HIV Plus Issue 101 - July/August 2014

STIGMA-FREE TREATMENT INFO

From Heartthrob to Heartache

MATT BOMER

talks about playing HIV+ for The Normal Heart

+

THE MOST COMPREHENSIVE TREATMENT GUIDE EVER JULY/AUGUST 2014

www.hivplusmag.com

What is STRIBILD? STRIBILD is a prescription medicine used to treat HIV-1 in adults who have never taken HIV-1 medicines before. It combines 4 medicines into 1 pill to be taken once a day with food. STRIBILD is a complete singletablet regimen and should not be used with other HIV-1 medicines.

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

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

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

• Take a medicine that contains: alfuzosin, dihydroergotamine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil when used for lung problems (Revatio®), triazolam, oral midazolam, rifampin or the herb St. John’s wort.

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

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

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

• If you take antacids. Take antacids at least 2 hours before or after you take STRIBILD.

What are the other possible side effects of STRIBILD?

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

Tell your healthcare provider if you become pregnant while taking STRIBILD.

Do not take STRIBILD if you:

Serious side effects of STRIBILD may also include:

• Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency.

Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

• New or worse kidney problems, including kidney failure. Your healthcare provider should do regular blood and urine tests to check your kidneys before and during treatment with STRIBILD. If you develop kidney problems, your healthcare provider may tell you to stop taking STRIBILD.

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

17160_stribild.indd 2

• All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, bone, or liver problems, including hepatitis virus infection.

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

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

Who should not take STRIBILD?

STRIBILD can cause serious side effects:

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

What should I tell my healthcare provider before taking STRIBILD?

• Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

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

• Changes in your immune system.

Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking STRIBILD. The most common side effects of STRIBILD include nausea and diarrhea. Tell your healthcare provider if you have any side effects that bother you or don’t go away.

• If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed.

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

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

Please see Brief Summary of full Prescribing Information with important warnings on the following pages.

3/24/14 10:40 AM

STRIBILD is a prescription medicine used as a complete single-tablet regimen to treat HIV-1 in adults who have never taken HIV-1 medicines before. STRIBILD does not cure HIV-1 or AIDS.

I started my personal revolution Talk to your healthcare provider about starting treatment.

STRIBILD is a complete HIV-1 treatment in 1 pill, once a day.

Ask if it’s right for you.

17160_stribild.indd 3

3/24/14 10:40 AM

Dostop not stop taking STRIBILD without first talking to your • Do•not taking STRIBILD without first talking to your Patient Patient Information Information healthcare provider healthcare provider ® ® (STRY-bild) (STRY-bild) STRIBILD STRIBILD (elvitegravir (elvitegravir 150 mg/cobicistat 150 mg/cobicistat 150 mg/emtricitabine 150 mg/emtricitabine 200 mg/ 200 mg/ • If you • Ifstop you stop STRIBILD, healthcare provider will need takingtaking STRIBILD, your your healthcare provider will need to to tenofovir tenofovir disoproxil disoproxil fumarate fumarate 300 mg) 300 mg) tablets tablets andblood do blood regularly for several checkcheck your your healthhealth oftenoften and do teststests regularly for several months to check HBV infection.

Tell your healthcare provider months to check your your HBV infection.

Tell your healthcare provider Brief Brief summary summary of fullofPrescribing full Prescribing Information.

Information.

For more For more information, information, about any new or unusual symptoms you may have after you stop about any new or unusual symptoms you may have after you stop please please see the seefull thePrescribing full Prescribing Information, Information, including including Patient Patient Information.

Information.

STRIBILD takingtaking STRIBILD WhatWhat is STRIBILD? is STRIBILD?

should not take STRIBILD? WhoWho should not take STRIBILD?

• STRIBILD is a prescription medicine to treat in adults • STRIBILD is a prescription medicine usedused to treat HIV-1HIV-1 in adults who whoDo not Dotake not take STRIBILD you also a medicine contains: STRIBILD if youif also taketake a medicine that that contains: medicines before.

STRIBILD is a complete havehave nevernever takentaken HIV-1HIV-1 medicines before.

STRIBILD is a complete ® ® ) ) • adefovir (Hepsera • adefovir (Hepsera regimen and should notused be used medicines. regimen and should not be with with otherother HIV-1HIV-1 medicines. ® ) ®) • alfuzosin • alfuzosin hydrochloride hydrochloride (Uroxatral (Uroxatral • STRIBILD not cure or AIDS. You must • STRIBILD doesdoes not cure HIV-1HIV-1 or AIDS. You must stay stay on on continuous therapy to control infection and decrease • cisapride continuous HIV-1HIV-1 therapy to control HIV-1HIV-1 infection and decrease ® ® ® , Propulsid , Propulsid Quicksolv Quicksolv ) ®) • cisapride (Propulsid (Propulsid HIV-related illnesses.

HIV-related illnesses.

• ergot-containing • ergot-containing medicines, medicines, including: including: dihydroergotamine dihydroergotamine Ask your healthcare provider about to prevent passing • Ask• your healthcare provider about how how to prevent passing ® ® ® ® Migranal , Migranal ), ergotamine ), ergotamine tartrate tartrate (Cafergot (Cafergot , ®, mesylate mesylate (D.H.E. (D.H.E. 45®, 45 to others.

Doshare not share or reuse needles, injection HIV-1HIV-1 to others.

Do not or reuse needles, injection ® ® ® ® ® ® ® Migergot Migergot , Ergostat , Ergostat , Medihaler , Medihaler Ergotamine Ergotamine , Wigraine , Wigraine , ®, equipment, or personal that have can have or body equipment, or personal itemsitems that can bloodblood or body fluidsfluids ® ® ® ® ® Wigrettes ), and ),methylergonovine and methylergonovine maleate maleate (Ergotrate (Ergotrate , Methergine , Methergine ) ®) on them.

Dohave not have sex without protection.

Always practice on them.

Do not sex without protection.

Always practice safersafer Wigrettes ® ® ® ® ® ® , Altoprev , Altoprev , Mevacor , Mevacor ) ) • lovastatin (Advicor (Advicor sexusing by using a latex or polyurethane condom to lower the chance • lovastatin sex by a latex or polyurethane condom to lower the chance of sexual contact semen, vaginal secretions, or blood. of sexual contact with with semen, vaginal secretions, or blood.

• oral• midazolam oral midazolam ® ) ®) • pimozide • pimozide (Orap(Orap the most important information I should WhatWhat is theismost important information I should knowknow ® ® ® ® ® ® ® about STRIBILD? about STRIBILD? , Rifamate , Rifamate , Rifater , Rifater , Rimactane , Rimactane ) ®) • rifampin • rifampin (Rifadin (Rifadin ® ® ), when ), when usedused for treating for treating lung lung problems problems • sildenafi • sildenafi l (Revatio l (Revatio STRIBILD can cause serious effects, including: STRIBILD can cause serious side side effects, including: ® ® ® ® ® ® 1. Build-up of lactic in your (lactic acidosis).

1. Build-up of lactic acid acid in your bloodblood (lactic acidosis).

LacticLactic • simvastatin , Vytorin , Vytorin , Zocor , Zocor ) ) • simvastatin (Simcor (Simcor acidosis can happen in some people STRIBILD or similar acidosis can happen in some people who who take take STRIBILD or similar ® ® ) ) • triazolam • triazolam (Halcion (Halcion (nucleoside analogs) medicines. acidosis is a serious (nucleoside analogs) medicines.

LacticLactic acidosis is a serious medical emergency that lead can lead to death. acidosis medical emergency that can to death.

LacticLactic acidosis can can • the•herb the herb St. John’s St. John’s wort wort be hard to identify because the symptoms be hard to identify early,early, because the symptoms couldcould seemseem Do not Dotake not take STRIBILD STRIBILD if youif also you also taketake any other any other HIV-1HIV-1 like symptoms of other health problems. healthcare medicines, like symptoms of other health problems.

Call Call youryour healthcare medicines, including: including: provider youany get of anythe offollowing the following symptoms provider rightright awayaway if youif get symptoms ® ® ® , Complera , Complera , ®, • Other • Other medicines medicines that contain that contain tenofovir tenofovir (Atripla (Atripla which be signs of lactic acidosis: which couldcould be signs of lactic acidosis: ® ® ® ® Viread Viread , Truvada , Truvada ) ) feel very or tired • feel• very weakweak or tired • Other • Other medicines medicines that contain that contain emtricitabine, emtricitabine, lamivudine, lamivudine, or ritonavir or ritonavir • have unusual (not normal) muscle • have unusual (not normal) muscle pain pain ® ® ® ® ® ® ® ® ® ® ® , Combivir , Combivir , Complera , Complera , Emtriva , Emtriva , Epivir , Epivir or Epivir-HBV or Epivir-HBV , ®, (Atripla (Atripla ® ® ® ® ® ® ® ® ® • have trouble breathing • have trouble breathing Epzicom Epzicom , Kaletra , Kaletra , Norvir , Norvir , Trizivir , Trizivir , Truvada , Truvada ) ®) • have stomach nausea or vomiting • have stomach pain pain with with nausea or vomiting STRIBILD STRIBILD is notisfor notuse for in use people in people who who are less are less thanthan 18 years 18 years old. old. feel cold, especially in your and legs • feel• cold, especially in your armsarms and legs WhatWhat are the arepossible the possible side side effects effects of STRIBILD? of STRIBILD? feel dizzy or lightheaded • feel• dizzy or lightheaded STRIBILD cause the following serious effects: STRIBILD may may cause the following serious side side effects: • have fast or irregular heartbeat • have a fasta or irregular heartbeat See “What the most important information I should • See• “What is theismost important information I should knowknow 2. Severe problems.

Severe problems can happen 2. Severe liverliver problems.

Severe liver liver problems can happen in in about STRIBILD?” about STRIBILD?” people STRIBILD. In some cases, problems people who who take take STRIBILD. In some cases, thesethese liver liver problems can lead to death. become (hepatomegaly) can lead to death.

Your Your liver liver may may become largelarge (hepatomegaly) and and • New or worse kidney problems, including kidney failure.

• New or worse kidney problems, including kidney failure.

Your Your you may develop in your (steatosis).

Call your healthcare healthcare you may develop fat infat your liver liver (steatosis).

Call your healthcare healthcare provider should do blood and urine to check provider should do blood and urine teststests to check your your provider youany get of anythe offollowing the following symptoms kidneys provider rightright awayaway if youif get symptoms kidneys before you start and while youtaking are taking STRIBILD. before you start and while you are STRIBILD. Your Your of liver problems: of liver problems: healthcare provider tell to you to stop taking STRIBILD healthcare provider may may tell you stop taking STRIBILD if youif you develop or worse kidney problems. new new or worse kidney problems.

• your the white part of your yellow (jaundice) develop • your skin skin or theorwhite part of your eyes eyes turnsturns yellow (jaundice) • Bone problems can happen in some people STRIBILD. • Bone problems can happen in some people who who take take STRIBILD. • dark “tea-colored” • dark “tea-colored” urineurine problems include softening or thinning (which BoneBone problems include bonebone pain,pain, softening or thinning (which may may • light-colored movements (stools) • light-colored bowelbowel movements (stools) to fractures). healthcare provider do tests lead lead to fractures).

Your Your healthcare provider may may needneed to dototests to to loss of appetite for several or longer • loss• of appetite for several daysdays or longer bones. checkcheck your your bones.

• nausea • nausea • Changes in body fat happen can happen in people • Changes in body fat can in people who who take take HIV-1HIV-1 medicine. changes include increased amount medicine.

TheseThese changes may may include increased amount of fatof fat • stomach • stomach pain pain the upper and neck (“buffalo hump”), breast, and around in theinupper backback and neck (“buffalo hump”), breast, and around You may be more tolactic get lactic acidosis or severe You may be more likelylikely to get acidosis or severe liverliver the middle the middle of your (trunk). fat from the legs, of your bodybody (trunk).

LossLoss of fatoffrom the legs, armsarms problems youfemale, are female, overweight (obese), or have and face problems if youif are veryvery overweight (obese), or have and face also happen.

The exact and long-term health may may also happen.

The exact causecause and long-term health taking STRIBILD a long beenbeen taking STRIBILD for afor long time.time. effects of these conditions areknown. not known. effects of these conditions are not 3. Worsening of Hepatitis B infection. you have hepatitis B virus • Changes 3. Worsening of Hepatitis B infection.

If youIf have hepatitis B virus • Changes in your immune system (Immune Reconstitution in your immune system (Immune Reconstitution infection and take STRIBILD, get worse (HBV)(HBV) infection and take STRIBILD, your your HBV HBV may may get worse Syndrome) can happen you start taking medicines.

Syndrome) can happen whenwhen you start taking HIV-1HIV-1 medicines.

Your Your (flare-up) you stop taking STRIBILD. A “flare-up” is when (flare-up) if youif stop taking STRIBILD. A “flare-up” is when your your immune system get stronger and begin to fiinfections ght infections immune system may may get stronger and begin to fight that that infection suddenly returns in a worse way than before.

HBV HBV infection suddenly returns in a worse way than before. hidden in your a long Tell your healthcare havehave beenbeen hidden in your bodybody for a for long time.time.

Tell your healthcare Dorun notout runofout of STRIBILD. ll your prescription or to talk to • Do•not STRIBILD. RefillRefi your prescription or talk provider you start having any new symptoms provider right right awayaway if youif start having any new symptoms after after healthcare provider before STRIBILD all gone your your healthcare provider before your your STRIBILD is allisgone starting medicine. starting your your HIV-1HIV-1 medicine.

17161_stribild.indd 2

3/24/14 10:45 AM

The most common side side effects of STRIBILD include: The most common effects of STRIBILD include: • Nausea • Nausea • Diarrhea • Diarrhea Tell your healthcare provider if youif have any side effect that that Tell your healthcare provider you have any side effect bothers you or doesdoes not go bothers youthat or that notaway. go away.

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

• Call• your healthcare provider for medical advice aboutabout side side effects.

Call your healthcare provider for medical advice effects.

You may reportreport side side effects to FDA 1-800-FDA-1088.

You may effects to at FDA at 1-800-FDA-1088.

