area with clothing after 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 doctor about your health conditions, especially breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Tell your provider what medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, 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 other: increased prostatespecific antigens, skin redness or irritation, abnormal dreams

FOSCAVIR

Initial dose of the liquid solution, is an intravenous infusion of 90 mg per kg of weight every 12 hours or 60 mg/kg every 8 hours for 2 to 3 weeks, followed by a maintenance dose of 90 mg/kg to 120 mg/kg daily. Dosage should be individualized according to your kidney function but should not exceed the recommended amount or frequency.

what it does: Treats Cytomegalovirus retinitis, a viral eye infection of the retina. what to know: 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.

most serious: impairment of kidney function, electrolyte abnormalities, seizures, anemia other: headache, nausea, vomiting, diarrhea, fever

GAMIMUNE N, GAMUNEX, GAMMAGARD, GAMUNEX-C

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

what it does: Treats primary humoral immunodeficiency and bacterial infection, primarily in children and teens with HIV. what to know: 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 other: headache, nausea, diarrhea, chills, fatigue

generic name: Anidulafungin maker: Pfizer

generic name: Etoposide maker: Bristol-Myers Squibb

generic name: Famciclovir maker: Novartis

generic name: Testosterone gel maker: Endo Pharmaceuticals

generic name: Foscarnet sodium maker: Hospira

generic name: Immune globulin maker: Bayer Biological, Talecris Biotherapeutics, Baxter Healthcare, Grifols Therapeutics

HIVPLUSMAG.COM

27

DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

HEPSERA

One 10 mg tablet daily.

what it does: Treats chronic hepatitis B infection. what to know: 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: buildup of lactic acid in blood, kidney impairment, worsening of hepatitis B, or hep B resistance in treatment-experienced CHB or HIV/HBV coinfected patients other: weakness, headache, abdominal pain, nausea, diarrhea, indigestion, gas, increased creatinine and hypophosphatemia

INTRON A

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.

what it does: Treats AIDS-related Kaposi’s sarcoma and hepatitis infection, especially hepatitis C. what to know: 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 lifethreatening liver disease other: difficulty sleeping, nervousness, muscle pain or numbness, blood in urine or stools, painful urination, chest pain, fever, chills, unusual bleeding or bruising, suicidal or homicidal thoughts.

MARINOL

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.

what it does: A man-made form of cannabis, it is used to stimulate the appetite of people living with HIV. what to know: 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 other: clumsiness, dizziness, drowsiness, euphoria, trouble thinking, nausea, vomiting

MEGACE ES

625 mg (one teaspoon), once daily.

what it does: Treats appetite loss, severe malnutrition, or unexplained, significant weight loss. what to know: May decrease effectiveness of Crixivan (indinavir).

May cause fetal harm when administered to a pregnant woman. If you have a history of blood clots, check with your doctor before taking.

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

MEGACE ORAL SUSPENSION

800 mg, once daily.

what it does: Treats severe malnutrition, appetite loss, or significant weight loss. what to know: May decrease effectiveness of Crixivan (indinavir).

May cause fetal harm when administered to a pregnant woman. If you have a history of blood clots, check with your doctor before taking.

most serious: Cushing’s syndrome, diabetes other: decreased libido, flatulence, high blood pressure, insomnia, upset stomach, increased blood sugar, betweenperiod bleeding

MEPRON

Oral suspension 1,500 mg once daily with food for prevention of mild to moderate Pneumocystis pneumonia. 750 mg twice daily with food for 21 days for treatment of mild to moderate Pneumocystis pneumonia.

Supplied in foil pouches and bottles. For a 5-ml dose, take entire contents by mouth either by dispensing into a spoon or cup or directly into the mouth. For a 10-ml dose, take 2 pouches.

what it does: Helps prevent and treat mild to moderate Pneumocystis pneumonia in patients who cannot tolerate other drugs. what to know: If taking rifampin (Rifadin), consider alternatives, as it reduces the amount of Mepron in the body. Use caution when taking with tetracycline, metoclopramide, or indinavir.

most serious: rash, diarrhea, nausea, headache, vomiting, fever

generic name: Adefovir dipivoxil maker: Gilead

generic name: Interferon Alfa-2B maker: Schering

generic name: Dronabinol maker: AbbVie

generic name: Megestrol acetate maker: Strativa

generic name: Megestrol acetate maker: Bristol-Myers Squibb

generic name: Atovaquone maker: GlaxoSmithKline

28

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

MEPRON

Oral suspension 1,500 mg once daily with food for prevention of mild to moderate Pneumocystis pneumonia. 750 mg twice daily with food for 21 days for treatment of mild to moderate Pneumocystis pneumonia.

Supplied in foil pouches and bottles. For a 5-ml dose, take entire contents by mouth either by dispensing into a spoon or cup or directly into the mouth. For a 10-ml dose, take 2 pouches.

what it does: Helps prevent and treat mild to moderate Pneumocystis pneumonia in patients who cannot tolerate other drugs. what to know: If taking rifampin (Rifadin), consider alternatives, as it reduces the amount of Mepron in the body. Use caution when taking with tetracycline, metoclopramide, or indinavir.

most serious: rash, diarrhea, nausea, headache, vomiting, fever

MYCOBUTIN

300 mg in capsules, once daily.

If prone to nausea or vomiting, split into two doses daily, with food.

what it does: Helps prevent disseminated Mycobacterium avium complex (MAC) disease. what to know: Do not use with Rescriptor or Norvir. May reduce effectiveness of Sporanox, Biaxin, Fortovase, and Invirase as well as oral contraceptives. Cut dose in half if also taking Crixivan or Viracept. Do not take if you have active tuberculosis.

most serious: neutropenia (lowered white blood cell count) other: rash, gastrointestinal disorders, flu-like symptoms, eosinophilla (increased white blood cell count)

MYTESI

generic name: Crofelemer maker: Napo

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

what it does: Relieves HIV-related diarrhea that is a side effect of antiretroviral drugs what to know: Formerly called Fulyzaq. You should be tested to make sure your diarrhea is not caused by an infection.

most serious: upper respiratory tract infection, bronchitis other: cough, flatulence, increased levels of the liver enzyme bilirubin

NEBUPENT

300 mg every four weeks, via oral inhalation.

what it does: Helps prevent Pneumocystis pneumonia in patients with a history of the disease or low T-cell counts. what to know: Use with caution with aminoglycosides (a class of antibiotics), amphotericin B (antifungal drug), Platinol, Foscavir, or Vancocin. If breastfeeding, take only if doctor determines benefits outweigh risks.

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

PANRETIN GEL

Topical gel initially applied twice a day to KS lesions, with frequency increased to 3 or 4 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. Allow the gel to dry before covering the skin with clothing. Treatment can continue as long as needed.

what it does: Provides topical treatment for Kaposi sarcoma lesions. what to know: Avoid using with products that contain DEET, a common ingredient of insect repellents. Minimize skinâ&#x20AC;&#x2122;s exposure to sun.

most serious: toxic skin reactions

RADIESSE

Available in single-use vials with 0.3, 1, or 1.3 ml of calcium hydroxylapatite suspended in a water-based gel. Injected into the skin, and results can last up to a year. Injectible implant for use in hands.

what it does: Treats facial fat loss (lipoatrophy) and stimulates the bodyâ&#x20AC;&#x2122;s collagen production to combat HIV-related facial wasting. what to know: 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

RIFADIN, RIFADIN IV

10 mg per kg of body weight, once daily, orally in capsule form (Rifadin) or intravenously (Rifadin IV). Daily dosage should not exceed 600 mg. Oral dosage should be 1 hour before or 2 hours after a meal with water.

what it does: Helps prevent or treat infections caused by certain type of bacterium, including the one that causes tuberculosis. what to know: 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 other: loss of appetite, fever, joint pain

generic name: Atovaquone maker: GlaxoSmithKline

generic name: Rifabutin maker: Pfizer (Mycobutin), Lupin Ltd. (Generic)

generic name: Pentamidine isethionate maker: APP Pharmaceuticals

generic name: Alitretinoin maker: Eisai

generic name: Calcium hydroxylapatite maker: Merz Aesthetics

generic name: Rifampin maker: Sanoifi-Aventis

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DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

SCULPTRA

Amount and frequency varies by patient; delivered by subcutaneous injection.

what it does: Helps restore or correct signs of facial fat loss (lipoatrophy). what to know: If you have an active skin infection or inflammation in or near the treatment area, do not use until this condition is under control. Minimize exposure to sunlight or sun lamps.

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

SEROSTIM

0.1 mg per kg of body weight daily (up to 6 mg), injected subcutaneously at bedtime.

what it does: Treats wasting (HIV-related weight loss). what to know: Do not use if you are critically ill, following surgery, have serious injuries, or a severe breathing problem, or have cancer.

Do not use if you have eye problems caused by diabetes or allergies to growth hormone.

most serious: musculoskeletal discomfort, swelling of the hands and feet, tingling and numbness, breast enlargement in men, nausea, extreme tiredness, nausea and vomiting. other: tumors or cancerous growths, high blood sugar (hyperglycemia/diabetes), headaches, changes in vision, serious allergic reactions, injection site reactions, abdomen pain and tenderness

SPORANOX

200 mg daily, in oral solution, for 1 to 2 weeks for oral candidiasis; 200 mg daily in capsule form, for other fungal infections, such as histoplasmosis and blastomycosis.

what it does: Treats fungal infections such as oral candidiasis (thrush). what to know: Do not take with methadone, disopyramide, dofetilide, dronedarone, quinidine, ergot alkaloids (dihydroergotamine), ergometrine (ergonovine), ergotamine, methylergometrine (methylergonovine), irinotecan, lurasidone, oral midazolam, pimozide, triazolam, felodipine, nisoldipine, ivabradine, ranolazine, eplerenone, cisapride, lovastatin, simvastatin, ticagrelor. If you have renal or hepatic impairment, do not take with colchicine, fesoterodine, telithromycin and solifenacin. Use caution if you have heart, lung, or kidney disease, or take protease inhibitors. Do not take capsules if you have or had congestive heart failure.

most serious: cardiac issues, including failure, liver failure, neuropathy, hearing loss other: nausea, diarrhea, vomiting, fever, respiratory disorders, rash, headache

TAXOL

135 mg per square meter of body surface, intravenously over three hours every 3 weeks, or 100 mg per square meter of body surface, intravenously over 3 hours every 2 weeks

what it does: Provides second-line treatment for Kaposiâ&#x20AC;&#x2122;s sarcoma. what to know: 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 others. (See HIVPlusMag.com)

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

TESTIM

50 mg in premeasured tube, applied to upper arms and shoulders, once daily. Apply at same time every day, after bathing or showering, to clean, dry skin.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50 what to know: 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 doctor about 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.

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

most serious: enlarged prostate, prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body other: skin irritation at application site, increased red blood cell count

TYZEKA

One 600-mg tablet, once daily, or 30 ml of oral solution for patients who have difficulty swallowing tablets.

what it does: Treats hepatitis B. what to know: 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.

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

generic name: Injectable Poly-L-Lactic Acid maker: Dermik Laboratories

generic name: Somatropin maker: EMD Serono

generic name: Itraconazole maker: Janssen

generic name: Paclitaxel maker: Bristol-Myers Squibb (Taxol); Teva Parenteral Medicines (Generic)

generic name: Testosterone gel maker: Endo Pharmaceuticals

generic name: Telbivudine maker: Idenix/Novartis

30

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

VALCYTE

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

what it does: Treats the eye infection cytomegalovirus retinitis. what to know: Do not take with Cytovene-IV. Use cautionwith Retrovir, CellCept, Myfortic, or Videx. Can cause seizures; do not drive until you know how the medication affects you. Do not use if you are pregnant or you or your partner are planning to become pregnant.

Continue contraception during treatment and for 30 to 90 days after treatment.

most serious: anemia, thrombocytopenia, fertility impairment, lower sperm count, fetal abnormalities, kidney failure, graft rejection other: diarrhea, nausea, vomiting, fever, tremors, seizures, neutropenia, anemia, low blood cell counts

VFEND

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/kg weight every 12 hours for the first 24 hours, followed by a maintenance dose of either 4 mg/kg weight every 12 hours or 200 mg in tablets or oral solution every 12 hours. Duration of treatment varies.

what it does: Treats fungal infections, such as esophageal candidiasis. what to know: Do not use with Atripla or high-dose Norvir; use with caution with low-dose Norvir. Do not use with St. Johnâ&#x20AC;&#x2122;s Wort, ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, quinidine, or rifabutin. Use with caution if you have a heart arrhythmia.

most serious: severe liver problems, heart arrhythmias, visual disturbances other: fever, nausea, rash, vomiting, chills, headache

ZITHROMAX

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.

what it does: Treats and helps prevent Mycobacterium avium complex (MAC). what to know: When used with Viracept, which can increase concentrations of Zithromax, you should be monitored closely for known side effects of Zithromax, such as liver enzyme abnormalities and hearing impairment.

most serious: irregular heart activity (including fatal); liver liver problems, severe diarrhea, hearing impairment other: nausea, vomiting, mild to moderate diarrhea, abdominal pain

ZOVIRAX

Dosage varies depending on type of infection; available in capsules, tablets, oral suspension, topical cream, and as intravenous injectable.

what it does: Treats and controls herpes viral infections, like shingles, genital warts, cold sores around the lip and mouth, and chicken pox. what to know: Use with caution with Retrovir, antifungal agents, probenecid, interferon, intrathecal methotrexate, and drugs that can cause kidney toxicity. Drink plenty of fluids while taking the drug.

Topical cream should not be applied to eyes, mouth, nose or genitals.