® ) ®) - digoxin - digoxin (Lanoxin (Lanoxin ® - disopyramide - disopyramide (Norpace (Norpace ) ®) - estazolam - estazolam ® - ethosuximide - ethosuximide (Zarontin (Zarontin ) ®) ® - flecainide - flecainide (Tambocor (Tambocor ) ®) - flurazepam - flurazepam ® ® ® ® ® ® ® - fluticasone - fluticasone (Flovent (Flovent , Flonase , Flonase , Flovent , Flovent Diskus Diskus , ®, ® ® ® ® HFA, HFA, Veramyst Veramyst ) ) Flovent Flovent ® - itraconazole - itraconazole (Sporanox (Sporanox ) ®) ® WhatWhat should I tell Imy provider before taking STRIBILD? should tellhealthcare my healthcare provider before taking STRIBILD? - ketoconazole - ketoconazole (Nizoral (Nizoral ) ®) ® - lidocaine - lidocaine (Xylocaine (Xylocaine ) ®) Tell your healthcare provider about all your medical conditions, Tell your healthcare provider about all your medical conditions, - mexiletine - mexiletine including: including: ® - oxcarbazepine - oxcarbazepine (Trileptal (Trileptal ) ®) • If have you have or any had kidney, any kidney, or liver problems, including • If you or had bone,bone, or liver problems, including hepatitis B infection hepatitis B infection - perphenazine - perphenazine • If are youpregnant are pregnant or plan to become pregnant.

It isknown not known • If you or plan to become pregnant.

It is not if if - phenobarbital ® - phenobarbital (Luminal (Luminal ) ®) STRIBILD can harm unborn Tell your healthcare provider STRIBILD can harm your your unborn baby.baby.

Tell your healthcare provider ® ® ® - phenytoin - phenytoin (Dilantin (Dilantin , Phenytek , Phenytek ) ®) you become pregnant taking STRIBILD. if youif become pregnant whilewhile taking STRIBILD. ® - propafenone - propafenone (Rythmol (Rythmol ) ®) - There is a pregnancy registry for women antiviral - There is a pregnancy registry for women who who take take antiviral ® medicines during pregnancy.

The purpose of registry this registry medicines during pregnancy.

The purpose of this is to is to - quinidine ) ®) - quinidine (Neudexta (Neudexta collect information the health of and you your and your collect information aboutabout the health of you baby.baby.

Talk Talk ® - rifabutin (Mycobutin (Mycobutin ) ®) healthcare provider you take can take with with your your healthcare provider aboutabout how how you can part part in in - rifabutin ® this registry. this registry.

- rifapentine - rifapentine (Priftin (Priftin ) ®) ® ® ® • If are youbreastfeeding are breastfeeding (nursing) or plan to breastfeed.

Do not • If you (nursing) or plan to breastfeed.

Do not - risperidone - risperidone (Risperdal (Risperdal , Risperdal , Risperdal Consta Consta ) ®) breastfeed you take STRIBILD. breastfeed if youif take STRIBILD. ® - salmeterol - salmeterol (Serevent (Serevent ) or ®salmeterol ) or salmeterol whenwhen takentaken in combination in combination ® ® You should not breastfeed you have because the risk with with - You-should not breastfeed if youif have HIV-1HIV-1 because of theofrisk , Advair , Advair HFA®HFA ) ®) fluticasone fluticasone (Advair (Advair Diskus Diskus of passing to your of passing HIV-1HIV-1 to your baby.baby. ® ® ® ® - sildenafi - sildenafi l (Viagra l (Viagra ), tadalafi ), tadalafi l (Cialis l (Cialis ) or ®vardenafi ) or vardenafi l (Levitra l (Levitra , ®, ® Two the medicines in STRIBILD can pass to your in your - Two- of theofmedicines in STRIBILD can pass to your babybaby in your Staxyn Staxyn ), for®),the fortreatment the treatment of erectile of erectile dysfunction dysfunction (ED).(ED).

If youIf get you get breast It isknown not known the other medicines in STRIBILD breast milk.milk.

It is not if theifother medicines in STRIBILD can can dizzydizzy or faint or faint (low (low bloodblood pressure), pressure), havehave visionvision changes changes or have or have into your breast passpass into your breast milk.milk. an erection an erection that last thatlonger last longer than than 4 hours, 4 hours, call your call your healthcare healthcare provider provider or getormedical get medical help help right right away.away.

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

- tadalafi - tadalafi l (Adcirca l (Adcirca ), for®),the fortreatment the treatment of pulmonary of pulmonary arterial arterial hypertension hypertension Tell your healthcare provider about allmedicines the medicines you take, Tell your healthcare provider about all the you take, ® including prescription and nonprescription medicines, vitamins, - telithromycin including prescription and nonprescription medicines, vitamins, - telithromycin (Ketek (Ketek ) ®) and herbal supplements: and herbal supplements: - thioridazine - thioridazine • STRIBILD the other way other medicines and other • STRIBILD may may affectaffect the way medicines work,work, and other ® voriconazole - voriconazole (Vfend (Vfend ) ®) medicines STRIBILD works. medicines may may affectaffect how how STRIBILD works. ® ® ® - warfarin - warfarin (Coumadin (Coumadin , Jantoven , Jantoven ) ®) Be sure tell your healthcare provider you take any • Be•sure to telltoyour healthcare provider if youif take any of theof the ® ® ® ® ® ® ® following medicines: following medicines: - zolpidem - zolpidem (Ambien (Ambien , Edlular , Edlular , Intermezzo , Intermezzo , Zolpimist , Zolpimist ) ®) - Hormone-based control patches, - Hormone-based birth birth control (pills,(pills, patches, rings,rings, shots,shots, etc) etc) KnowKnow the medicines the medicines you take. you take.

KeepKeep a listaoflist allofyour all your medicines medicines and and it to your it to your healthcare healthcare provider provider and pharmacist and pharmacist whenwhen you get youaget a - Antacid medicines that contain aluminum, magnesium hydroxide,showshow - Antacid medicines that contain aluminum, magnesium hydroxide, medicine. medicine.

Do not Dostart not start any new any new medicines medicines whilewhile you are youtaking are taking or calcium carbonate. antacids at least 2 hours before or calcium carbonate.

TakeTake antacids at least 2 hours before or or new new STRIBILD STRIBILD without without first talking first talking with with your your healthcare healthcare provider. provider. you take STRIBILD after after you take STRIBILD STRIBILD STRIBILD and all andmedicines all medicines out of outreach of reach of children. of children.

- Medicines to treat depression, transplant rejection, or highKeepKeep - Medicines to treat depression, organorgan transplant rejection, or high pressure bloodblood pressure This This BriefBrief Summary Summary summarizes summarizes the most the most important important information information ® ® ® ® about about STRIBILD. STRIBILD. If you If would you would like more like more information, information, talk with talk with your your , Pacerone , Pacerone ) ) - amiodarone (Cordarone - amiodarone (Cordarone healthcare healthcare provider. provider.

You can You also can ask alsoyour ask your healthcare healthcare provider provider or or ® ® ® ® - atorvastatin - atorvastatin (Lipitor (Lipitor , Caduet , Caduet ) ) pharmacist pharmacist for information for information aboutabout STRIBILD STRIBILD that is that written is written for health for health ® ® ® professionals, professionals, or callor1-800-445-3235 call 1-800-445-3235 or goortogo www.STRIBILD.com. to www.STRIBILD.com. , Bepadin , Bepadin ) ®) - bepridil - bepridil hydrochloride hydrochloride (Vascor (Vascor ® Issued: Issued: October October 20132013 - bosentan - bosentan (Tracleer (Tracleer ) ®)

- buspirone - buspirone ® ® ® ® ® ® ® - carbamazepine - carbamazepine (Carbatrol (Carbatrol , Epitol , Epitol , Equetro , Equetro , Tegretol , Tegretol ) ®) ® ® ® - clarithromycin - clarithromycin (Biaxin (Biaxin , Prevpac , Prevpac ) ®) ® ® - clonazepam - clonazepam (Klonopin (Klonopin ) ) ® ® ® - clorazepate - clorazepate (Gen-xene (Gen-xene , Tranxene , Tranxene ) ®) ® ® ) ) - colchicine - colchicine (Colcrys (Colcrys - medicines - medicines that contain that contain dexamethasone dexamethasone ® ) ®) - diazepam - diazepam (Valium (Valium

17161_stribild.indd 3

COMPLERA, COMPLERA, EMTRIVA, EMTRIVA, GILEAD,GILEAD, the GILEAD the GILEAD Logo, GSI, Logo, HEPSERA, GSI, HEPSERA, STRIBILD, STRIBILD, the STRIBILD the STRIBILD Logo, Logo, TRUVADA, TRUVADA, and VIREAD and VIREAD are trademarks are trademarks of Gilead of Gilead Sciences, Sciences, Inc., orInc., its related or its related companies. companies.

ATRIPLA ATRIPLA is a trademark is a trademark of Bristol-Myers of Bristol-Myers SquibbSquibb & Gilead & Gilead Sciences, Sciences, LLC. AllLLC. other Allmarks other marks referenced referenced herein herein are theare property the property of theirofrespective their respective owners.owners. © 2014©Gilead 2014 Gilead Sciences, Sciences, Inc. All Inc. rights Allreserved. rights reserved.

STBC0076 STBC0076 03/14 03/14

3/24/14 10:46 AM

M

A

G

A

Z

I

N

E

Diane Anderson-Minshall SVP, GROUP PUBLISHER Joe Valentino SENIOR VP, MARKETING & BR AND STR ATEGY Stephen Murray ART DIRECTOR Boo Jarchow SENIOR DIRECTOR, INTEGR ATED MARKETING Amanda Johnson COPY CHIEF Trudy Ring SENIOR MANAGER, INTEGR ATED MARKETING Steven O’Brien CONTRIBUTING EDITORS Neal Broverman, Sunnivie Brydum, Michelle Garcia, Todd Heywood ART DIRECTOR, INTEGR ATED MARKETING Stacey Toth COORDINATOR, ADVERTISING Paige Popdan AS SISTANT EDITOR Daniel Reynolds COORDINATORS, INTEGR ATED MARKETING EDITORIAL INTERN Kevin O'Keeffe Vineet Sathe, John McCourt WELLNESS EDITOR Sam Page SENIOR DIRECTOR, MEDIA STR ATEGY Stewart Nacht MENTAL HEALTH EDITOR Gary McClain CIRCUL ATION DIRECTOR Jeff Lettiere V IDEO CORRESPONDENT Josh Robbins FULFILLMENT MANAGER Argus Galindo CREATI VE DIRECTOR, DIGITAL MEDIA Dave Johnson PRODUCTION DIRECTOR John Lewis DIRECTOR, DIGITAL MEDIA Scott Ragan ADVERTISING PRODUCTION MANAGER Heidi Medina INTER ACTI VE ART DIRECTOR Christopher Harrity FRONT END DE VELOPER Mayra Urrutia ONLINE PHOTO AND GR APHICS PRODUCER Yannick Delva TR AFFIC MANAGER Kevin Bissada MANAGER, APPLICATION DE VELOPMENT Alex Lim EDITOR IN CHIEF

D DOWNLOIAVPLUS H THE FREEENT GUIDE TREATMILE APP MOB HIVPLUSMAG.COM/TREATMENTGUIDE

HERE MEDIA

Stephen P. Jarchow CEO Paul Colichman CFO/COO Tony Shyngle EXECUTIVE VICE PRESIDENTS Bernard Rook, Joe Landry EDITORIAL DIRECTOR Lucas Grindley CHAIRMAN

Christin Dennis, John Mongiardo, Stephen Murray, Josh Rosenzweig, Joe Valentino VICE PRESIDENTS Greg Brossia, Eric Bui, Steven Capone, Justin Garrett SENIOR VICE PRESIDENTS

Follow us on Facebook and Twitter

Facebook.com/ HIVPlusMag

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

Twitter.com/ HIVPlusMag

EDITORIAL OFFICES 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email mail@HIVPlusMag.com DISTRIBUTE HIV PLUS FOR FREE AT YOUR OFFICE OR FACILITY HIV/AIDS service organizations, community-based groups, pharmacies, physicians’ offices, and other qualifying agencies can request bulk copies for free distribution at your office or facility. Log on to HIVPlusMag.com and select “digital edition” on the “subscribe” link at the top of the page to download a copy request form. There is a 10-copy minimum.

FREE INDIVIDUAL SUBSCRIPTIONS HIV Plus magazine is now available FREE to individual subscribers. Subscribe and get a digital copy of each magazine delivered to the privacy of your computer six times per year. We require only your email address to initiate delivery. You may also share your copies with friends. To sign up, just log on to HIVPlusMag.com and select “digital edition” on the “subscribe” link at the top of the page.

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

WHAT’S YOUR STORY? We want to hear from you: Email us at editor@HIVPlusMag.com or write us at HIV Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. Visit Twitter @HIVPlusMag. HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2013 by Here Publishing Inc. All rights reserved. Printed in the USA.

4

HIV plus

•

J U LY/A U G U S T 2 0 1 4

The most trusted brand in HIV news today has launched a free mobile app that's a super easy way to get information wherever you are. Don't have a phone? You can get it on your computer too. Available on all mobile platforms.

IN THIS ISSUE

JULY/AUGUST 2014

13

Moving from White Collar to The Normal Heart, actor Matt Bomer gives a breakout performance we can’t stop talking about. He talks to us about his inspiration.

2014 TREATMENT GUIDE FEATURES 24 THE MASTER PILL LIST Our rundown, from dosages to side effects and so much more, on every single medication approved by the Food and Drug Administration to treat HIV and AIDS.

36 OPPORTUNISTIC INFECTIONS Medications that treat the viruses, bacteria, or parasites that take advantage of your weakened immune system when you have HIV.

GE T T Y IMAGES

42 INVESTIGATIONAL MEDS Every medication used to treat HIV and its complications goes through many clinical trials before being approved for use. These are the medications, vaccines, and potential cures that scientists are looking at this year.

13 THE NEW NORMAL

A beloved, 30-year-old stage play from HIV activist and agitator Larry Kramer has finally made its way to film. But is it any good? You betcha.

MORE 7 DO ALTERNATIVE THERAPIES REALLY WORK? From bitter melon to colloidal silver, we put a few to the truth vs. myth test

18 HOW CAN YOU PAY FOR THOSE MEDS? A state-by-state guide to HIV drug assistance programs.

48 DAILY DOSE

Yes, he’s taking PrEP and proud of it.