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, hair loss, jaundice, seizures, confusion; dullness, tiredness, weakness; hallucination other: skin redness, dryness and cracking; headache, visual impairment, tremors, rash or stinging skin

generic name: Valganciclovir maker: Genentech

generic name: Voriconazole maker: Pfizer

generic name: Azithromycin maker: Pfizer

generic name: Acyclovir maker: GlaxoSmithKline

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31

LEDBUG

the 2017 hepatitis c treatment guide

32

JULY / AUGUST 2017

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

traditional dosage

INTRON A

drug interactions, precautions, and recommendations

side effects

See page 19 for information on this drug.

See page 19

PEGASYS

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. Do not take with Videx. Use with caution if taking Tyzeka, Theo-24, Elixophyllin, Uniphyl, Theolair, Azasan, Imuran, warfarin (Coumadin, Jantoven), phenytoin (Dilantin, Phenytek, Dilantin-125, Cerebyx), or methadone.

most serious: severe eye, blood, liver, nerve, intestines, eye, 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; neuropsychiatric reactions including suicide, homicidal ideation, relapse of drug addiction, and drug overdose other: flu-like symptoms, tiredness, weakness, stomach problems, loss of appetite, skin reactions, tongue discoloration, hair thinning, insomnia

PEGINTRON

1.5 micrograms per kg of body weight, once weekly, by subcutaneous injection; other doses no longer being manufactured.

Use caution with drugs metabolized by CYP2C8/9 or CYP2D6.

Monitor for toxicities when used with NRTIs. Do not take if you have Stevens-Johnson syndrome, autoimmune hepatitis, or certain other liver problems. Do not take if you are pregnant or plan to become pregnant. Use with caution if you have a history of psychiatric disorders.

most serious: severe eye, heart, blood, liver, nerve, thyroid, or lung problems; pancreatitis, colitis, high blood sugar or diabetes; or allergic reaction other: flu-like symptoms, tiredness, appetite problems, headache, nausea, myalgia, anxiety or emotional irritability, skin reactions, thinning hair

ROFERON-A

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

Use caution if taking with Retrovir and similar HIV drugs, theophylline (treats breathing problems), or Tyzeka.

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

generic name: Peginterferon alfa-2A maker: Genentech

generic name: Peginterferon alfa-2B maker: Merck

generic name: Interferon alfa-2 maker: Roche

S3/4A PROTEASE INHIBITOR

This class of drugs fight HCV by inhibiting the NS3-4A enzyme, an essential element in hep Câ&#x20AC;&#x2122;s replication. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

OLYSIO

150mg capsule taken once daily with food. Olysio can be given in combination with sofosbuvir (Sovaldi). Olysio has also been approved for use in combination with peginterferon alfa and ribavirin (Copegus, Rebetol, and others) and Pegasys.

Do not take Olysio in combination with ribavirin if you or your partner are pregnant or plan to become pregnant as birth defects or fetal death can result. No human data on risk of using Olysio alone in pregnancy, but fetal toxicity was observed in mice, so caution is advised. Avoid using cobicistat-containing products and HIV protease inhibitors, with or without ritonavir (Norvir). Also, do not combine with amiodarone (Cordarone, Nexterone, and Pacerone), carbamazepine, fluconazole, dexamethasone, rifampin, and herbal products such as milk thistle and St. Johnâ&#x20AC;&#x2122;s Wort. Use with caution if taking Tegretol, Mycobutin, Rifadin, Norvir, Kaletra, Biaxin, cimetidine, antifungal meds, grapefruit juice, Sovaldi; antibiotics like Priftin, Ketek, erythromycin; the corticosteroid dexamethasone (Maxidex, Ozurdex, Baycadron); generic cisapride; or some anticonvulsants.

most serious: liver failure, severe rash, seriously low heart rate (in combination with sofosbuvir and amiodarone) other: fatigue, headache, nausea, itching, rash, photosensitivity

generic name: Simeprevir maker: Janssen

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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 hepatitis C virus. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

HARVONI

One tablet daily, containing 90 mg ledipasvir and 400 mg sofosbuvir. Treatment duration 8, 12, or 24 weeks.

Doesn’t need to be taken with ribavarin (except for those with decompensated cirrhosis or recipients of liver transplant) or interferon. (Harvoni combines a NS5A inhibitor and a nucleotide NS5B polymerase inhibitor.)

Do not use with St. John’s Wort, Cordarone, Crestor, Mycobutin, Rifadin, Priftin, or Olysio; the anticonvulsant drugs Tegretol, Dilantin, Luminol or Trileptal; or the HIV drugs Aptivus, Norvir, Atripla, or Stribild. For HIV regimens that contain tenofovir disoproxil fumarate, such as Viread and Truvada, monitor for tenofovir-associated adverse events. No clinically significant interactions with tenofovir alafenamide. Leave at least four hours between Harvoni and antacid consumption. Use with caution if pregnant or breastfeeding. Do not take with other sofosbuvir products. If taken with ribavirin (Copegus, Rebetol), all ribavirin warnings and contraindications apply.

most serious: serious symptomatic bradycardia when coadministered with cordarone; hepatitis B virus reactivation; skin rashes, sometimes with swelling and blisters occurring other: fatigue, headache

TECHNIVIE

Two tablets taken orally, once daily with food; used commonly with ribavirin (Copegus, Virazole, 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 with ribavirin (Copegus, Rebetol), all ribavirin warnings and contraindications apply.

most serious: liver failure other: asthenia, fatigue, nausea, insomnia

VIEKIRA PAK

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 nonnucleoside 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, Norvir-boosted Prezista, Sustiva, Dilantin, Phenytek, Luminal, Orap, Zocor, Vytorin, Simcor, Viagra, Cialis, St. 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 other: nausea, itching, sleep problems

ZEPATIER

One tablet daily containing 50 mg elbasvir and 100 mg grazoprevir. For treatment of chronic HCV genotype 1 or 4 infection in adults, use with or without ribavirin. (Zepatier combines a NS5A inhibitor, and a NS3/4A protease inhibitor.)

Do not take with anticonvulsants (Phenytoin, Carbamazepine), antimycobacterials (Rifampin), immunosuppressants (Cyclosporine), St. John’s Wort, Efavirenz, atazanavir, darunavir, lopinavir, saquinavir, or tipranavir. Co-administration is not recommended with CYP3A inhibitors, ketoconazole, bosentan, tacrolimus, etravirine (Intelence), modafinil, and cobicistat containing drugs (Stribild, Genvoya). May increase concentrations of statins; use caution with atorvastatin, rosuvastatin, fluvastatin, lovastatin, simvastatin. You should be tested for current or prior hepatitis B infection before initiating Zepatier. HCV/HBV coinfected individuals should be monitored for HBV reactivation and hepatitis flare-up during and after treatment. Hepatic lab testing should occur prior to therapy, at treatment week 8, and as clinically indicated. Those receiving 16 week therapy, should receive additional hepatic lab testing at week 12. If ALT levels elevate, follow doctor recommendations. If administered with ribavirin, the warnings and precautions for ribavirin (Copegus, Rebetol) also apply.

most serious: elevation of liver enzymes, hepatitis B reactivation other: fatigue, headache, nausea, anemia

generic name: Ledipasvir and sofosbuvir maker: Gilead

generic names: Ombitasvir, paritaprevir, and ritonavir maker: AbbVie

generic names: Ombitasvir, paritaprevir, and ritonavir tablets packaged with dasabuvir tablets maker: AbbVie

generic names: Elbasvir and grazoprevir maker: Merck

34

JULY / AUGUST 2017

NUCLEOSIDE ANALOGS

Often used in combination with Pegasys or PegIntron, these drugs inhibit RNA replication of the hepatitis C virus.