ON THE COVER: Matt Bomer by Getty Images

I

HAVE BEEN CAPTIVATED

by movies and television all my life, from the children's programs of the '70s (can anything today top H.R. Pufnstuf? I think not) to the movies of my adulthood (I could not make it through tough weeks without Groundhog Day). After the young gay men (boys, really) around me started getting sick in the 1980s, I joined ACT UP and took to the streets demanding justice—and medication—for people living with HIV and AIDS. And I remember each of those early movies about men with AIDS, from An Early Frost (the star of which is now on a hit TV show, defying rumors that his career was over because of the part) to Parting Glances and Philadelphia. But it was 1989's Longtime Companion that had me in tears for an hour, as it was an experience too close to my own, of seeing people in love torn apart by disease. Today, in real life we still have to remember that in many cases, and for many people, that while, yes HIV is a chronic manageable condition, it can still turn into AIDS in heartbeat for folks who are not on medication that works. That all came back to me this year when I watched what I think is the most stunning film about AIDS, The Normal Heart, the HBO flick based on Larry Kramer's now-famous 30-year-old stage play. Mark Ruffalo is Ned Weeks, the character modeled on Kramer, a cofounder of GMHC and ACT UP. You'd think that because he's central to every scene, every angle, it'd be Ruffalo's film to carry (and in some ways it is). But make no mistake, this is Matt Bomer's star turn, his moment to shine.

He's brilliant and captivating, and after he gets sick, he's heartbreaking. For one of Hollywood's sexiest men alive, a heartthrob who carries a network TV show as a handsome but wily rascal, Bomer took risks to play a gay man who has sex, falls in love, and gets very visibly ill with the effects of what was still being called the "gay cancer." I may be overstating this when I threaten that if he doesn't win an Emmy, I'm moving to Canada (mostly because my husband might object), but I feel strongly that he deserves every accolade Hollywood could throw at him this year. And he deserves our thanks too, for reminding everyone (a) why access to effective medication is critical for healthy lives and (b) of the people who came before us, who fought those battles and demanded people that stand up and listen, even when it was easier to keep their heads in the sand.

Diane Anderson-Minshall EDITOR IN CHIEF | Editor@HIVPlusMag.com

6

HIV plus

• J U LY/A U G U S T 2 0 1 4

WRITE TO US AT EDITOR@HIVPLUSMAG.COM

Dear Editor, I am a HIV counselor at Hartford Correctional Center in Hartford, Connecticut. I wanted to take a minute to thank you for the wonderful dedication and focus you have displayed in getting information out to the community of people with and without HIV infection.

Todd Heywood's article "Did 'De-Gaying' HIV Doom a Generation of Men?" answered the questions that I've had about why HIV education and counseling has been losing ground. I have been involved in HIV work for 25 years in both Ohio and Connecticut. I have been very angry and frustrated over changes I have seen in HIV care and funding.

Instead of making programs and educational packages available to everyone, they are tied to funding that has limits and only go out to the right and best “bidder.” The federal dollars get tightly focused on a specific tool for education.

That teaches the providers of the programs that they should not be concerned about anyone outside of their program's focus getting the disease because, after all, the federal government is paying only for the program they won in bidding. That “win” provided jobs for people in this field. But they had to give up their ability to reach everyone in order to focus on the funding limits and paperwork that comes with it all. So what I have seen is increased infection rates in men over 40 and increased STD infections, including hepatitis and HPV. Here's an example of my frustration. I can no longer talk with inmates who have HIV to provide support or education. This includes creating and monitoring peer supports. I used to run two support groups a week for men with HIV in this jail setting. Then the focus changed, and I was told to no longer provide support but to instead only push for testing. This includes standing in front of angry, detoxing, alcohol-ridden, recently incarcerated men—who haven't even gotten shoes or a chance to take a shower—and offer them HIV testing. That did not increase testing. HIV support groups are offered in the sentenced facilities but no longer in the jail setting, where men sometimes are held for their full sentence. I have found a way to work around things and still test 200 to 250 men a month; that is what I did with my frustration.

I talk with 50 men each week, who may be straight, gay, trans, or bisexual, about getting tested for HIV. They have taught me that they do not know much about HIV prevention. They do not use condoms at all, and some have admitted to never using them in their 40- or 50-year lifetime. They make decisions about sex based on drive and opportunity.

When told how a man can get infected, many say they had never had heard the information; sometimes they give me a look of shear fear.

Today, the best I can do is enlighten and empower them with knowledge and encourage them to realize that they are very much worth the effort to change. They must first love and care for themselves before thinking about loving someone else.

I agree that the de-gaying of HIV in the U.S. and de-sexualizing of information has made a huge impact on the infection rates of LGBT people. If someone needs to understand, I could show them the face of infection in 2014; it looks just like the face of 1980, when I first looked into the eyes of a man with AIDS, and he was my friend. The face is no different; we are still dying. Social media has changed the way we come together. Maybe this time around we need both the technology and the human factor to finally get the correct information out. We especially need to come together and decide to help each other, once more.

Respectfully yours, John Gawel Hartford, Conn.

BRADFORD ROGNE

EDITOR'S LETTER

BUZZWORTHY

Can Complementary and Alternative Medicine Help Treat HIV? The use of what’s called complementary and alternative medicine (CAM) is popular in the U.S., where yoga and massage have become mainstream activities. In fact, according to a study published in the journal AIDS Care, 60 percent of HIV-positive people have tried some form of CAM, most in addition to their antiretrovirals.

But they aren’t all safe. —Diane Anderson-Minshall TREATMENT

WORTH IT?

WHAT IT DOES

ACUPUNCTURE

YES

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

CHINESE BITTER MELON

MAYBE

Researchers found two proteins in bitter melon that inhibit HIV in laboratory tests: MAP 30 and momorcharin. But no one knows for sure if there’s any clinical usefulness.

COLLOIDAL SILVER

NO

The FDA doesn’t consider it to be safe. Among its many side effects is argyria, an irreversible bluish discoloration of the skin.

MANGANESE

NO

Scientists have discovered that increasing manganese in cells can decrease HIV’s ability to replicate, but there’s no evidence that dietary manganese has any effect on HIV.

MASSAGE

YES

Massage is a complementary medicine that, according to the Mayo Clinic, reduces anxiety and pain, lowers blood pressure, releases endorphins, improves blood circulation, and boosts immunity.

MULTIVITAMINS

YES

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

PRAYER

MAYBE

If you are a believer, there’s ample evidence that prayer offers a positive interpersonal coping mechanism and may be as beneficial in helping you cope with, if not eliminate, symptoms.

REFLEXOLOGY

MAYBE

A study in Thailand found that foot reflexology reduced pain and fatigue in hospitalized AIDS patients.

REIKI

NO

Many participants feel better after this energy therapy, but there’s no scientific proof it works.

SELENIUM

YES

A study in the Archives of Internal Medicine found that selenium increased healthy CD4 cells and reduced the amount of HIV in the blood.

SPIRULINA

YES

The health benefits of spirulina (also known as blue-green algae) have been touted for years because it naturally includes numerous vitamins. One study, in the Journal of Acquired Immune Deficiency Syndromes, found that the algae supplement inhibited HIV replication in the blood. A perk: It’s sold in a powder that can easily be added to smoothies.

VITAMIN D

YES

Higher vitamin D levels have been associated with slower progression of HIV to AIDS and women with higher vitamin D levels had lower risk of dying of any causes.

YOGA

YES

Numerous studies show it has a positive physiological effect and helps alleviate symptoms of HIV.

ZINC

YES

Zinc deficiency occurs in over half of HIV-positive adults; studies show that zinc delays immunological failure and decreases diarrhea.

never take these supplements without doctor’s approval: sutherlandia, saint-john’s-wort, grapefruit, african potato, vitamin c, and garlic.

J U LY/A U G U S T 2 0 1 4 •

HIV plus

7

MATT BOMER WON’T LET YOU LOOK AWAY

He’s one of cable TV’s biggest stars, but when heartthrob Matt Bomer traded in his White Collar to star in The Normal Heart, he gave an HIV-positive performance unparalleled in cinema history

BY DIANE ANDERSON-MINSHALL

PHOTOS BY JOJO WHILDEN

A

ctor matt Bomer, star of the new HBO film The Normal Heart, is blessed with a lot of beauty—the chiseled jaw, the perfect hair, the rock-hard abs—but it is his eyes that capture you first. The ice-blue pools of warmth seem to bore deep into your soul whether you see them in person or on the cover of a magazine. So when he’s crying, crumpled on the floor in a semi-fetal position, too weak to make it to the bathroom alone, covered in shit and piss and Kaposi lesions—the effects of dying of AIDS at a time when the term AIDS wasn’t even coined yet—it’s devastating to watch.

The film, which premiered earlier this summer, packs plenty of star power, including Mark Ruffalo, Taylor Kitsch, Jim Parsons, Julia Roberts, Alfred Molina, Jonathan Groff, Denis O’Hare, and B.D. Wong. But this movie, this role, this moment belongs to Matt Bomer, who serves as the heart of a film that is at turns infuriating, playful, painful, arousing, and mournful.

Directed by Ryan Murphy (the gay creator of hit series Glee and American Horror Story) and written by gay activist Larry Kramer (based on his groundbreaking Tony Award–winning play of the same name), The Normal Heart is an unflinching look at the onset of the AIDS epidemic in New York City in the early 1980s, the nascent gay movement, the disparate sexual politics of the day, and the hysterical fear of a disease nobody had yet named.

Hollywood hunk Ruffalo as Ned Weeks (the pseudonymous character that stands in for Kramer himself) inhabits the activist who helped launch the Gay Men’s Health Crisis and later ACT UP. Ned worries about this so-called gay cancer as friends and acquaintances begin to get sick in droves, many dying suddenly, others locked in isolation in hospitals where even the staff won’t enter their rooms for fear of contagion. Ned aligns himself with no-nonsense Dr. Emma Brookner, who is one of the first to deal with patients with this gay plague, doing so from her wheelchair after surviving childhood polio. Played

by Roberts, the plain-talking and acerbic Brookner is modeled on Dr. Linda Laubenstein, an early HIV and AIDS researcher who in 1982 coauthored the first scientific article on the outbreak of Kaposi’s sarcoma among gay men, a sign of what would soon be known as AIDS. Ned joins others to begin a group serving men with this disease (the real-life GMHC) and he urges gay, handsome, and closeted New York Times reporter Felix, played by Bomer, to expose the government’s inaction on the medical crisis. It is Felix who ignites Ned’s deepest passions.

A date that vacillates between political tirade and excitingly tense sexual interplay marks the beginning of the relationship at the movie’s core, a partnership that inspires Ned to push the government for action, even going so far as to out real-life New York City mayor Ed Koch, whom activists like Kramer argued had done too little to combat AIDS because of his own fear of being discovered as gay. (Koch did not come out in his lifetime but was outed posthumously by several sources.)

Rarely can a movie about AIDS be called sexy, but The Normal Heart is, and it is the initial date between Ned and Felix that sets a standard for a new normal—a film that recognizes how integral sex is to gay men’s lives and how fraught it had become with danger once HIV made its widespread appearance.

It neither marginalizes nor glorifies (homo)sexuality but shows at least two points on a spectrum (monogamy in one scene, group sex in another) that is as broad as that of heterosexual expression.

The movie will change viewers, perhaps a bit like it changed Bomer. “I don’t know how you could be a part of this movie and not be changed on some level, unless you’re just really a slab of concrete,” the actor says, chuckling with an extremely slight but still perceptible Texas drawl. “It’s so rare that you get to portray a well-written character that’s fully developed and is also part of a story

14

hiv plus

•

j u ly/a u g u s t 2 0 1 4

that you hope has some type of social significance, and also that changes you.”

Bomer says that bringing Kramer’s opus to the big screen gave him “a profound sense of gratitude for the people who struggled through this time period and who fought and persisted and rose up—and as difficult and painful as it was, joined together and found their voice and gave us a lot of the rights we have today.”

It is Kramer to whom Bomer also felt the most responsibility. Kramer, who has been too ill to travel, was rushed a print of the film and was said to have been overcome with emotion at the final result. It’s that, not the talk of Emmy nominations, that makes Bomer the most proud.

“For me, getting to meet Larry Kramer was akin to someone getting to meet one of the Beatles,” he says. “I had been reading his stuff since I was a kid. It was sort of my only understanding of what was going on in the world outside of suburban Texas.”

The actor was only 14 when he initially read The Normal Heart, after first reading Kramer’s follow-up play, The Destiny of Me (which is both a sequel and a prequel of sorts, introducing Ned’s childhood in flashbacks and his life as an AIDS crusader later on). Bomer was in awe of Kramer and his work.

“I used to perform scenes from The Destiny of Me in my high school drama class and things like that,” he recalls. “I’m sure people were kind of scratching their head as to why a 14-year-old kid was doing a scene from The Destiny of Me, but it felt really important to me at the time, and there was a sense of injustice and of God, this neon SOS I got when I read it that I felt needed to be put out there.”

Though he read The Normal Heart in the early 1990s, it wasn’t until he started working in professional theater in 1995, when he was 17, that he had his first direct experience with HIV and AIDS. “Those were my first friendships with people who were struggling with the illness, and as you know, that was a particularly difficult time in the AIDS crisis because there was a lot of medication coming through but also a lot of people who had been holding on for a long time waiting for it to come through,” he recalls. “That was the first time I lost a friend.”

The actor-turned-activist wishes he had known more about HIV and AIDS at the time. “I knew my experience from reading Larry’s works and Angels in America and things like that, but I didn’t know enough,” he says. “They weren’t really teaching us about it in school on a level that I wanted to know and understand. I believe it was mentioned, but there weren’t a lot of specifics as to how it could be transmitted or how to be the most supportive friend you could be. It was perceived as something that would be outside our reality…but once it was in my reality, I thought, I wish I knew more.”

He lost more theater friends to AIDS over the years, and he met poz friends who were healthy on antiretrovirals, all the while trying to bring visibility to all of their lives.

“I guess it was the first thing I felt like an activist about,” Bomer says.

“Maybe the reason I was doing The Destiny of Me at the theaters in Spring, Texas, was my own way of bringing awareness to it at that time. So it was just a cause that always stuck with me, and I only grew more passionate about it as I got older, because being in the theater, it was part of our community.”

He always felt like telling Kramer’s story was important, maybe more so now that the author-activist is almost 80, so he took Kramer a batch of cupcakes and sat and talked with him for hours in his apartment about Felix and Ned and their world. “He gave me some important pointers. And I shared some of the research, which I’d done with him, and he sort of just steered me in the right direction.”

Kramer was on set when Bomer filmed his first scene with Ruffalo, at The New York Times’ office, which dramatizes the first meeting between Kramer and his

late boyfriend. Bomer had a flicker of doubt, of worry that he couldn’t pull it off.

There were many moments like that, he says, before and during filming.

“I think it’s why I wanted to play the role,” he admits. “I feel like that’s always a good sign as an actor. That’s always a good place to start from. Because then you know you have to push yourself and stress your parameters as an actor and as an artist and dig deeper than maybe you had to before—especially in this medium. I think there were a lot of things that terrified me about it. But I think at my core I knew I cared enough about the material…and Larry and the characters and the world, and I knew that I would put in the work that I needed to, to do the best that I could. But yeah, there were a lot of scenes that scared the shit out of me.”