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

COPEGUS

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 (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 other: flu-like symptoms, tiredness and weakness, nausea and vomiting, loss of appetite, anemia, hair thinning, trouble sleeping

REBETOL

800 to 1,400 mg daily, based on patient’s weight, by oral solution, taken with food. Capsule version no longer manufactured. Usually prescribed in combination with PegIntron.

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 (Combivir, Epivir, Epzicom, Retrovir, 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 other: dental problems caused by dry mouth, mood changes, flulike symptoms, headache, fever, stiffness, injection site reaction, neutropenia

generic names: Ribivarin maker: Roche

generic name: Ribivarin maker: Schering, Merck

NUCLEOTIDE NS5B POLYMERASE INHIBITORS

This class of drugs mimics the NS5B enzyme; incorporated into viral replication they cause RNA chain termination. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

SOVALDI

One 400 mg tablet, once daily, in combination with ribivarin (Copegus, Rebetol, and others); with some types of hep C virus, peginterferon alfa (Pegasys) and ribavirin should both be used.

Do not take with Cordarone, Aptivus, Olysio, Tegretol, Dilantin, Tileptal, Mycobutin, Rifadin, Priftin, St. John’s Wort, or drugs containing phenobarbital. Warnings and precautions of other direct acting hep C antivirals also apply in Sovaldi combination treatment; avoid other sofosbuvir-containing medications like Harvoni. When taken along with ribavirin or peginterferon, all of their associated warnings and contraindications apply. Do not take if you or partner are pregnant or plan to be, as birth defects or fetal death can result (when taken with ribavirin).

most serious: serious symptomatic bradycardia when coadministered with cordarone, risk of HBV reactivation, fetal damage (when taken with ribavirin) other: fatigue, headache, nausea, insomnia, anemia

generic name: Sofosbuvir maker: Gilead

NONSTRUCTURAL PROTEIN 5A (NS5A) REPLICATION COMPLEX INHIBITORS

Inhibitors of NS5A block a protein essential for HCV to reproduce, thus stopping viral production at an early stage. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

DAKLINZA

One 60 mg tablet taken orally, once daily in combination with sofosbuvir (Sovaldi) with or without ribavirin (Rebetol, Copegus, Virazole, Ribasphere).

Also available in 30 mg and 90 mg doses.

Do not take with amiodarone, anticonvulsants (phenytoin, carbamazepine), antimycobacterials (rifampin), and St. John’s wort. Use caution with atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Dosage adjustments may been necessary when taken with protease inhibitors (atazanavir, ritonavirb, indinavir, nelfinavir, saquinavir), cobicistat-containing antiretroviral regimens, NNRTIs (efavirenzb, etravirine, nevirapine), clarithromycin, itraconazole, ketoconazole, nefazodone, posaconazole, telithromycin, voriconazole, bosentan, dexamethasone, modafinil, nafcillin, rifapentine, and digoxin.

most serious: symptomatic bradycardia (in patients taking Solvaldi, Harvoni, or amiodarone: Cordarone, Nexterone, Pacerone) other: headache, fatigue

generic name: Daclatasvir maker: Bristol-Myers Squibb

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WHAT IS PREZCOBIX®?

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

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

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

PREZCOBIX® should be taken once daily with food.

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

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

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

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

IMPORTANT SAFETY INFORMATION What is the most important information I should know about PREZCOBIX®? ®

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

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

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

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

Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.®

Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

• Serious problems can happen if you take any of these medicines with PREZCOBIX.® What should I tell my healthcare provider before taking PREZCOBIX®?

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

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

What are the possible side effects of PREZCOBIX®?

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

• Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.® ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long-term health effects of these changes are not known. ○ Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines.

Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time.

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

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

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736).

Please see full Product Information for more details.

®

Who should not take PREZCOBIX ?

• Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol® Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®) cisapride (Propulsid®), colchicine (Colcrys®, Mitigare®, if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®), dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot®, Ergomar®,

Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2017 03/17 068102-170228

061037-161017

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

“RESISTANCE IS A RISK I TAKE SERIOUSLY.” Everyone is at risk of developing drug resistance. So when deciding on an HIV treatment, think long-term.

Once-Daily* PREZCOBIX® has a high genetic barrier to resistance, which may help.

Wisdom inspired by real people

ASK YOUR DOCTOR ABOUT DRUG RESISTANCE AND ONCE-DAILY

*

PREZCOBIX.com

}

“Learning is part of my journey.

Asking questions helps me feel more confident.”

PREZCOBIX® (prez-koe-bix) (darunavir and cobicistat) tablets What is PREZCOBIX® used for?

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

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

What are the most serious warnings about PREZCOBIX®?

• PREZCOBIX® may cause liver problems which may be life-threatening. Tell your healthcare provider right away if you have any symptoms such as: • Vomiting • Dark (tea-colored) urine • Pain or tenderness on your right side below your ribs • Yellowing of your skin or the whites of your eyes • Loss of appetite • Pale-colored stools (bowel movements) • Nausea • PREZCOBIX® may cause severe or life-threatening skin reactions or rashes. Stop taking PREZCOBIX® and call your healthcare provider right away if you develop any skin changes with symptoms below: • Blisters or skin lesions • Fever • Mouth sores or ulcers • Tiredness • Red or inflamed eyes, like “pink eye” (conjunctivitis) • Muscle or joint pain • PREZCOBIX,® when taken with some other medications, can cause new or worse kidney problems, including kidney failure.

What do I need to tell my healthcare provider?

Tell your healthcare provider if you: • Have liver problems, including hepatitis B or hepatitis C • Have kidney problems • Are allergic to sulfa (sulfonamide) • Have diabetes • Have hemophilia • Have any other medical condition

• Are pregnant or plan to become pregnant. (It is not known if PREZCOBIX® will harm your unborn baby. Tell your healthcare provider if you become pregnant while taking PREZCOBIX.®) • Are breastfeeding or plan to breastfeed. Do not breastfeed if you take PREZCOBIX® because it is unknown if PREZCOBIX® can pass into your breast milk. You should not breastfeed if you have HIV-1 because of the risk of passing HIV to your baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Some medications may prevent PREZCOBIX® from working or cause increased side effects. Do not start taking a new medicine without telling your healthcare provider.

Who should not take PREZCOBIX®?

• Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®), colchicine (Colcrys®, Mitigare,® if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®), dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot ,® Ergomar ®, Ergostat ,® Medihaler,® Migergot,® Wigraine,® Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev,® Advicor,® Mevacor ®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin,® Rifater ,® Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor,® Vytorin®, Zocor ®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).

• Serious problems can happen if you take any of these medicines with PREZCOBIX.® What are the possible side effects of PREZCOBIX®?

PREZCOBIX® may cause serious side effects including: • Diabetes and high blood sugar • Changes in body fat can happen in people taking HIV-1 medications • Immune system changes (Immune Reconstitution Syndrome) can happen in people who start HIV-1 medications • Increased bleeding can occur in people with hemophilia who are taking PREZCOBIX.® The most common side effects are: • Diarrhea • Headache • Nausea • Stomach area (abdominal) pain • Rash • Vomiting These are not all of the possible side effects of PREZCOBIX®. For more information, ask your healthcare provider.

What should I know about this Brief Summary?

This information is not complete. To get more information: • Talk to your healthcare provider or pharmacist • Visit www.PREZCOBIX.com to read over the FDA-approved product labeling and patient information • Call to report side effects either to the FDA at 1-800-FDA-1088 or to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736). © Janssen Therapeutics, Division of Janssen Products, LP 2016 10/16 054195-160602

R E S I S TA N C E WA R R I O R

BY DIANE ANDERSON-MINSHALL

RESISTANCE CON LA FAMILIA

COURTESY JORGE DIAZ

DEALING WITH HIV DRUG RESISTANCE WAS MUCH EASIER WITH HIS MOM BY HIS SIDE. GROWING UP IN Orange County, California, the child of Latino immigrants, Jorge Diaz learned early that “I came from a different social class and … [to some] being Latino meant being inferior.”

His parents never took government assistance, even as they struggled financially.

“My parents built everything they now have from nothing. It created this sense that we must do it on our own.”

The insistence on self-reliance was so engrained, he didn’t seek help even when he learned he had HIV. But as a 21-yearold college student and go-go dancer with no insurance, he was terrified.

Now a mental health and substance abuse program manager with Bienestar, a social service health organization for Latinos in Southern California, Diaz shares his story to educate others and combat stigma and shame.

In 2001, Diaz says, “I viewed HIV as a death sentence. I felt a sense of loss—loss of health, loss of identity. The shame I brought upon myself, the fear of being rejected by my peers … or being viewed as a disappointment to my parents and family—was all going through my head.”

He was afraid of a paper trail, too. “What I heard from that [first doctor’s visit] was, ‘If you want to be invisible with your HIV, clinical trials are the way to go.’ Looking back, I simply feared being outed.”

He took the advice and enrolled in a clinical trial. “It was the worst experience of my life. It was my first regimen; in a sense, my first step into the world of HIV. Managing the side effects became overwhelming; Sustiva was not an easy medication for me. It truly gave me horrible side effects. The vivid dreams caused me to have insomnia and the insomnia impacted so many aspects of my daily functioning.”

Yet every night he’d go to the club to dance, and escape into an alter ego who was the center of attention. “[Dancers] are idolized and sexualized by many,” Diaz admits. “It was like living a double life. On one hand, I was desirable and sexy. However, when the lights went off,

the crowd went home and the club closed, I was simply another HIVpositive guy.”

Looking back, he admits, “I wanted to be liked by those who didn’t even know me. I wanted to be loved by all the wrong men. I felt ashamed of myself, yet I wanted to be desired.”

Five months into his clinical trial, his treatment failed, which later impacted his treatment options. He wasn’t able switch to Atripla, the once-a-day regimen, when it came out because Sustiva was one of the drugs included in the regimen. “I soon realized how many new drugs are, at times, a combination of a new drug with an old one,” he says.

Six months after that treatment failure, Diaz finally came out to his mother. “It was the hardest thing I ever had to do, but I couldn’t manage the secret anymore. We both cried.

We both held each other … Then, my mother stopped crying. She looked me in the eyes, grabbed [my] hand, and said, ‘We are going to be OK, and we will fight together.’ And indeed, we

have. My mother was instrumental in my fight against HIV.” With her support, Diaz had success with his second regimen and eventually earned a master’s degree. “Graduate school allowed me to work on me and process unfinished business. It was an amazing opportunity that paved the way to begin to heal … and forgive.

Forgiveness truly set me free.”

He choose social work to help guys like him. “I wanted to provide the space for individuals to process how HIV has impacted [them] … and identify healthy coping skills and tools during this life changing experience. There is shame and stigma associated with mental health. I wanted to be part of that change, be part of the solution.”

Having overcome so much, Diaz now talks about his “amazing life,” full of nieces and nephews to whom he is godfather. Next he plans a series of books on the Latino LGBT community and maybe “running for office—and winning!”

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By Savas Abadsidis + Photography

by Phil Knott

Actor, model, and former basketball star DEMARCO MAJORS comes out about living with HIV and, in the process, discovers the peace even he didnâ&#x20AC;&#x2122;t know he was looking for.

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PHOTO CREDIT

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candy store, “Which way is Eighth Avenue?” before setting out on foot.

Majors interrupts himself, “The crazy thing is I know exactly what I was wearing. I remember the tank top … the pants … and the boots.”

But that’s not important. Not yet.

“The important part,” he says, “is, as I started walking, I started seeing these houses and they all looked decrepit. They looked like the people inside of them were doing drugs. And I thought about what it

PHOTO CREDIT

has been having a recurring dream—one he’s spent countless hours trying to decipher. In the dream, he’s 12 years old and at his favorite candy store.

“I had a $20 bill, a $1 bill, and some quarters and dimes. The kind of money I never had as a kid,” he says, laughing.

The candy store isn’t essential to the story. It’s just the set up. “It’s going to make a lot of sense” in a moment, Majors says, urging continued attention.

Originally from Illinois, Majors lived in California for a long time before moving to New York City, where he’s been nearly a decade. He doesn’t say what city the dream takes place in, but he asks a guy in the dream’s

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would be like to own a house like that.”

A recovering addict, Majors can easily imagine that life.

The former basketball star interrupts himself, recalling how uncomfortable his clothes in the dream were. Majors says he realizes the houses he’s passing symbolize a way of life. He keeps walking. The city streets turn to country roads and he’s still walking. He decides to “walk to my mom’s house” in his hometown, Evansville, Indiana, when he’s again reminded about how uncomfortable he is and starts “stretching my shirt to make it bigger.”

He continues walking, passing housing projects, when, “All of a sudden, my pants are comfortable, my shirt … and my shoes are comfortable.” The road has changed again. The pavement has ended and now it’s all green.

“Not once did I look back. I never turned around. I just kept walking.

I woke up in tears. I looked at my phone and there was a song playing on Pandora. The title was ‘Letting Go.’” And that outfit? It was one a former boyfriend had loved seeing him in. “And I was always uncomfortable wearing it, but I always wore it because he loved it.”

Majors believes this dream was about his decision talk to Plus, the first time telling the media he’s living with HIV. “[In the dream] I finally walked a mile in my own shoes. I wasn’t trying to be someone else. I wasn’t trying to fit in someone else’s clothing. I wasn’t trying to fit into the image society gave to me when I was coming out. I’m walking down the street and I was OK. I didn’t go to my mom’s house. I didn’t turn around to see where I was going.”