For Bomer, there were just as many of those scenes in the first half of the script, before Felix gets sick, as there are in the second half. “I remember being terrified about the New York Times scene. It was the first scene up, and I thought, Oh, shit. Here we go.”

Kramer was also present a month later, Bomer notes, “when we shot the April shower scene, which was one of the brighter spots in the film, where the organization [GMHC] is finally getting some traction and building some momentum and their fundraising efforts are starting to actually bear fruit… and it was also the day that [the Defense of Marriage Act] was overturned and we were able to celebrate together and celebrate him and all the work he had done to make that day possible. It was just one of those moments where you felt like you were in the right place at the right time, which can be so rare. Getting to see Larry there that day was just one of those experiences I’ll never forget.”

For his part, Kramer has told the filmmakers he’s awed by the film as well.

“Once I heard that Larry was happy with it, I felt that was everything to me; I think that was everything to all of us who worked on this,” Bomer says. “So I breathed a sigh of relief and just said a prayer of thanks. You don’t want to tell someone’s story and have them not be happy about it.”

One reason the film is so good is that Ryan Murphy—the man who finally brought this story to the screen nearly 30 years after it was first produced on stage—was, as Bomer says, “in cahoots” with Kramer, sharing Bomer’s reverence for a man who fought for LGBT rights and for the rights and visibility of people with HIV and AIDS at all costs, including friendships and public partnerships with people who thought he was too angry, aggressive, or unwilling to play the game. Kramer, in fact, was booted from his own organization, GMHC, for being just, well, Larry Kramer.

“Ryan was gracious and involved him in the process, and he never let it stray from the source,” Bomer recalls. “He wanted it to be Larry’s story as well. He just brought such a level of great emotion and so much heart to the set from the first day on that it sort of trickled down from there on to everybody, whether they lived through this particular time period or not.”

Ruffalo did the same, spending a great deal of time with Kramer, which allowed him to completely channel the larger-than-life, often curmudgeonly thought leader, who has lived with HIV for decades. “It was so fun to get to play off of because I would see his little idiosyncrasies and gestures,” Bomer says.

“And it was really fun and spontaneous, and he was just a dream to collaborate with.” Ruffalo nails Kramer’s quirks, his facial tics, his ability to bring even lighthearted conversation back to serious social issues. Ruffalo helped usher this film into being decades after Barbra Streisand first tried and failed. And

j u ly/a u g u s t 2 0 1 4 •

hiv plus

15

The new Normal (previous page): Bomer and Ruffalo (right) share ice cream and an intimate moment; (this page) Bomer as Felix on the job.

he exposes something we don’t see much of behind the agitation of Kramer’s public persona—his sentiment, romanticism, and humanity.

The most telling is their initial date scene, a frustrating mélange of aggressive rabble-rousing and nuanced sexual tension that Ruffalo and Bomer make appear seamless. “If you look at the date scene on paper, Ned is going off on these tangents and the conversation keeps getting redirected and so there are a lot of little subtle shifts within that scene that I had to map out—and also be present to what was happening on the day the cameras were rolling,” says Bomer.

To see Bomer, whose only gay roles so far have been a bit part on The New Normal and one in the stage play 8, flirt and seduce Ruffalo is powerful. But when these two attractive Hollywood A-listers of leading-man status actually end up having sex and the camera doesn’t immediately cut away to gauzy curtains or some other de-gaying cinema trope, it’s wonderfully jarring. This is a film for all adults, but it’s not one that waters down gay sexuality to appeal to the masses. It defies you to turn away.

“Whenever you’re dealing with big celebrities like that on a set, the ball is really in their court to extend the olive branch of comfortability, and Mark was so amazing about that—he doesn’t bring a lot of ego to the set,” says Bomer of the duo’s intimate scenes. “I mean, from day one, he treated me with such profound respect and patience, so I felt really comfortable being able to go to those places with him. Because regardless of the type of intimate scene you’re filming, it’s never a terribly comfortable situation. No matter what you’re doing, really you’re just trying to commit to the story from ‘action’ ‘ to ‘cut.’

I think we both knew, coming from theater, that we didn’t have six weeks of rehearsal or three weeks of rehearsal to piece things together, and so from the very beginning, we related to each other more or less in character…we tried to stay in that zone, so when it became a professional thing we didn’t have to suddenly leap into each other’s arms.”

That helped to underscore the love, the romanticism between the two men, especially near the end of the film, when the parallels between the 1980s quest for recognition and the current era’s fight for marriage equality come into stark clarity.

“I think that my understanding of unconditional love and compassion has certainly changed for the rest of my life,” Bomer admits.

But The Normal Heart’s counterpoints to modern culture go beyond relationship recognition. When Ned criticizes Felix for not writing about the gay “cancer” because he’s closeted, Felix shoots back at him, saying no, he doesn’t write about medical stuff but he does write about gay directors, gay designers, gay musicians, and so on, even if they aren’t called “gay” in print. For the role, to get inside Felix’s professional mind-set, Bomer started his research at The New York Times, trailing a reporter for a few days and talking to staffers who’d been there since the late ’70s and early ’80s “and had a lot of stories from the administration of that time,” Bomer says. “The climate was obviously very different there at that time, and exposing certain aspects of your personal life were much riskier than they probably are today. That climate was important for me to understand in terms of where Felix was and his life at that time…how he [felt he] had done what he could, given the circumstances he faced. I think there are certainly parallels today still and I think that conversation is still relevant, but you know, it’s also highly subjective.”

For a kid from the heartland—the son of a Dallas Cowboys football player and his wife, who is himself now married with three kids all under the age of 10, Bomer’s backstory sounds very all-American. But is it?

“I have been through an incredible amount of struggles and difficulties in my life, so to paint it as some rosy picture would be completely false,” he

16

hiv plus

•

j u ly/a u g u s t 2 0 1 4

admits. “And I’m thankful for all those experiences because I think they’ve given me a little bit more depth or compassion or understanding than I would’ve had, had I not gone through them all. So I certainly have an understanding of the all-American experience. I guess I have it from an outsider as well as an insider.”

There’s a scene in the film that makes it seem like Felix might share this perspective, and it’s a moment that perhaps only people who lived through the ‘80s and ’90s might really understand in a visceral way: Bomer is on the subway, he has a small Kaposi’s sarcoma lesion on his face and another on his forehead beneath a knit stocking cap. He sees a woman staring at him and he reflexively pulls down the cap (an action Bomer inadvertently improvised that Murphy decided to leave in). Nearby is another gay man, ravaged by Kaposi’s, emaciated, and probably near death. Bomer shows an amazing range of emotions simply through his eyes, what it was like to stare into the abyss and see your future, a deadening trap of purple lesions and wasting.

“That scene, from the first time I read it, it really resonated with me because it is such a glimpse for Felix,” the actor recounts. “I mean, even though he does have Kaposi’s at that point, he’s still at a hopeful place in terms of where he is with his illness; he’s still going to work. I just tried to be ruthlessly present

Continued on page 23

MISSION: UNDETECTABLE PARTNER Study Progress Report | 2 Years THE PARTICPANTS

60%

1140

COUPLES ONE HIV+ & UNDETECTABLE ONE HIV-

40%

14,000 16,400

THE RESULTS (SO FAR) ACCORDING TO AIDSMAP

LIKELY CHANCE OF TRANSMISSION VIA ANAL SEX FROM SOMEONE ON SUCCESSFUL HIV TREATMENT. (PER YEAR)

When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: LIKELY CHANCE OF TRANSMISSION VIA RECEPTIVE ANAL SEX WITH EJACULATION FROM SOMEONE ON SUCCESSFUL HIV TREATMENT. (PER YEAR)

"Our best estimate is it's zero."

VISIT THESTIGMAPROJECT.ORG FOR MORE EDUCATIONAL GRAPHICS Rodger A et al. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study.

21st Conference on Retroviruses and Opportunistic Infections, Boston, abstract 153LB, 2014.

17134_Stigma.indd 1

3/26/14 2:09 PM

ADAP A STATE-BY-STATE GUIDE TO THE AIDS DRUG ASSISTANCE PROGRAM (ADAP)

Don’t have deep pockets? The federally created, state-managed AIDS Drug Assistance Program (ADAP) can help people pay for their HIV medications. The programs provide prescription medication to uninsured or underinsured people with HIV or AIDS. The requirements vary by state, but typically you have to be a resident, have HIV, and earn less than a certain amount per year, calculated as a percentage of the federal poverty level.

Below is a guide to ADAP income requirements and contact information. Each state’s Maximum Qualifying Income (MQI) to be in ADAP is shown as a percentage of the federal poverty level as well as the dollar amount for a one-person household (in the 48 contiguous states the federal poverty level for one person is $11,670; add $4,060 per family member).

ALABAMA Website: adph.org/aids Phone: (334) 206-5364 MQI: 250% or $29,175

IDAHO

ALASKA

ILLINOIS

Website: bit.ly/ALASKAadap (907) 452-4222 MQI: 300% or $43,740

Website: bit.ly/ILLadap Phone: (217) 782-4977 MQI: 300% or $35,010

ARIZONA

INDIANA

ARKANSAS Website: bit.ly/ARadap Phone: (501) 661-2408 MQI: 200% or $23,340

IOWA

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

KANSAS

COLORADO Website: bit.ly/COadap Phone: (303) 692-2716 MQI: 400% or $46,680

KENTUCKY Website: bit.ly/kentuckyADAP Phone: (866) 510-0005 MQI: 300% or $35,010

CONNECTICUT Website: bit.ly/CTadap Phone: (800) 233-2503 MQI: 400% or $46,680

LOUISIANA Website: hiv.dhh.louisiana.gov Phone: (504) 568-7474 MQI: 300% or $35,010

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

MAINE

DISTRICT OF COLUMBIA Website: bit.ly/DCadap Phone: (202) 671-4900 MQI: 500% or $58,350

MARYLAND Website: bit.ly/MDadap Phone: (800) 205-6308 MQI: 500% or $58,350

FLORIDA

MASSACHUSETTS Website: bit.ly/MAadap Phone: (800) 228-2714 MQI: 500% or $58,350

GEORGIA

MICHIGAN Website: michigan.gov/dap Phone: (888) 826-6565 MQI: 450% or $52,515

HAWAII

MINNESOTA Website: bit.ly/minnesotaADAP Phone: (800) 657-3761 MQI: 300% or $35,010

Website: bit.ly/ARIZadap Phone: (800) 334-1540 MQI: 300% or $35,010

Website: floridaADAP.org Phone: (800) 352-2437 MQI: 400% or $46,680 Website: bit.ly/GEORGIAadap Phone: (404) 657-3100 MQI: 300% or $35,010 Website: bit.ly/adapHawaii Phone: (808) 586-4400 MQI: 400% or $53,680

18

Website: safesex.idaho.gov Phone: (208) 334-6527 MQI: 200% or $23,340

HIV plus

• J U LY/A U G U S T 2 0 1 4

Website: bit.ly/indianaADAP Phone: (866) 588-4948 MQI: 300% or $35,010 Website: bit.ly/iowaADAP Phone: (515) 281-0926 MQI: 200% or $23,340 Website: bit.ly/KANadap Phone: (785) 368-8218 MQI: 300% or $35,010

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

MISSISSIPPI Website: bit.ly/mississippiADAP Phone: (601) 362-4850 MQI: 400% or $46,680

PENNSYLVANIA

MISSOURI Website: bit.ly/missouriADAP Phone: (866) 628-9891 MQI: 300% or $35,010

RHODE ISLAND Website: bit.ly/RhodeIslandADAP Phone: (401) 462-3294 MQI: 400% or $45,960

MONTANA Website: bit.ly/montanaADAP Phone: (406) 444-4744 MQI: 330% or $38,511

SOUTH CAROLINA Website: bit.ly/SCadap Phone: (800) 569-9954 MQI: 300% or $35,010

NEBRASKA Website: bit.ly/NEadap Phone: (402) 559-4673 MQI: 200% or $23,340

SOUTH DAKOTA Website: bit.ly/SDakADAP Phone: (605) 773-3737 MQI: 300% or $35,010

NEVADA

TENNESSEE Website: bit.ly/TNadap Phone: (615) 532-2392 MQI: 300% or $35,010

NEW HAMPSHIRE Website: bit.ly/NHadap Phone: (603) 271-4502 MQI: 300% or $35,010

TEXAS

NEW JERSEY Website: bit.ly/newjerseyADAP Phone: (877) 613-4533 MQI: 500% or $58,350

UTAH

NEW MEXICO Website: nmhivguide.org Phone: (505) 827-2435 MQI: 400% or $46,680

VERMONT

NEW YORK Website: bit.ly/adapNewYork Phone: (800) 542-2437 MQI: 435% or $50,764

VIRGINIA

NORTH CAROLINA Website: bit.ly/adapNCar Phone: (877) 466-2232 MQI: 300% or $35,010

WASHINGTON Website: bit.ly/WAadap Phone: (360) 236-3426 MQI: 400% or $46,680

NORTH DAKOTA Website: ndhealth.gov/HIV Phone: (800) 472-2180 MQI: 300% or $35,010

WEST VIRGINIA Website: bit.ly/WestVAADAP Phone: (304) 558-2195 MQI: 400% or $46,680

OHIO

Website: bit.ly/OHadap Phone: (800) 777-4775 MQI: 300% or $35,010

WISCONSIN Website: bit.ly/WIadap Phone: (800) 991-5532 MQI: 300% or $34,470

OKLAHOMA Website: bit.ly/OKADAP Phone: (405) 271-4636 MQI: 200% or $23,340

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

Website: bit.ly/nevadaADAP Phone: (775) 684-4247 MQI: 400% or $46,680

OREGON

Website: bit.ly/oregonADAP Phone: (800) 805-2313 MQI: 400% or $46,680

Website: bit.ly/PennADAP Phone: (800) 922-9384 MQI: 500% or $58,350

Website: bit.ly/texasADAP Phone: (800) 255-1090 MQI: 200% or $23,340 Website: bit.ly/utahADAP Phone: (801) 538-6197 MQI: 250% or $28,725 Website: bit.ly/vermontADAP Phone: (802) 863-7245 MQI: 500% or $58,350 Website: bit.ly/virginiaADAP Phone: (855) 362-0658 MQI: $11,490-$28,725, depending on plan

ADAP also covers Puerto Rico, Guam, the Virgin Islands, and Pacific Island Territories. Visit http://bit.ly/HHSadap for more information.