More importantly, Majors noticed, “I didn’t have my security blanket. I didn’t try to go to those houses. ‘Cause sometimes when you’re doing drugs, despite the fear and a shame in it, there was a feeling of safety in it. [But] I was walking down the street and I had no fear or shame. And we were supposed to do this interview over the last three days and things kept coming up. And I had this dream an hour ago: now we’re finally having the interview.”

Despite his fond memories of candy stores, Majors says, “growing up black in Indiana in the ‘80s—that wasn’t a great thing for me. You grow up poor but you don’t know any better. You pick up a basketball because that’s what people tell you you have to do. I didn’t play

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I finally walked a mile in my own shoes. I wasn’t trying to be someone else. I wasn’t trying to fit in someone else’s clothing. I wasn’t trying to fit into the image society gave to me when I was coming out.

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PHOTO CREDIT

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basketball because I was a good basketball player. I picked up a basketball because it was the only way that I felt safe and that no one was gonna hurt me.”

Majors became a phenomenal talent, but insists, he wasn’t a natural. “I worked my ass off. I was that guy in high school that sat on the end of the bench … that never got to play.”

Hard work paid off when he was recruited

by National Collegiate Athletic Association teams. By then, his game was on fleek.

“I remember the one day I dunked for the first time. I didn’t let people know I [could] jump, but I kept trying and trying in secret.

I was 13 or 14 years old. I was 5’8” and the ball slid off the rim and I jumped up and pushed the ball in. You couldn’t tell me I wasn’t taller than Michael Jordan at the time—that’s how I felt after accomplishing that dunk!”

In videos, Majors seems much taller.

“My coach thought the same thing in high school,” he says. “He had me listed as 6’3”.”

Majors kept practicing, and he got even better, eventually earning the moniker ‘The Helicopter’ for an amazing slam dunk he would do. He looked like a helicopter on the court, arms out, spinning, the ball in his palm.

Despite all that, Majors says, “I had no confidence,” at least not until he moved to California for college. Then, he recalls, “I started to blossom a little bit more. Because that’s what happens to people. Once you get away from people and your past, and you’re actually on your own, you start dribbling a different way, you start thinking a different way, believing a different way.”

His senior year in college, he got the opportunity to play ball professionally—in Argentina. He jumped at the chance and eventually played in Australia, Brazil, and in Hawaii (in the American Basketball Association). He came out along the way, becoming one of a few publicly out gay pro basketball players in the world, and

The shame comes from not just being raped. I lived in a cycle of depression, anxiety, fear and paranoia and hurt and regret for years. I developed an addiction.

I didn’t know how to break it…

garnering a spot on the 2007 Out 100 list.

He’s since become a model and actor, starring first in the Logo reality show Shirts & Skins (about the all-gay basketball team The Rock Dogs), then in the stage adaptation of James Earl Hardy’s bestselling novel B-Boy Blues, directed by Stanley Bennett Clay. He was also the male lead in Beyoncé’s “Freakum Dress” video and had guest spots on Law & Order and Blue Bloods. Most recently, he wrote, directed, and stars in the forthcoming film, 7.

The onetime underwear model has become a personal trainer, with a knack for motivating clients. He finds his own motivation, he insists, in his personal relationship with God. “As a little kid,” he says, “there was always a lot of shit that was going on in my family,” he recalls. “I had an imaginary friend [like] a lot of kids do, but my imaginary friend was God. I played Transformers with him.

I played ball with him.”

He says, “I still cling to those memories.

They give me comfort.” And they helped him realize, “God’s message … was in me.”

A self-described loner, Majors says he “was always so worried about my mom, so worried about my sisters, because of all the things we had seen and were going through.”

Even after he’d become a star, the athlete turned actor felt like his outward image was all a veneer, still hiding the scared little boy from Indiana and all he’d been through, “from the deepest, darkest depressions, suffering paranoid delusions, and hardships.”

Then came a night Majors doesn’t remember, other than some guy telling him he was a doctor. When he woke up Majors discovered he had been drugged, sexually assaulted, and abandoned. Like a lot of survivors, he’s replayed the night over a hundred times in his head, wondering if he could have done something different.

CONTINUED ON PAGE 54

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WHAT IS GENVOYA®?

GENVOYA is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older who weigh at least 77 pounds. 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 infection 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: • 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 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. • Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

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 or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and over-the-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.

GENVOYA.com

GENVOYA does not cure HIV-1 or AIDS.

SHOW YOUR

POWER Take care of what matters mostâ&#x20AC;&#x201D;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 WHAT IS GENVOYA®? ( jen-VOY-uh ) MOST IMPORTANT INFORMATION ABOUT GENVOYA GENVOYA may cause serious side effects, including: •

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.

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.

•POSSIBLE SIDE EFFECTS OF GENVOYA GENVOYA can cause serious side effects, including: •

• •

• • Too much lactic acid in your blood (lactic acidosis), which

is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

GENVOYA does not cure HIV-1 infection or AIDS. ABOUT GENVOYA GENVOYA is a prescription medicine used to treat HIV-1 in people 12 years of age and older who weigh at least 77 pounds and 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 IMPORTANT SAFETY INFORMATION HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements.

What is the most important information I should

•

•know GENVOYA does not cure HIV-1 or AIDS. Ask your healthcare about GENVOYA?

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 ), lurasidone (Latuda®), methylergonovine Who should not take GENVOYA? (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.

•

What are the other possible side effects GET MORE INFORMATION of GENVOYA? •

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.

Those in the “Most Important Information About GENVOYA” section.

Changes in your immune system.

New or worse kidney problems, including kidney failure.

Severe liver problems, which in rare cases can lead to death.

Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, What I tell my healthcare provider before darkshould “tea-colored” urine, light-colored stools, loss of appetite taking GENVOYA? for several days or longer, nausea, or stomach-area pain.

•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 have had any kidney or liver problems, including

• hepatitis infection.

Have any other medical condition.

Are pregnant or plan to become pregnant.

• • 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-thecounter 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.

Ask your healthcare provider if GENVOYA is right for you.

• Take GENVOYA with food.

GENVOYA.com

GENVOYA, the GENVOYA Logo, LOVE WHAT’S INSIDE, SHOW YOUR POWER, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: April 2017 © 2017 Gilead Sciences, Inc. All rights reserved. GENC0141 04/17

D A I LY D O S E

BY DESIREÉ GUERRERO

I’M NOT A BAD PERSON— JUST BIOLOGICALLY UNLUCKY WOMEN WITH HIV AREN’T BAD PEOPLE— NOR AS RARE AS DOCTORS SEEM TO THINK.

SHUTTERSTOCK

R E G A N H O F M A N N , O N E of our Most

Amazing HIV-positive People of 2016, has been an HIV advocate and educator for the past 15 years.

But she’s still regularly reminded of the work that remains. She recently sought medical attention following an accident. The attending physician asked, “How did it happen?” As she began to describe the car crash, the doctor interrupted.

“No,” he said. “The AIDS?” Not only was the physician ignorant of proper medical terminology (Hofmann is HIV-positive, she does not have AIDS), but his curiosity about her status kept him from providing the immediate care she needed.

“He seemed so surprised that I was living with HIV, it distracted him from my injuries,” says Hofmann. “The fact that people focus on how I got HIV speaks to the disbelief that ‘normal’ women, or people, get HIV doing ‘normal’ things. There is this sense that you [must] have been doing something bad or unusual to contract the virus. The bottom line is that I contracted HIV doing something everyone’s mom has: I had [condomless] sex with someone I cared for. That the virus was present when I made the same choice as millions of [women] do every day, doesn’t make me a bad person, it makes me a biologically unlucky one.”

The former Poz editor is now a policy officer for the U.S. Liaison Office of UNAIDS and a board member of amfAR (since 2009), two positions that have provided her a platform to speak for the underrepresented. Her experience with the clueless doctor reinforced the need to educate people about women and HIV: One in four people living with HIV are female, yet health care providers rarely seem to recognize that, or recommend women get HIV tests.

“We need to help more health care providers become aware of the fact that women are at risk for HIV,” Hofmann says. “But until that changes, women need to be agents of their own health.

When you go to your doctor for your annual exam, ask for an HIV test. If your doctor [says] you don’t need one, ask to get one anyway.”

Visibility of women living with HIV is critical, but Hofmann acknowledges she—like many poz women—originally struggled with being so open about her health. Even though she’d been writing regularly for Poz magazine since 2002, she initially did so anonymously. But when she took over as the publication’s editor in chief, she officially came out—on the cover, with the headline: “I am no longer afraid to say I have HIV.” Despite this very public declaration, Hofmann

admits now that it wasn’t entirely true. She continued to struggle with the fear and shame related to social stigma.

“There is nothing shameful about having HIV,” Hofmann says now. “I came to realize that I didn’t do anything for which I should be vilified.”

She hopes being open with her story will help other women rid themselves of the fear and shame she once felt. “There’s no reason anyone with this condition—let alone any medical condition—should suffer in fear and isolation.

Everyone affected by HIV deserves love, support, encouragement, and proper healthcare.”

Hofmann says she deeply appreciates the bravery of people living with HIV who choose to be open about their status, but respects and understands that this is not an option for many. “I only was able to do it because of all the amazing people who came before me who paved the way. But we need to continue the trend. The more [people] who come forward, the more people will realize that HIV is just a virus that can affect anyone.”

Hofmann adds, “The less we ‘exceptionalize’ it, the greater the chances that one day, [HIV] will shed its stigma, as has been true for breast cancer.

Having a cure will help. AmfAR is working hard on finding one through our Countdown to the Cure campaign. But until we get there,” Hofmann says, we need to help people understand that HIV can and does happen “to men and women, girls and boys, all over the world. And, that when people are aware of their status and on treatment, they are healthy and non-infectious, so there is no need to fear or stigmatize them.”

Former Poz editor Regan Hofmann sits on the board of amfAR, which is funding research initiatives aimed at finding a cure for HIV by 2020.

Her voice is a reminder that HIV impacts women, too.

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CHILL

HOW TO DISCLOSE YOUR STATUS ON A FIRST DATE DATES CAN BE AWKWARD. COMING OUT DOESN’T HAVE TO BE. 52

JULY / AUGUST 2017

I S P E N D M OST of every first date contemplating whether he’s worth a second one. Am I having fun yet? Do I care to hear these stories again?

What did he say his job was? Usually it ends with a pat or a hug and one of us nervously attempting the lean-in (you know, going in for a kiss while trying to look like you aren’t just in case it’s rebuffed).

Of course, I’m not alone in this. For most poz folks, there is always a little extra anxiety leading up to the end of a date, which stems from one of two things: you’ve either decided they’re not worth a second date and you’re figuring out how to enjoy the next half hour, or you’ve decided they are worth a second date and you’re spending the next half hour searching for the words to tell them you’re HIV-positive.

SHUTTERSTOCK

B Y D AV I D A R TAV I A

1 IS HE WORTH TELLING? Because HIV is still stigmatized, we often associate disinterest with our status. If he ghosts us afterwards, we’re quick to assume it’s because we’re poz, when really he might have ghosted us anyway, because he’s a jerk. So be selective in who you disclose to. Trust me, it will save you so much emotional strength down the road. Allow yourself time to decide whether he’s worth a second date. If he is, and he’s still interested, then you can decide when to take that next step.

Sometimes it’s better to wait until the second or third date to see his character before you share your status.

2 IF IT’S TRUE, SAY, “I’M UNDETECTABLE.” Yes, you’re HIV-positive and you aren’t denying it. But if your viral load is suppressed to undetectable levels you have zero chance of transmitting HIV. That’s right you’ve got the safer sex thing in the bag! So own that word “undetectable.”

Sing it from the rooftops, because while HIV might be part of you, it is never who you are. If you’re lucky enough to be undetectable, make sure your date knows it, and that undetectable means uninfectious (it’s science, baby).

3 SHOW THEM PASSION FIRST, BEFORE YOUR STATUS. Hear me out. There’s always a moment in every first date when they ask you about your passions, goals, and dreams. Instead of talking about career or business goals, tell them, “I dream of the day HIV stigma ends.” Or mention offhand that one of your missions is to lead by example. Imagine saying, “Something I’m super passionate about is educating people about HIV. I’m undetectable, which means I can’t give the virus to anyone because I’m virally suppressed. But not a lot of people know what that means.”

Not only can you disclose your status in a way that’s not awkward or apologetic, you’re showcasing your enthusiasm and passion. And enthusiasm is very sexy. You inadvertently change molecules in the air by showing your date it’s not a big deal. That kind of attitude is magnetic.

4 BE ON YOUR OWN TEAM.

Don’t worry—everyone has been in this kind of situation, whether it’s related to HIV or not. The secret is to own it. At this point in your life, if you let a virus define who you are to the point where you’re trembling in fear to tell a complete stranger about your health, there needs to be some serious personal work outside the dating world.

We all know what it’s like to be in the hot seat, afraid we’re about to be judged or rejected (or worse). But if you think about it, we’re often judging ourselves long before the world is. If we skip that step, we might surprise ourselves. Here are some things to consider:

Never apologize for living with a virus. Everyone fears rejection, especially at the beginning. But at the end of the day, fear is a coward. When you look at it directly in the face, it runs away. Don’t be afraid to mention the topic of HIV in a discussion without going into detail. See how your date responds, and try your best to convey compassion for them regardless of how they do. Once you get them on your level, tease them by saying something sarcastic like, “Well I’m HIVpositive, so I’ve been judging everything you said.” I’ve seen this happen. It always gets a laugh, and a laugh is often a window into trust.

5 ASK HIM (OR HER) FIRST.

Why not turn the tables for a change and ask him what his status is? That way he’s more present when you disclose yours.