J U LY/A U G U S T 2 0 1 4 •

HIV plus

19

SHARE YOUR

#PRIDE

"1/° " É*,

Matt Bomer continued from page 16 and available. At the time I had been living on my own—trying to create his physical reality for myself—for about a month. So I tried to just bring all of that to the work and then just get out of my own way and respond to this amazing actor they’d hired to play this man on the subway. Felix is someone who was appreciated aesthetically for the majority of his life, and you know when I first came onto the subway, a girl stared at me, and I remember pulling my hat over the lesion. Ryan was so present and available as a director that he saw that and he made sure that we covered that in the scene. We did a bunch of different takes on that and played with a lot of different emotions in response to Felix’s glimpse into the future, and the rest was really up to the editors.”

His transformation wasn’t complete until the second round of filming.

Production was halted for several weeks so Bomer could transform himself into Felix toward the end of the film, as the man is dying of AIDS complications. He lost 40 pounds (partly by doing a two-week cleanse at We Care Spa in Desert Hot Springs, Calif., in which he only ingested alkalized water, juice, tea, and enzymes). He went to live on his own for a month, in part because he didn’t want his kids to see him wasting away.

“I felt a tremendous responsibility in playing this role, and part of it was creating that physical reality for the second half of the film,” he admits. “It was sort of one month of casual weight loss and then two months of really aggressive weight loss, and that’s when I left my family, toward the end of the second month, and then just lived on my own in New York and really tried to focus on really solely what Felix was going through. I obviously consulted someone and I prepared our kids as best I could, but I felt it was best for me to be away at that point in time until I sort of finished the project and could start eating again.”

Though this is his first big gay role, and a doozy at that, he says he’s

“never avoided gay roles on my own volition. I would go on auditions. And if I ever passed on something, it was because it wasn’t a role I related to; it certainly wasn’t because the character was gay.” He says the roles just didn’t come to him, perhaps that’s Hollywood’s way of keeping the glass closet intact. Though he’s been out in his private life for many years, he didn’t officially come out as a gay man in Hollywood until 2012, when he thanked his husband, publicist Simon Halls, and their three sons—Kit, Henry, and Walker—while accepting an award for his HIV charity work from the Desert AIDS Project.

The 36-year-old star of USA’s White Collar told Out magazine recently, “I felt a responsibility to Simon and to our kids to be able to live with integrity and not have some strange split psychology of ‘This is who my dad is at home, and this is who he is to the public.’ That trumped any type of professional repercussions that it could have had.… Whatever happens from this point on says a lot more about the business and society than it does about me.”

The same could be said about performers who are out about being HIVpositive. When will an actor of his stature who is living with HIV feel safe enough to come out? “Gosh, that’s a really interesting question,” Bomer says, pausing in thought. “And you know, it’s hard to say. I would like to believe that tolerance and acceptance has profoundly changed in the past decade for sure, so hopefully soon. I mean, I can speculate, but I would really just be theorizing and I’m probably too ignorant to be doing that.

But whoever it is [that does come out as poz] and whenever it is, if I am still around, I will stand there beside them and give them a standing ovation and thank them, that’s for sure.” ✜

j u ly/a u g u s t 2 0 1 4 •

hiv plus

23

2014 HIV C O M P L E T E

TREATMENT

GUIDE

researched and compiled by Diane Anderson-Minshall, Neal Broverman, Trudy Ring Daniel Reynolds, Sunnivie Brydum, and Michelle Garcia

24

HIV plus

• J U LY/A U G U S T 2 0 1 4

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

J U LY/A U G U S T 2 0 1 4 •

HIV plus

25

THE 2014 COMPLETE HIV TREATMENT GUIDE

PROTEASE INHIBITORS HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

PREZISTA darunavir Janssen

REYATAZ atazanavir Bristol-Myers Squibb

APTIVUS tipranavir Boehringer Ingelheim

CRIXIVAN indinavir Merck

26

HIV plus

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

One 800-mg tablet with one 100-mg Norvir capsule, once daily, with food, or one 600-mg tablet for patients without drug resistance

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

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

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

Take at the same time every day

Do not take with Versed, Halcion, Cafergot, Migranal, D.H.E. 45, Methergine, other ergot medicines, or Orap, Camptosar, Crixivan, Mevacor, Zocor, UroXatral, Revatio, Rimactane, Rifadin, Rifater, Rifamate, Saint-John’s-wort, Viramune, Diskus, or Advair. Do not take Vfend or Victrelis if you are taking Reyataz and Norvir, and do not take Tegretol, Dilantin, or drugs containing phenobarbital with Reyataz alone.

If you are taking Videx, Videx EC, or antacids, take Reyataz two hours before or one hour after those medicines. Use with caution if taking drugs for indigestion, heartburn, or ulcers. If taking Reyataz with Norvir and also taking Lamictal, dosage of the latter may need to be adjusted.

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

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

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

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

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

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

Most serious: liver failure, kidney stones, changes in body fat, diabetes, anemia, 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 pain, headache, dizziness, taste changes, rash, itchy skin, yellowing of the skin and/or eyes, upper respiratory infection, dry skin, sore throat

• J U LY/A U G U S T 2 0 1 4

SIDE EFFECTS

PROTEASE INHIBITORS HELP PREVENT REPLICATION OF HIV MEDICATION MEDICATION

Generic Generic Name Name Maker Maker

INVIRASE saquinavir mesylate HoffmannLa Roche

KALETRA lopinavir and ritonavir Abbott Laboratories

LEXIVA fosamprenavir ViiV Healthcare

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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 UroXatral, Cordarone, Vascor, Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot medications such as Parlodel, Migranal, Ergonovine, Bellamine, Cafergot, Ergomar, Methergine, or Permax, oral Versed, Orap, Rifadin, Revatio when used to treat pulmonary hypertension, Mevacor, Advicor, Zocor, Juvisync, Simcor, Vytorin, Desyrel, Oleptro, or Halcion.

Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Aptivus, Rescriptor, Viramune, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Saint-John’s-wort, garlic capsules, hormonal contraceptives, certain calcium channel blockers, certain antibiotics and antifungal medicines, some antipsychotics or antidepressants, and proton pump inhibitors. Do not use if you have severe liver problems, low potassium or low magnesium in your blood, Congenital Long QT Syndrome, or complete atrioventricular block.

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

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

800 mg, typically four tablets, once daily, or 400 mg, typically two tablets, twice daily. Swallow tablets whole; do not chew, break, or crush.

An oral solution is available but should be taken with food

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

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

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

Reduced dosage recommended for patients with liver impairment

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

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

SIDE SIDE EFFECTS EFFECTS

J U LY/A U G U S T 2 0 1 4 •

HIV plus

27

THE 2014 COMPLETE HIV TREATMENT GUIDE

PROTEASE INHIBITORS HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

NORVIR

ritonavir

Abbott Laboratories

VIRACEPT

nelfinavir

ViiV Healthcare

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

600 mg (six 100mg 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, SaintJohn’s-wort. Do not take with both Invirase and any version of rifampin (Rimactane, Rifadin, Rifater, or Rifamate), and use with caution with either of those drugs separately.

Use with caution with Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Tracleer, Rapamune, Flonase, Agenerase, Crixivan, Viracept, Videx, Mycobutin, Aptivus, Rescriptor, Reyataz, Celsentrin, Telzir, Prezista, Tiazac, Adalat, Isoptin, Nizoral, Sporanox, Demerol, Tegretol, Dilantin, phenobarbital, Mycobutin, Biaxin, Duragesic, theophylline, Colcrys used for treatment of gout, certain anticancer medications, certain antidepressants. Use with caution if you have 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 in hands, in feet, or around the lips

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, Saint-John’s-wort, Mevacor, Zocor, or Serevent.

Use with caution with Lipitor, Crestor, Pravachol, Lescol, Viagra, Levitra, Cialis, Adcirca, or Tracleer. If also taking Videx, take Viracept with food one hour after or more than two hours before you take Videx. May reduce effectiveness of birth control pills, so use additional or alternative form of contraception. Doses of Crixivan, Norvir, Invirase, Fortovase, Mycobutin or Dilantin may need to be adjusted.

Rescriptor may lower the amount of Viracept in the blood or vice versa. Do not take if you have moderate to severe liver impairment.

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

SIDE EFFECTS

ENTRY AND FUSION INHIBITORS HELP BLOCK HIV FROM ENTERING T CELLS MEDICATION

Generic Name Maker

TRADITIONAL DOSAGE

SELZENTRY

300 mg twice daily, or 150 mg twice daily if given with potent CYP3A inhibitors, or 600 mg twice daily if given with potent CYP3A inducers

maraviroc

ViiV Healthcare

28

HIV plus

• J U LY/A U G U S T 2 0 1 4

WHAT IT DOES

This is yet another mechanism of inhibiting viral replication. Always taken with other anti-HIV medications.

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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

SIDE EFFECTS

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

ENTRY AND FUSION INHIBITORS HELP BLOCK HIV FROM ENTERING T CELLS MEDICATION

Generic Name Maker

FUZEON

enfuvirtide

Roche Laboratories (brand name) Trimeris (generic)

TRADITIONAL DOSAGE

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

WHAT IT DOES

This is another mechanism of inhibiting viral replication.

Always taken with other anti-HIV medications.

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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

SIDE EFFECTS

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

INTEGRASE INHIBITORS HELP BLOCK AN HIV-ENABLING ENZYME ISENTRESS raltegravir

Merck

W! TIVICAY NE dolutegravir GlaxoSmithKline

One 400-mg tablet, twice daily, available in oral suspension or chewable tablet for children, with dosage varying by weight

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

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, changes in your immune system Other: headache, trouble sleeping, nausea, tiredness; less common side effects include weakness, stomach pain, dizziness, depression, and suicidal thoughts and actions

One 50-mg tablet, once daily for those new to integrase inhibitors or antiretroviral drugs generally, twice daily for those patients if given in combination with certain other antiretrovirals, and twice daily for patients who have taken integrase inhibitors previously and may have resistance to such drugs

Blocks integrase, an enzyme HIV needs to reproduce itself.

Do not take with dofetilide (brand name Tikosyn), a drug used to treat atrial fibrillation. Do not take with etravirine (Intelence) without coadministration of Norvir (ritonavir) and either Reyataz (atazanavir), Prezista (darunavir), or lopinavir (a combination of ritonavir and lopinavir is sold under the brand name Kaletra). Do not take with oxcarbazepine, phenytoin, phenobarbital, carbamazepine, or Saint-John’s-wort. Take two hours before or six hours after any medication containing substances known as polyvalent cations, including certain antacids and laxatives, the ulcer drug sucralfate (brand name Carafate), oral iron or calcium supplements, and buffered medications. Patients who are starting or stopping the diabetes drug metformin at the same time as Tivicay should be monitored closely, and dosage of metformin may need to be adjusted. For patients who are also taking rifampin, a drug that treats tuberculosis and other infections, twice-daily dosage of Tivicay is recommended. Tivicay may be taken with or without food. Take during pregnancy only if potential benefit outweighs risk.

Most serious: hypersensitivity reactions characterized by rash, constitutional findings, and sometimes organ dysfunction, including liver injury (consult your doctor immediately if these reactions occur, as treatment may need to be stopped); worsening of hepatitis B or C; accumulation or redistribution of body fat; changes in immune system. Other: insomnia, headache

J U LY/A U G U S T 2 0 1 4 •

HIV plus

29

THE 2014 COMPLETE HIV TREATMENT GUIDE

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI) HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

TRUVADA

emtricitabine and tenofovir disoproxil fumarate Gilead Sciences

COMBIVIR

lamivudine and zidovudine ViiV Healthcare (Brand name) Hetero Labs, Aurobindo, Teva Pharmaceuticals (Generic)

EMTRIVA

emtricitabine

Gilead Sciences

EPIVIR

lamivudine or 3TC ViiV Healthcare

30

HIV plus

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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

Truvada contains two NRTIs, which act on reverse transcriptase, a substance HIV needs for replication. Do not take Truvada if you take Atripla, Combivir, Emtriva, Epivir or Epivir-HBV, Epzicom, Trizivir, or Viread, which have the same or similar active ingredients. You may need to adjust dosage if also taking Videx, Reyataz, or Kaletra. Do not take with Hepsera. If you have had kidney problems or take other drugs that can cause kidney problems, your doctor should do regular blood tests to check your kidneys. In 2012, the FDA approved Truvada for use in HIV prevention among HIV-negative people who are at high risk of acquiring the virus. The FDA’s updated labeling on the drug notes that persons using the drug preventatively need to be confirmed as HIV-negative every three months and use the drug as prescribed, in combination with safer-sex practices and counseling.

Most serious: buildup of lactic acid in the blood, serious liver problems, flare-ups of hepatitis B virus infection, kidney problems, thinning bones, changes in body fat, symptoms of inflammation from previous infections Other: diarrhea, dizziness, nausea, vomiting, headache, fatigue, abnormal dreams, sleeping problems, rash, depression, shortness of breath, pain, fatty liver, stomach pain, weakness, indigestion, intestinal gas, high volume of urine, excessive thirst, skin discoloration. In patients using Truvada for prevention, the most common side effects have been headache, abdominal pain, and weight loss.

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

Do not take with other medicines containing lamivudine, zidovudine, or emtricitabine (such as Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir, Atripla, Emtriva, and Truvada).

Use caution with if taking interferon alfa, ribavirin, doxorubicin, or ganciclovir. Tell your doctor if 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 the blood, liver toxicity or worsening of liver disease, pancreatitis, muscle disorders and inflammation, changes in body fat, changes in the immune system Other: headache, nausea, fatigue, diarrhea, cough, stuff y nose, general feeling of discomfort

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

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

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

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

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

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

• J U LY/A U G U S T 2 0 1 4

SIDE EFFECTS

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI) HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

EPZICOM

abacavir sulfate and lamivudine ViiV Healthcare

RETROVIR

zidovudine or AZT

ViiV Healthcare; generic versions also available

TRIZIVIR

abacavir sulfate, lamivudine, and zidovudine

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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

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

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

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

Do not take with other medicines that contain the same active ingredients, including Combivir and Trizivir.

Not recommended for use with the antihepatitis drugs Copegus, Rebetol, RibaTab, or Ribasphere. Use with caution if taking ganciclovir or interferon alfa. Do not use Retrovir with stavudine or doxorubicin. Retrovir can also be used to prevent transmission of HIV from a mother to her unborn child.

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

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

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

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

Depends on weight.

For individuals weighing 132 pounds or more, the recommended dose is 400 mg in enteric-coated capsules, once daily.

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

Do not take if you take Lopurin or Zyloprim, which are used to treat gout and kidney stones, or the antihepatitis drugs Copegus, Rebetol, Riba-Tab, or Ribasphere.