People are so comfortable blithely asking someone’s status through hookup apps that we forget what it feels like asking in person. Hearing the words, “Do you have HIV?” still gives me chills. There’s so many ghosts attached to that question. In a weird way, it does relieve your anxiety a bit by laying it on the line. And you never know, he might be HIV-positive, too.

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CONTINUED FROM PAGE 47

“Just because you’re curious and you go off … and want to hook up with somebody … you never ask for someone to put something extra into your drink. People are hitting on you, you feel good, and every answer is ‘yes.’ You say ‘Yes’ to everything when you’re high. I didn’t say ‘No.’ But when you know that something has happened because you wake up somewhere and you’re looking around and you have no idea where you are— that’s the most terrifying feeling ever. And following that came the shame.”

Majors had lived with shame before.

Shame from being poor. Shame from being effete. Shame from not being able to help his mom and sisters. But this—this was an entirely new disgrace.

“The shame comes from not just being 54

JULY / AUGUST 2017

raped. I developed an addiction. I lived in a cycle of depression and anxiety and fear and paranoia and hurt and regret for years. I didn’t know how to break it.”

Majors also learned he had acquired HIV from the attack. He admits now that he feared it had defiled him.

“I was afraid that I had corrupted the message that was in me.”

Now he sees, “there is still this message of hope and God in me. Yet, I’m still dealing with this addiction, with this depression. I’m still dealing with an unhealthy personal environment and not knowing what’s truly going on with me.

Because all I’ve ever known how to do in my life is keep going.”

For Majors, “that night, its details, they don’t matter. It’s what happened in my life after that and the significance of it

that I didn’t understand until today. Until my dream.”

Today, he’s physically healthy, his viral load undetectable, and he recognizes the importance of being “healthy mentally,” especially “when you have an addiction” that you may have to monitor for life.

“You still [make mistakes]. I’m gonna be open about this part. Most men of color, we just don’t deal with being HIV-positive. We [have to] deal with our peers, our church, our society—and everyone who reads this will be like, ‘Don’t we all?’ You may not be able to understand what it’s like to be black and gay in America. But I know what it’s like to be white in America. I’ve had to adapt.

I’ve had to learn to speak a certain way. I’ve had to educate myself a certain way.”

Dealing with homophobia and racism is hard enough, he says, but then there’s also

the stigma around HIV. “When you hear the things that people say about HIV—. I came out when I was living in San Francisco and I saw these men with facial lesions, skeletal frames, and protruding bellies [from AIDS complications]. That was my fear, of [becoming] what that looks like.”

Although he doesn’t face the physical ramifications of an AIDS diagnosis, Majors admits, “Even with medication, today people don’t understand, yes you are healthy. But the social stigma can destroy a person more than the actual virus itself.”

The thing about stigma is you can stand up to it by coming out about the very thing society has made you feel ashamed of. That’s what Majors thinks his dream meant. By coming out about being HIV-positive, he’s finally comfortable in his own skin, walking in his own shoes—and not looking back. This is Majors letting go of all that fear and shame and claiming his future. Imagine what he can accomplish now with nothing holding him back.

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55

B AC K TA L K

BY DIANE ANDERSON-MINSHALL

REFLECTIONS OF A POX LOVER LESBIAN JOURNALIST ANNECHRISTINE D’ADESKY ON HIV, ACTIVISM, AND THE THREAT OF RIGHT-WING POPULISM French-Haitian-American Anne-christine d’Adesky is an award-winning journalist and documentary filmmaker who reported on the AIDS crisis, protested with ACT UP, co-created the Lesbian Avengers, and was the founding editor of Plus magazine. We talked with her about her new memoir, the lasting impact of the epidemic, and the new resistance.

Right. The simian version of HIV is widespread among certain monkeys but they’ve developed immune responses.

For me, these are models for vaccineand immune-based treatments that we are beginning to see in the search for a cure—combination treatments that can now produce short-term remission.

Why was it important to you to share your diary entries from the 1990s in The Pox Lover?

Looking back, I feel like my experiences do mirror many of my peers. I was pulled into activism, shaped by the AIDS epidemic. I became who I am, in part, as a professional journalist, and as an engaged citizen, due to the personal impact of the epidemic on my close circle—friends in Haiti, in the LGBTQ community, then later, in France, in the diaspora African communities.

As a woman, as a lesbian, I feel my experience is my own, but also a generational story, and one where the lives and evolution of women’s and lesbian’s engagement was passionate, consistent, and shaped the AIDS movement.

Has the impact of the AIDS epidemic on the lesbian community gone unexamined?

I think that lesbians have been overlooked in the public narratives of AIDS, yes. That history is only now being told by a newer generation of

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writers and filmmakers. I feel that the role of straight women in ACT UP has barely been discussed. The contribution of African-American and Latino and the different international ACT UP activists is also waiting to be known.

How was the treatment of people living with HIV different in France, where you’ve also lived?

There’s a different evolution of the LGBTQ movement and that led to a different AIDS movement. At the same time, France has and had socialized medicine, and a very different social system for providing care and medicine to its citizens. French doctors at the Pasteur Institute were the ones who discovered HIV—Luc Montagnier’s lab— and French activists made an incredible contribution to the science and access to treatment.

Speaking of France, let’s talk Marine Le Pen, and the LGBT community’s response to populism.

We can all feel a huge relief that 65 percent of the voting [French] electorate chose a centrist, Emmanuel Macron.

But it should alarm us—greatly—that Le Pen got the remainder. The LGBTQ movement [has] by and large failed to invite and embrace progressive and LGBTQ Muslim leaders and citizens to speak out … and to engage in the public conversations that we must now have to help counter the divisive, racist, Islamophobic narratives put forward by leaders like Le Pen, or [Trump].

Where do we start?

Look at your own assumptions, and biases. Start local. Engage in your community. We need to show the courage and urgency of action we did in the ’90s and take to the streets, refuse government indifference, fight against this state-sanctioned homophobia, do our all to act in solidarity. Every one of us has a role to play.

JUNO ROSENHAUS (D’ADESKY)

You were the first editor of Plus (then HIV Plus). Did you think the magazine—or the virus— would still be around?

I did think HIV Plus would—or could—become a magazine that would fill a practical niche for HIVpositive individuals by focusing on trends in treatment. Our early issues were focused on themes for that reason—prison issues, trans issues, etcetera—to provide context for treatment, and to look at hurdles to access. Looking back, I think from the earliest issues, HIV Plus serves as a document of our evolving practical knowledge of treating patients with an ever-refined arsenal.

I also assumed—and assume—HIV [always] will be with us, but I look to monkey models and attenuation that may have taken place for centuries in animal species.

The weight of my diagnosis only made me stronger.

Let’s Grow Old Together See what life with HIV looks like from diagnosis through grandkids with a little help from Walgreens. Explore Jack’s HIV journey at Walgreens.com/LetsGrowOldTogether. ©2017 Walgreen Co. All rights reserved.

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