Use with caution if taking methadone or ganciclovir, or any drugs that may cause toxicity to the pancreas or nervous system. If you are also taking Viread, the dose of Videx EC should be reduced, and it should be taken on an empty stomach or with a light meal.

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

ViiV Healthcare

VIDEX EC didanosine Bristol-Myers Squibb

SIDE EFFECTS

J U LY/A U G U S T 2 0 1 4 •

HIV plus

31

THE 2014 COMPLETE HIV TREATMENT GUIDE

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI) HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

VIREAD

tenofovir disoproxil fumarate Gilead Sciences

ZERIT

stavudine or d4T

Bristol-Myers Squibb

ZIAGEN

abacavir

GlaxoSmithKline

32

HIV plus

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

One 300mg tablet, once daily.

Adults who are unable to swallow tablets whole may take 7½ scoops of Viread oral powder.

Patients with kidney problems may be prescribed a lower dose

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

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

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

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

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

Patients with mild liver impairment should take 200 mg twice daily

Do not take if you have moderate to severe liver impairment. Do not breast-feed while taking the drug. If you have a severe allergic reaction, do not resume taking Ziagen or any other abacavir-containing drug (Epzicom, Trizivir). Risk of allergic reaction is higher if you have a gene variation called HLA-B*5701.

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

• J U LY/A U G U S T 2 0 1 4

Viread is also used to treat hepatitis B.

SIDE EFFECTS

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

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI) HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

EDURANT rilpivirine

Janssen

INTELENCE etravirine

Janssen

RESCRIPTOR delavirdine

ViiV Healthcare

SUSTIVA efavirenz

Bristol-Myers Squibb

VIRAMUNE nevirapine

Boehringer Ingelheim (generic versions also available)

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

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

NNRTIs attack the same enzyme NRTIs do, in a different way. Edurant is for patients who have not previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less. It is always administered with other antiretrovirals. Do not take Edurant with antiseizure drugs like Tegretol, Trileptal, and Dilantin; antibacterials Mycobutin, Rifadin, Rimactane, or Priftin; proton pump inhibitors such as Nexium, Vimovo, Prevacid, Prilosec, Protonix, and Aciphex; more than one dose of dexamethasone; or Saint-John’s-wort.

Use with caution with antifungals taken orally, antibiotics such as Biaxin and Ketek, and methadone. Take antacids or H2 blockers at least 12 hours before or four hours after Edurant.

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

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

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

Most serious: severe skin reactions such as Stevens-Johnson syndrome Other: changes in body shape or body fat, changes in immune system, tingling or pain in the hands or feet, numbness

400 mg (two or four tablets) three times daily

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

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

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

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

Take Sustiva on an empty stomach, preferably at bedtime, with water.

Most serious: severe liver problems, rashes, and skin reactions Other: changes in the immune system, changes in body fat, dizziness, nausea, headache, insomnia, tiredness

One 200-mg tablet daily for first 14 days, then one 200mg twice daily; also available in oral suspension; or 100mg tablet for children

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

SIDE EFFECTS

J U LY/A U G U S T 2 0 1 4 •

HIV plus

33

YOU DESERVE

ANSWERS Diagnosed with HIV and not sure where to start?

GET ANSWERS AT

HIVANSWERS.COM

Download the free HIV Answers App

8x10.625_HIVAnswers_ad.indd 1

5/12/14 10:54 AM

THE 2014 COMPLETE HIV TREATMENT GUIDE

COMBINATION DRUGS HELP PREVENT REPLICATION OF HIV MEDICATION

Generic Name Maker

STRIBILD elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate Gilead Sciences

ATRIPLA efavirenz, emtricitabine, and tenofovir disoproxil fumarate Bristol-Myers Squibb & Gilead Sciences

COMPLERA emtricitabine, rilpivirine, and tenofovir disoproxil fumarate Gilead Sciences

TRADITIONAL DOSAGE

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

One tablet, once daily, with a meal (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate)

Stribild is not approved for treatment of patients who have hepatitis B, as Stribild can exacerbate the disease and cause flare-ups. Stribild should not be used for patients with an estimated creatinine clearance below 70 mL per minute. Do not use with other anti-HIV drugs containing emtricitabine or tenofovir disoproxil fumarate, including Atripla, Complera, Emtriva, Truvada, or Viread; do not use with drugs containing lamivudine or with drugs or regimens containing ritonavir, such as Combivir, Epivir, Epivir-HBV, Epzicom, or Trizivir.

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

Most serious: buildup of lactic acid in the blood; severe liver or kidney problems, which could lead to potentially fatal renal failure; thinning bones, and changes in the immune system.

Other: nausea and diarrhea

One tablet, once daily, on an empty stomach, preferably at bedtime (600 mg of efavirenz, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate). If you are also taking Rifadin, add 200 mg of efavirenz

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

Do not take while breast-feeding.

Most serious: severe skin reactions such as Stevens-Johnson syndrome, buildup of lactic acid in the blood, severe liver or kidney problems, serious psychiatric problems, thinning bones (a vitamin D supplement may be indicated for the latter) Other: dizziness, headache, insomnia, drowsiness, trouble concentrating, unusual dreams, fatigue, upset stomach, nausea, vomiting, gas, diarrhea

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

Rilpivirine is an NNRTI, the other components NRTIs. Complera is for patients who have not previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less, or it can be used as a replacement regimen for patients who have a viral load of 50 copies/mL or less. Do not take with medicines that contain lamivudine (Epivir, EpivirHBV, Epzicom, Combivir, and Trizivir), other HIV antiretroviral medications, drugs to treat seizures or tuberculosis, proton-pump inhibitors such as Kapidex or Dexilant, Hespera, Saint-John’s-wort, or more than one dose of dexamethasone.

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

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

SIDE EFFECTS

J U LY/A U G U S T 2 0 1 4 •

HIV plus

35

THE 2014 COMPLETE HIV TREATMENT GUIDE

OPPORTUNISTIC INFECTIONS AND OTHER DRUGS MEDICATION

Generic Name Maker

EGRIFTA tesamorelin

TRADITIONAL DOSAGE

sulfamethoxazole/ trimethoprim

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

Do not take if you have or had issues involving your pituitary gland, if you have active cancer, or if you are pregnant or breastfeeding.

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

400 mg (two or four tablets) three times daily

Treats and helps prevent recurrence of Pneumocystis pneumonia in HIVpositive patients; also used on other bacterial infections

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

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

Treats hepatitis B

Do not take 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 in body, severe liver problems, muscle pain or weakness, nerve problems, flare-up of hepatitis B after discontinuation Other: diarrhea, abdominal pain or swelling, cough, headache, dizziness, sore throat, fever

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

Treats the eye infection cytomegalovirus retinitis

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

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

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

Treats anemia that results as a side effect of Retrovir

Do not take if you have uncontrolled high blood pressure.

Iron supplements may be needed for patients who undergo blood transfusions. Talk to your doctor if you have cancer, as there is an increased risk of tumor progression or shortened survival.

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

625 mg (one teaspoon), once daily

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

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

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

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

Treats wasting (HIVrelated weight loss)

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

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

800 mg, once daily

Treats severe malnutrition, appetite loss, or significant weight loss

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

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

Various (see HIVPlusmag.com)

TYZEKA telbivudine Idenix/Novartis

VALCYTE

valganciclovir Genentech

EPOGEN, PROCRIT epoetin alfa Amgen (Epogen); Janssen (Procrit)

MEGACE ES

megestrol acetate Strativa

SEROSTIM

somatropin

EMD Serono

MEGACE ORAL SUSPENSION megestrol acetate Bristol-Myers Squibb 36

HIV plus

SIDE EFFECTS

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

EMD Serono

BACTRIM, SEPTRA, SULFATRIM

WHAT IT DOES

DRUG INTERACTIONS, PRECAUTIONS, & RECOMMENDATIONS

• J U LY/A U G U S T 2 0 1 4

medication

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

PegIntron peginterferon alfa-2b

DOSAGE

what it does

what to know

SIDE EFFECTS

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

Provides secondline treatment for Kaposi’s sarcoma

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

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

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

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

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

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

180 micrograms, once weekly, by subcutaneous injection

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

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

Most serious: severe eye, blood, liver, nerve, thyroid, or lung problems, pancreatitis, colitis, high blood sugar or diabetes, allergic reaction Other: flulike symptoms, tiredness and weakness, stomach problems, loss of appetite, skin reactions, hair thinning, trouble sleeping

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

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

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

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

300 mg every four weeks, via oral inhalation

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

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

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

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

Treats AIDS-related Kaposi’s sarcoma and hepatitis infection, especially hepatitis C

Use caution if taken with Retrovir, theophylline, or Tyzeka.

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

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

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

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

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

Most serious: rash, diarrhea, nausea

Merck

Pegasys peginterferon alfa-2a Genentech

Baraclude entecavir Bristol-Myers Squibb

NebuPent pentamidine isethionate APP Pharmaceuticals

Intron A interferon alfa-2b Schering

Roferon-A interferon alfa-2 Roche

Mepron atovaquone GlaxoSmithKline

3 million IUs per square meter of body surface, subcutaneously or intramuscularly, three times a week For prevention, 1,500 mg of oral solution, once daily, with a meal; for treatment, 750 mg of solution, twice daily, with meals

Treats chronic hepatitis C

Helps prevent and treat mild to moderate Pneumocystis pneumonia in patients who cannot tolerate other drugs

j u ly/a u g u s t 2 0 1 4 •

hiv plus

37

medication

w! ne

Solvadi sofosbuvir Gilead

Sporanox itraconazole Janssen

Gamimune N, Gamunex, Gammagard immune globulin

DOSAGE

what it does

what to know

SIDE EFFECTS

One 400-mg tablet, once Treats chronic hepadaily, in combination titis C infection with ribivarin (marketed under brand names Copegus, Rebetol, and others); with some types of hep C virus, peginterferon alfa (PegIntron or Pegasys) should be used

Do not take if you or partner are pregnant or plan to be, as birth defects or fetal death can result. Do not take with Aptivus, Tegretol, Dilantin, Tileptal, Mycobutin, Rifadin, Priftin, Saint-John’s-wort, or drugs containing phenobarbital.

Most serious: fetal damage Other: fatigue, headache, nausea, insomnia, anemia

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

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

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

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

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

Helps fight bacterial May interfere with immune infections in children response to live-virus vaccines for with HIV measles, mumps, or rubella.

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

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

Treats Kaposi’s sar- Dose may need to be adjusted if coma in patients who you have liver problems. cannot tolerate other medicines or whose disease is advanced

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

Amount and frequency varies by patient; delivered by subcutaneous injection

Helps restore or cor- If you have an active skin infection rect signs of facial fat or inflammation in or near the treatment area, do not use until this conloss (lipoatrophy) dition is under control. Minimize exposure to sunlight or sun lamps.

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

800 to 1,200 mg daily, depending on patient’s weight and type of virus, taken twice daily in 200-mg capsules, with food

In combination with Pegasys, treats chronic hepatitis C infection

Do not use if you take Videx or Videx EC. Use caution when taking with NRTIs like Combivir, Epivir, Epzicom, Retrovir, Trizivir, as drug interactions could lead to toxicity. Do not take if you have certain blood disorders, such as thalassemia major or sickle-cell anemia, or certain types of hepatitis. Do not take if you are pregnant or if you or your partner plan to become pregnant.

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

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

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

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

Do not take with blood dyscrasiacausing 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 anti-HIV medications containing zidovudine or didanosine.

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

150-mg capsule, once daily, with food, in combination with ribivarin (marketed under brand names Copegus, Rebetol, and others) and peginterferon alfa (PegIntron or Pegasys)

Treats chronic hepa- Do not take if you or partner are pregnant or plan to be, as birth defects or titis C infection fetal death can result. Use with caution if taking Tegretol, Mycobutin, Rifadin, Saint-John’s-wort, Norvir, Kaletra, Biaxin, cimetidine, antifungal meds, or grapefruit juice.

Most serious: severe rash, fetal damage Other: milder rash, itching, sensitivity to light, nausea

Bayer Biological Talecris Biotherapeutics, Baxter Healthcare

Doxil doxorubicin, liposomal Janssen

Sculptra injectable poly-L-lactic acid Dermik Laboratories

Copegus ribivarin Roche

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

w! ne

Olysio simeprevir Janssen

38

hiv plus

• j u ly/a u g u s t 2 0 1 4

medication

Rebetol ribivarin Schering, Merck

Mycobutin rifabutin Pfizer (Mycobutin); Lupin Ltd. (generic)

Rifadin, Rifadin IV rifampin Sanoifi-Aventis

AmBisome, Amphotec, Abelcet, Amphocin,

DOSAGE

what it does

what to know

SIDE EFFECTS

800-1,400 mg daily, based on patient’s weight, by capsule or oral solution, taken with food

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

Do not use if you take Videx or Videx EC. Do note take if you have autoimmune hepatitis, certain blood disorders, or severe kidney disease. Do not take if you are pregnant or if you or your partner plan to become pregnant. 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 or suicidal thoughts, dental problems caused by dry mouth Other: less serious mood changes, flulike symptoms, headache, fever, stiffness, anorexia

300 mg in capsules, once daily. If prone to nausea or vomiting, split into two doses daily, with food

Helps prevent disseminated Mycobacterium avium complex (MAC) disease

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

Most serious: neutropenia Other: rash, gastrointestinal disorders, flulike symptoms

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

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

Do not take if taking Reyataz, Prezista, Lexiva, Fortovase, Invirase, or Aptivus. Dosage of anticoagulant 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

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

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

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

Most serious: allergic reaction, kidney problems, rash, irregular heartbeat, muscle cramps or pain, weakness, bleeding, hearing loss, blurred vision, hepatitis Other: fever, shaking, chills, weight loss, nausea, headache, jaundice

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

Treatment can continue as long as needed

Provides topical treatment for KS lesions

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

Most serious: toxic skin reactions

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

Treats recurrent episodes of orolabial herpes (cold sores) or genital herpes

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

Most serious: acute kidney failure Other: headache, nausea, skin or subcutaneous tissue disorders, heart palpitations

amphotericin B Astellas, Alkopharma, Sigma-Tau, Pfizer

panretin gel alitretinoin Eisai

Famvir famciclovir Novartis

j u ly/a u g u s t 2 0 1 4 •

hiv plus

39

medication

DOSAGE

what it does

what to know

SIDE EFFECTS

For esophageal candidiasis,

Treats fungal infections, such as esophageal candidiasis

Do not use with high-dose Norvir; use with caution with low-dose Norvir. Do not use with Saint-John’s-wort, ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, quinidine, or rifabutin. Use with caution in patients with heart arrhythmias.

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

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

Treats esophageal candidiasis, candidemia, and other Candida infections

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

Most serious: abnormal liver function, anaphylactic shock Other: nausea, diarrhea, vomiting

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

Treats advanced HIV-related Kaposi’s sarcoma

Do not use in patients with less than advanced KS.

Most serious: suppression of the bone marrow’s production of blood cells and platelets; patients should have regular blood counts Other: back pain, flushing, chest tightness

Initial dose of Foscavir, a liqTreats CMV retinitis uid solution, is an intravenous infusion of 90 mg per kilogram of weight every 12 hours or 60 mg/kg every eight hours for two to three weeks, followed by a maintenance dose of 90 mg/kg to 120 mg/kg daily.

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

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

Delivered by intravenous infu-

Treats CMV retinitis

The antigout drug probenecid (brand name Benemid or Probalan) should be taken orally with each Vistide treatment.

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

Most serious: kidney toxicity, decreased interocular pressure Other: nausea, vomiting, fever

Fights bacterial infections, especially Mycobacterium avium complex (MAC)

There have been life-threatening interactions with Colcrys and serious interactions with Altacor, Altoprev, Mevacor, Zocor, Lipitor, and blood pressure drugs. Use caution when taking with Viagra.

Most serious: abdominal pain, fever, nausea, vomiting, bleeding or bruising, diarrhea, colitis, liver failure, hepatitis Other: milder diarrhea, headache, nausea and vomiting, change in taste

Vfend 200 mg in tablets or oral

voriconazole Pfizer

Eraxis anidulafungin Pfizer

DaunoXome daunorubicin liposomal

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

Duration of treatment varies according to the infection

Galen

Foscavir foscarnet sodium Hospira

vistide sion, the initial dose depends cidofovir Gilead

on the patient’s weight, gender, and kidney function, with the latter measured by a test that determines how well the kidneys clear creatinine from the blood. Maintenance dose is 5 mg per kilogram of body weight, by infusion, once every two weeks

500 mg, 2 or 3 times daily,

Biaxin depending on the infec-

clarithromycin Abbott Laboratories

40

hiv plus

tion. Available in immediate release tablets, extended release tablets, and granules to be mixed with water

• j u ly/a u g u s t 2 0 1 4

medication

Etopophos etoposide Bristol-Myers Squibb

Zovirax acyclovir GlaxoSmithKline

Hepsera adefovir dipivoxil

DOSAGE

what it does

what to know

SIDE EFFECTS

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

Treats various types of cancer; being tested for treatment of non-Hodgkin’s lymphoma and Kaposi’s sarcoma

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

Most serious: severe allergic reaction, alopecia (hair loss), chills or fever, nausea, constipation, abdominal pain Other: rash, unusual tiredness

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

Treats and controls herpes viral infections, like shingles, genital warts, and chicken pox

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

Most serious: severe allergic reaction, blood and liver disorders, hepatitis, peripheral edema (blood clotting leading to swelling of the legs or arms), gastrointestinal upset, nausea, alopecia (hair loss), jaundice, seizures, confusion, hallucination Other: headache, visual impairment, tremors, rash or stinging skin with topical ointment

One 10-mg tablet daily

Treats chronic hepatitis B infection

Do not take with Viread, Atripla, Truvada, Complera, or Stribild. Use caution when taking with drugs that affect kidney function or are eliminated by the kidneys, or with other NRTIs.

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

Varies, but usually starts with one 2.5-mg capsule taken twice daily, before lunch and dinner. Also available in 5-mg or 10-mg capsules. Take the capsules whole; do not crush or chew

Helps stimulate the appetite of HIV patients

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, feelings of unreality, hallucinations, depression, nervousness, anxiety, and rapid heartbeat Other: clumsiness or unsteadiness, dizziness, drowsiness, euphoria, trouble thinking, nausea, vomiting

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

Treats and helps prevent Mycobacterium avium complex

When this drug is used with Viracept, which can increase concentrations of Zithromax, the patient should be monitored closely for known side effects of Zithromax, such as liver enzyme abnormalities and hearing impairment.

Most serious: irregular heart activity, in rare cases fatal; liver enzyme abnormalities and other liver problems, severe diarrhea, hearing impairment Other: nausea, vomiting, mild to moderate diarrhea, abdominal pain

Varies; the drug is available in singleuse vials with 0.3, 1, or 1.3 milliliters of calcium hydroxylaptite suspended in a water-based gel. It is injected into the skin, and results can last up to a year

Treats facial fat loss (lipoatrophy) and stimulates the body’s collagen production to combat HIV-related facial wasting

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

Most serious: prolonged swelling, irritation, redness, swelling, itching, burning, or tenderness at the injection site may occur, but typically resolve shortly after treatment

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

Relieves diarrhea that is a side effect of antiretroviral drugs

Patients should be tested to make sure the diarrhea is not caused by an infection or gastrointestinal disease.

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

Doses vary based on targeted infection.

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

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

Do not take with Quinaglute, Quinidex, Hismanal, Propulsid, Orap, or erythromycin. Use with caution with antidiabetic agents, anticonvulsants, blood pressure medications, immunosuppressive drugs, protease inhibitors, blood thinners, and vitamin A nutritional supplements. Use with caution if pregnant or if you have heart problems or kidney dysfunction. Do not take if you have sugar intolerance.

Most serious: liver problems, potentially severe allergic reaction, seizures Other: rash, nausea, headache, vomiting, diarrhea, dizziness

Gilead

marinol dronabinol AbbVie

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

Radiesse calcium hydroxylapatite Merz Aesthetics

Fulyzaq crofelemer Salix

Diflucan fluconazole Pfizer

For more info go to HIVPlusMag.com j u ly/a u g u s t 2 0 1 4 •

hiv plus

41

THE 2014 COMPLETE HIV TREATMENT GUIDE

INVESTIGATIONAL MEDICATIONS The medications used to treat HIV and all its complications go through extensive investigations and clinical trials before being approved for general use. Doctors are now working on vaccines and cures for HIV, seeking to improve on current drug therapies and using new approaches such as introducing virus-blocking cells into the body. These and other promising treatments are under development in medical, university, and pharmaceutical organizations. Some of these new medications, which are not yet approved for use outside clinical trials, may soon be coming to a pharmacy near you.

NAME & MAKER

WHAT IT DOES

BMS-663068

BMS-663068 is the first investigational antiretroviral to prevent initial viral attachment to the host CD4+ T cell and entry into the host immune cell by binding directly to the virus. Findings from week 24 of a Phase IIb trial are promising: specifically, the virus was undetectable in 69 percent to 80 percent of patients, with no serious complications.

TENOFOVIR-UC781

One form of tenofovir is marketed as an oral HIV medication under the brand name Viread, but it has also been studied as a component of a microbicide gel for a vaginal use. While some gel trials have produced disappointing results, scientists are studying whether tenofovir’s performance can be improved by combining it with the nonnucleoside reverse transcriptase inhibitor UC781 in a vaginal gel and potentially a film. Gilead Sciences has granted a license to nonprofits Conrad and the International Partnership for Microbicides to create a gel that could be used by women in developing countries to prevent HIV transmission during sex. Clinical trials in South Africa are ongoing. An intravaginal ring that would dispense tenofovir is also under development.

ELVITEGRAVIR

A type of medicine that blocks integrase, a protein that HIV needs to insert its viral genetic material into the genetic material of an infected cell, elvitegravir is taken orally to fight HIV, in combination with other antiretroviral medicines. Elvitegravir is a component of the Stribild combination pill. Elvitegravir was approved for use as a standalone under the brand name Viketa in the European Union, Canada, and Australia, but an application for U.S. use is still under review by the FDA.

COBICISTAT (GS-9350)

Cobicistat is a pharmaco-enhancer or “boosting agent” that raises the blood levels of other drugs that are broken down by the same protein. Cobicistat itself does not have any antiviral activity. Like elvitegravir, it is a component of Stribild. It has been approved as a stand-alone drug under the brand name Tybost in the European Union, Canada, and Australia, but an application for U.S. use is still under review by the FDA.

572_TRII

A complete, single-pill regimen that contains the integrase inhibitor dolutegravir and Epzicom, 572_TRII is an already-approved drug that prevents HIV from altering the genetic material of healthy CD4 cells. Dolutegravir is marketed under the brand name Tivicay and received FDA approval as a stand-alone drug in August 2013. 572_TRII is currently in Phase III clinical trials.

DORAVIRINE

Doravirine, a nonnucleoside reverse transcriptase inhibitor, showed promise in suppressing HIV with fewer side effects than some other medications in a Phase II trial, the results of which were presented at a conference in March. Patients took the drug in combination with Truvada (itself a combo of emtricitabine and tenofovir). Merck plans to start a Phase III trial in the second half of 2014.

TENOFOVIR ALAFENAMIDE

Tenofovir disoproxil fumarate, a nucleoside reverse transcriptase inhibitor, is already available as an anti-HIV pill under the brand name Viread and as a component of several combination drugs, including Stribild. Gilead is currently conducting clinical trials of a variant, tenofovir alafenamide or TAF (formerly GS-7340); TAF may be able to have a greater antiviral effect than Viread at a dose that is 10 times lower and is better distributed into lymphoid tissues, potentially improving the tolerability of HIV therapy. In a Phase II study, the TAF-based single tablet regimen suppressed the virus as well as Stribild while being gentler on kidneys and bones. Several Phase III studies regarding its efficacy, including a single-tablet regimen of TAF combined with elvitegravir, cobicistat, and emtricitabine, are ongoing, with estimated completion dates in 2015 and 2016.

ATAZANAVIR SULFATE WITH COBICISTAT

In April Bristol-Myers Squibb submitted an application U.S. Food and Drug Administration for a fi xed-dose combination of atazanavir sulfate, a protease inhibitor marketed as Reyataz, and cobicistat, an investigational boosting agent that can increase the level of certain HIV-1 medicines in the blood and make them more effective. If approved, atazanavir sulfate and cobicistat could offer patients living with HIV-1 (the most common strain of HIV) another single-tablet regimen.

Bristol-Myers Squibb

Gilead Sciences

Gilead Sciences

Gilead Sciences

ViiV Healthcare

Merck

Gilead Sciences

Bristol-Myers Squibb

42

HIV plus

• J U LY/A U G U S T 2 0 1 4

NAME & MAKER

WHAT IT DOES

IBALIZUMAB

TaiMed

A CXCR4 inhibitor that works by blocking HIV’s entry into cells, ibalizumab (formerly known as TMB-355) is injected intravenously to treat HIV. Various doses, based on body weight, have been studied. Phase I and II trials have shown the drug to be safe and active against HIV. A form of the drug to be injected subcutaneously, which would allow patients to inject it under the skin without assistance, is also being evaluated.

APRICITABINE Avexa Ltd.

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

ELVUCITABINE

Another NRTI, elvucitabine (or ACH-126443) is similar to the FDA-approved anti-HIV drug lamivudine (Epivir).

Elvucitabine may be effective in treating individuals infected with HIV strains resistant to lamivudine and may delay the emergence of resistance and prolong the effectiveness of therapy. Phase II clinical trials have been completed.

’744 LAP

S/GSK1265744, or simply ’744 LAP, is an integrase inhibitor that is considered ViiV’s follow-up to dolutegravir. The drug is currently in Phase II studies to evaluate the long-term safety and tolerability of oral and injectable forms.

VIVAGEL

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

PRO 140

CytoDyn

PRO 140 is an antibody, not a drug, designed to block HIV from entering a cell. It accomplishes this by binding to a molecule called CCR5, a normal cell protein that HIV attaches to after contact with the primary receptor for the virus. PRO 140 has no apparent issues with toxicity and could serve a role as PrEP or PEP in treating high-risk negative individuals.

AMPLIGEN

Ampligen is an RNA drug product that is administered intravenously. It’s in human clinical development for various therapeutically oriented studies, including treatment for HIV, renal cell carcinoma, and malignant melanoma.

MUCOCEPT

MucoCept, a third-generation engineered probiotic product, is in pre-clinical development and nearing an Investigational New Drug submission as a novel microbicide for the prevention of HIV infection in women.

AGS-004

Argos Therapeutics employs a trademarked technology called Arcelis, an immunotherapy that is tailored to the immune response of individual patients. Its most promising candidate for HIV treatment with this technology, AGS-004, currently in Phase IIb of testing, takes small plasma samples from patients in order to generate a response by the patient’s immune system to the virus. Results from Phase IIa were promising, showing a significant viral load reduction and delay in viral rebound during a 12-week interruption of antiretroviral treatment, compared to those before treatment.

CAL-1

In 2008 doctors announced that an American treated in Berlin had been effectively cured of HIV after undergoing a transplant of bone marrow stem cells as treatment for leukemia the previous year. Since then, scientists have attempted to replicate this result through the development of a blood stem cell therapy that would block the expression of the CCR5 protein, which the virus uses to enter T cells. Calimmune has developed a gene medicine called Cal-1, which would modify a person’s T cells and blood stem cells to block CCR5 so that HIV could not enter. The strategy is currently in Phase I and II human trials, with results expected in 2015.

DAPIVIRINE

As a nonnucleoside reverse transcriptase inhibitor, or NNRTI, dapivirine prevents HIV from replicating its genetic material after the virus enters a healthy cell. IPM is evaluating two methods for administration of dapirivine by women to prevent sexual transmission of HIV: a vaginal gel for daily use and a vaginal ring for monthly administration. They have been through Phase I and II trials, and two Phase III studies of the dapirivine ring are going on in Africa, from which results are expected in 2016.

DERMAVIR

Genetic Immunity

DermaVir is a post-infection vaccine that helps make HIV more visible to the body’s immune system, thereby enabling it to attack the virus. It is administered by applying it under a patch to skin that has been deliberately irritated. DermaVir releases a small amount of the virus’s DNA into the skin, where it is picked up by dendritic cells and then transported the lymph nodes, where T cells are generated, and elevates the ability of healthy T cells to recognize and destroy the virus.

HIV VACCINE GeoVax Labs

Utilizing DNA and viral vector technologies, GeoVax Lab is developing a vaccine to prevent HIV infection. This vaccine, which recently completed Phase II safety trials through the U.S. government-sponsored HIV Vaccine Trials Network, is also being tested in a Phase I trial as a treatment for HIV-positive patients, which may reduce the need for treatment with drugs.

Achillion Pharmaceuticals

ViiV

Starpharma

Hemispherx Biopharma

Osel Inc.

Argos Therapeutics

Calimmune

International Partnership for Microbicides

J U LY/A U G U S T 2 0 1 4 •

HIV plus

43

COMPLERA is a prescription medicine used as a complete HIV-1 treatment in 1 pill a day. It is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood. COMPLERA can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements. COMPLERA does not cure HIV-1 or AIDS.

Just the

one

for me

COMPLERA is a complete HIV-1 treatment in only 1 pill a day.

Ask your healthcare provider if COMPLERA may be the one for you.

Pill shown is not actual size.

17158_Complera.indd 2

3/24/14 12:28 PM

What is COMPLERA?

COMPLERA (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). COMPLERA can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements.

COMPLERA combines 3 medicines into 1 pill to be taken once a day with food. COMPLERA is a complete single tablet regimen and should not be used with other HIV-1 medicines. It is not known if COMPLERA is safe and effective in children under the age of 18 years.

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

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

COMPLERA can cause serious side effects: • Build-up of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual (not normal) muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold especially in your arms and legs, feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.

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

• You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time. In some cases, these serious conditions have led to death.

Call your healthcare provider right away if you have any symptoms of these conditions.

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

Who should not take COMPLERA?

Do not take COMPLERA if you: • Take a medicine that contains: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol), oxcarbazepine (Trileptal), phenobarbital (Luminal), phenytoin (Dilantin, Dilantin-125, Phenytek), rifabutin (Mycobutin), rifampin (Rifater, Rifamate, Rimactane, Rifadin), rifapentine (Priftin), dexlansoprazole (Dexilant), esomeprazole (Nexium, Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole sodium (Protonix), rabeprazole (Aciphex), more than 1 dose of the steroid medicine dexamethasone or dexamethasone sodium phosphate, or the herbal supplement St. John’s wort.

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

starting treatment with COMPLERA. If you have had kidney problems, or take other medicines that may cause kidney problems, your healthcare provider may also check your kidneys during treatment with COMPLERA. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: feeling sad or hopeless, feeling anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself.

• Changes in liver enzymes: People who have had hepatitis B or C, or who have had changes in their liver function tests in the past may have an increased risk for liver problems while taking COMPLERA. Some people without prior liver disease may also be at risk. Your healthcare provider may do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.

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

• Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking COMPLERA. The most common side effects of COMPLERA include trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, and depression. Other common side effects include vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), and pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking COMPLERA?

All your health problems. Be sure to tell your healthcare provider if you have or had any kidney, mental health, bone, or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

COMPLERA may affect the way other medicines work, and other medicines may affect how COMPLERA works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist.

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

• If you take antacids. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. • If you take stomach acid blockers. Take acid blockers at least 12 hours before or at least 4 hours after you take COMPLERA. Ask your healthcare provider if your acid blocker is okay to take, as some acid blockers should never be taken with COMPLERA. • If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking COMPLERA. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk. Also, some medicines in COMPLERA can pass into breast milk, and it is not known if this can harm the baby.

•

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

What are the other possible side effects of COMPLERA?

Serious side effects of COMPLERA may also include: • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood tests to check your kidneys before

17158_Complera.indd 3

Learn more at www.COMPLERA.com

3/24/14 12:29 PM

Brief Summary of full Prescribing Information COMPLERA® (kom-PLEH-rah) (emtricitabine 200 mg, rilpivirine 25 mg, tenofovir disoproxil fumarate 300 mg) tablets Brief summary of full Prescribing Information. For more information, please see the full Prescribing Information, including Patient Information.

What is COMPLERA? • COMPLERA is a prescription medicine used as a complete HIV-1 treatment in one pill a day. COMPLERA is for adults who have never taken HIV-1 medicines before and who have no more than 100,000 copies/mL of virus in their blood (this is called ‘viral load’). Complera can also replace current HIV-1 medicines for some adults who have an undetectable viral load (less than 50 copies/mL) and whose healthcare provider determines that they meet certain other requirements.

• COMPLERA is a complete regimen and should not be used with other HIV-1 medicines. HIV-1 is the virus that causes AIDS. When used properly, COMPLERA may reduce the amount of HIV-1 virus in your blood and increase the amount of CD4 T-cells, which may help improve your immune system. This may reduce your risk of death or getting infections that can happen when your immune system is weak.

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

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

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

17159_Complera.indd 2

• You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight (obese), or have been taking COMPLERA for a long time.

• Worsening of Hepatitis B infection. If you have hepatitis B virus (HBV) infection and take COMPLERA, your HBV may get worse (flare-up) if you stop taking COMPLERA. A “flare-up” is when your HBV infection suddenly returns in a worse way than before. COMPLERA is not approved for the treatment of HBV, so you must discuss your HBV with your healthcare provider.

– Do not run out of COMPLERA. Refill your prescription or talk to your healthcare provider before your COMPLERA is all gone.

– Do not stop taking COMPLERA without first talking to your healthcare provider.

– If you stop taking COMPLERA, your healthcare provider will need to check your health often and do blood tests regularly to check your HBV infection. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking COMPLERA. Who should not take COMPLERA? Do not take COMPLERA if you also take any of the following medicines: • Medicines used for seizures: carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol-XR, Teril, Epitol); oxcarbazepine (Trileptal); phenobarbital (Luminal); phenytoin (Dilantin, Dilantin-125, Phenytek) • Medicines used for tuberculosis: rifabutin (Mycobutin); rifampin (Rifater, Rifamate, Rimactane, Rifadin); rifapentine (Priftin) • Certain medicines used to block stomach acid called proton pump inhibitors (PPIs): dexlansoprazole (Dexilant); esomeprazole (Nexium, Vimovo); lansoprazole (Prevacid); omeprazole (Prilosec, Zegerid); pantoprazole sodium (Protonix); rabeprazole (Aciphex) • Certain steroid medicines: More than 1 dose of dexamethasone or dexamethasone sodium phosphate • Certain herbal supplements: St. John’s wort • Certain hepatitis medicines: adefovir (Hepsera), lamivudine (Epivir-HBV) Do not take COMPLERA if you also take any other HIV-1 medicines, including: • Other medicines that contain tenofovir (ATRIPLA, STRIBILD, TRUVADA, VIREAD) • Other medicines that contain emtricitabine or lamivudine (ATRIPLA, Combivir, EMTRIVA, Epivir, Epzicom, STRIBILD, Trizivir, TRUVADA) • rilpivirine (Edurant) COMPLERA is not for use in people who are less than 18 years old.

What are the possible side effects of COMPLERA? COMPLERA may cause the following serious side effects: • See “What is the most important information I should know about COMPLERA?” • New or worse kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before you start and while you are taking COMPLERA. If you have had kidney problems in the past or need to take another medicine that can cause kidney problems, your healthcare provider may need to do blood tests to check your kidneys during your treatment with COMPLERA. • Depression or mood changes. Tell your healthcare provider right away if you have any of the following symptoms: – feeling sad or hopeless – feeling anxious or restless – have thoughts of hurting yourself (suicide) or have tried to hurt yourself • Change in liver enzymes. People with a history of hepatitis B or C

3/24/14 12:31 PM

virus infection or who have certain liver enzyme changes may have an increased risk of developing new or worsening liver problems during treatment with COMPLERA. Liver problems can also happen during treatment with COMPLERA in people without a history of liver disease.

Your healthcare provider may need to do tests to check your liver enzymes before and during treatment with COMPLERA. • Bone problems can happen in some people who take COMPLERA. Bone problems include bone pain, softening or thinning (which may lead to fractures). Your healthcare provider may need to do tests to check your bones.

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

These changes may include increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the main part of your body (trunk). Loss of fat from the legs, arms and face may also happen.

The cause and long term health effect of these conditions are not known.

• Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your healthcare provider if you start having any new symptoms after starting your HIV-1 medicine.

The most common side effects of COMPLERA include: • Trouble sleeping (insomnia), abnormal dreams, headache, dizziness, diarrhea, nausea, rash, tiredness, depression Additional common side effects include: • Vomiting, stomach pain or discomfort, skin discoloration (small spots or freckles), pain Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

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

• Call your healthcare provider for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my healthcare provider before taking COMPLERA? Tell your healthcare provider about all your medical conditions, including: • If you have or had any kidney, mental health, bone, or liver problems, including hepatitis B or C infection.

• If you are pregnant or plan to become pregnant. It is not known if COMPLERA can harm your unborn child.

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

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

– Two of the medicines in COMPLERA can pass to your baby in your breast milk. It is not known if this could harm your baby.

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

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

• If you take certain medicines with COMPLERA, the amount of COMPLERA in your body may be too low and it may not work to help

17159_Complera.indd 3

control your HIV-1 infection. The HIV-1 virus in your body may become resistant to COMPLERA or other HIV-1 medicines that are like it.

• Be sure to tell your healthcare provider if you take any of the following medicines: – Antacid medicines that contain aluminum, magnesium hydroxide, or calcium carbonate. Take antacids at least 2 hours before or at least 4 hours after you take COMPLERA. – Certain medicines to block the acid in your stomach, including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine hydrochloride (Zantac). Take the acid blocker at least 12 hours before or at least 4 hours after you take COMPLERA. Some acid blocking medicines should never be taken with COMPLERA (see “Who should not take COMPLERA?” for a list of these medicines).

– Medicines that can affect how your kidneys work, including acyclovir (Zovirax), cidofovir (Vistide), ganciclovir (Cytovene IV, Vitrasert), valacyclovir (Valtrex), and valganciclovir (Valcyte).

– clarithromycin (Biaxin) – erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone) – fluconazole (Diflucan) – itraconazole (Sporanox) – ketoconazole (Nizoral) – methadone (Dolophine) – posaconazole (Noxafil) – telithromycin (Ketek) – voriconazole (Vfend) Know the medicines you take. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. Do not start any new medicines while you are taking COMPLERA without first talking with your healthcare provider.

How should I take COMPLERA? • Stay under the care of your healthcare provider during treatment with COMPLERA. • Take COMPLERA exactly as your healthcare provider tells you to take it.

• Always take COMPLERA with food. Taking COMPLERA with food is important to help get the right amount of medicine in your body. A protein drink is not a substitute for food. If your healthcare provider decides to stop COMPLERA and you are switched to new medicines to treat HIV-1 that includes rilpivirine tablets, the rilpivirine tablets should be taken only with a meal.

Keep COMPLERA and all medicines out of reach of children.

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

Issued: December 2013

COMPLERA, the COMPLERA Logo, EMTRIVA, GILEAD, the GILEAD Logo, GSI, HEPSERA, STRIBILD, TRUVADA, VIREAD, and VISTIDE are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other marks referenced herein are the property of their respective owners. ©2014 Gilead Sciences, Inc. All rights reserved. CPAC0098 02/14

3/24/14 12:31 PM

DA ILY DO SE

WHY I TAKE PrEP No one should be shamed out of taking a pill to prevent HIV transmission

I

have gay sex with gay men. Not as much as I would like, mind you, but I’m striving. I am also single and new to Los Angeles—six weeks on the job, three parking tickets, two earthquakes, and one fender bender. So I’m official. This week I get my first prescription for the pre-exposure prophylaxis (PrEP) drug Truvada, which has proved to be effective at preventing HIV infection. I am an HIV-negative gay Latino—part of a group at higher risk of infection—who is quite capable of making my own decisions about my health care. I do not want Truvada in place of condoms; I want Truvada in addition to my condom use.

Some critics say Truvada is a “party pill,” outrageously equating it with recreational drugs, and that those who use it will have more unsafe sex and higher rates of HIV. To be sure, some gay men will use Truvada without condoms. Some gay men will choose not to wear condoms nor take Truvada at all. Being on an effective PrEP regimen is a good thing, and Truvada is another tool in the toolbox to protect yourself from HIV. So I’m going to take it.

Like all drugs, it may have side effects, and as with any other prescription drug, you should consult your doctor. My doctor told me that a rare but possible side effect was that Truvada could harm my kidneys, so we would have to monitor that. I told him that given my love of wine, beer, and the not-so-occasional dirty blue cheese stuffed olive martini, I thought that would be wise.

While the analogy is by no means exact, the recent pushback against PrEP and Truvada reminds me of the sexist old arguments that birth control pills will lead to female promiscuity and forgetting to take a pill can lead to unwanted pregnancy. And, to be sure, forgetting to take Truvada could lead to possible HIV infection. Still, does that mean

48

HIV plus

• J U LY/A U G U S T 2 0 1 4

we do away with birth control and PrEP pills altogether? As we say in Spanish, “Um…no.”

I am taking Truvada because I have sex with men. I will not be shamed for saying or doing so. I am a young, healthy, professional gay man who goes to the gym every morning, not because I want to look good for my trainer (not entirely, anyway), but because I want to stay healthy. And Truvada will help me.

HIV and AIDS remain a serious problem for our community, especially for men who have sex with men and our transgender brothers and sisters. We know we can end the epidemic if we can get people tested and keep them in care. Access to Truvada is about providing options. We have a responsibility to provide access to as many tools as possible that have been shown to help protect against HIV. If I want to take Truvada and use condoms to protect myself against HIV, I will. If an HIV-negative person is dating an HIV-positive person (a serodiscordant couple), it makes sense that they have the choice to be on Truvada. If a person chooses not to wear condoms, it makes sense that they have the choice to be on Truvada. If you’re new to L.A. and you’re looking to meet the love of your life named Seth who looks remarkably like Josh Hartnett and you’re sexually active, it makes sense to be on Truvada.

It’s my body, it’s my life, it’s my choice, and no amount of sex shaming or dissemination of misinformation will change that. I will make my own educated decisions based on the research and evidence regarding PrEP and Truvada, and I strongly encourage you to do the same.

Seth, I hope you’re reading.

Antonio David Garcia is the director of policy and community building for the L.A. Gay and Lesbian Center.

THINKSTOCK.COM

By A NTONIO DAV ID GARCIA

With pride We embrace 32 years

GMHC provides the following to people living with and affected by HIV/AIDS: Care Services • Public Policy Advocacy Legal Services • Meals & Nutrition Program Volunteer Opportunities • Workforce Development HIV Testing & Prevention Services

For more information on joining us at the Pride march, parades and festivals, please visit gmhc.org or call the GMHC HIV/AIDS Hotline: 800-243-7692.

GMHC 446 West 33rd Street, NYC The David Geffen Center for HIV Prevention and Health Education 224 West 29th Street, NYC

17218_GMHC.indd 1

5/8/14 7:24 AM

WE KNOW

HIV/AIDS MEDICATION THERAPY But we also know you make a mean marinara.

Welcome to a pharmacy that gets to know you, not just your diagnosis. We’re not just treating HIV patients, we’re getting to know individuals. So no matter the level of support, guidance and confidentiality you prefer, we’re here for you.

To learn more, visit HIV.Walgreens.com.

©2014 Walgreen Co. All rights reserved.

17222_Wallgreens.indd 1

13SP0059-0114

5/8/14 7:19 AM