Plus 149 July August 2022 by Equal Pride

BECAUSE YOU’RE MORE THAN YOUR STATUS JULY/AUGUSThivplusmag.com2022 ROBERTSDANNY LOUGANISGREG IS SURVIVORULTIMATETHETHE TOP REASONS10 TOHIVSWITCHMEDSTODAY The Real World star is more than just a tall drink of water GUIDETREATMENTANNUAL1OTH

Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY.

The most common side e ects of BIKTARVY in clinical studies were diarrhea (6%), nausea (6%), and headache (5%). These are not all the possible side e ects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY.

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.

treatment. (bik-TAR-vee) BIKTARVY, the BIKTARVY Logo, GILEAD, the GILEAD Logo, GSI, and KEEP BEING YOU are trademarks of Gilead Sciences, Inc., or its related companies. Version date: February 2021 © 2022 Gilead Sciences, Inc. All rights reserved. US-BVYC-0008 01/22

BIKTARVY and other medicines may a ect each other. Ask your healthcare provider and pharmacist about medicines that interact with BIKTARVY, and ask if it is safe to take BIKTARVY with all your other medicines.

Take BIKTARVY 1 time each day with or without food.

BIKTARVY may cause serious side e ects, including: Those in the “Most Important Information About BIKTARVY” section.

BIKTARVY may cause serious side e ects, including:

HOW TO TAKE BIKTARVY

Have any other health problems.

healthcare

Tell your healthcare provider if you:

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

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults and children who weigh at least 55 pounds. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BEFORE TAKING BIKTARVY

Go to BIKTARVY.com or call 1-800-GILEAD-5

This is only a brief summary of does not replace your provider your your

about

This is only a brief summary of important information about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.

If you need help paying for your medicine, visit BIKTARVY.com for program information.

Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without ﬁrst talking to your healthcare provider, as they will need to check your health regularly for several months, and may give you HBV medicine.

IMPORTANT FACTS FOR BIKTARVY®

ABOUT BIKTARVY

Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

anyrifampindofetilideother

Have or have had any kidney or liver problems, including hepatitis infection.

GET MORE INFORMATION

POSSIBLE SIDE EFFECTS OF BIKTARVY

Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

important information about BIKTARVY and

Do NOT take BIKTARVY if you also take a medicine that contains:

condition and

medicines to treat HIV-1

Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

MOST IMPORTANT INFORMATION ABOUT BIKTARVY

Are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY.

Tell your healthcare provider about all the medicines you take:

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

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

Changes in your immune system. Your immune system may get stronger and begin to ﬁght infections that may have been hidden in your body. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY.

talking to

Please see Important Facts about BIKTARVY, including important warnings, on the previous page and visit BIKTARVY.com. BIKTARVY® is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in certain adults. BIKTARVY does not cure HIV-1 or AIDS. Ask your healthcare provider if BIKTARVY is right for you. Because HIV doesn’t change who you are. ONE SMALL PILL, ONCE A DAY #1 HIVPRESCRIBEDTREATMENT* *Source: IQVIA NPA Weekly, 04/19/2019 through 05/28/2021. Pill shown not actual size (15 mm x 8 mm) | Featured patients compensated by Gilead. Scan to see their stories. KEEPBEING YOU.

FEATURES

16 THE REAL HIV and LGBTQ+ advocate Danny Roberts opens up about the pressures of being in the spotlight, living with HIV, overcoming selfdoubt — and his decision to return to reality TV in The Real World

Why you may want to talk to your

before they knock you down.

innovative AIDS memorial in Philadelphia aims to honor all those we’ve lost to the epidemic.

16 2 JULY / AUGUST 2022

For those who are HIV-negative, these drugs prevent trasmission.

Drug classes ﬁght HIV with their own superpowers. Go team-ups!ects

Our annual rundown of most common HIV medications.

These HIV drugs still need more work before being approved.

This scientist’s new and improved HIV test will help those who need it Amost.new

ON THE COVER & ABOVE Danny Roberts of The Real World Homecoming: New Orleans (courtesy Paramount+)

34 UNDER CONSTRUCTION

9 BOSS BILLY

12 SPANISH SNAFU

Oliver Sim of The xx opens up about living with HIV in a new song.

The U.S. military is still failing those living with HIV.

Remembering two HIV advocates we’ve recently lost.

13 IGNORANCE IS NOT BLISS

11 FAREWELL TO FRIENDS

10 SOUTHERN COMFORT

Pose star Billy Porter steps into the director’s chair.

8 BOOT CAMP BLUES

How many people living with HIV don’t know it?

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Are gay hot spots in Spain the source of a recent monkeypox outbreak?

PARTING SHOT

Georgia’s Republican leaders update local HIV laws.

46 GOLDEN GREG Olympic gold-medalist Greg Louganis reﬂects on his amazing life and career.

CON TENTS

12 HIVPLUSMAG.COM 3

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PRIDE MEDIA EDITORIAL editorial director, digital MIKELLE STREET editor in chief, the advocate TRACY E. GILCHRIST digital director, advocate.com ALEX COOPER editor at large JOHN CASEY associate editors DONALD PADGETT, RACHEL SHATTO sta writer MEY RUDE editor in chief, out DANIEL REYNOLDS creative director, out BEN WARD digital director, out.com RAFFY ERMAC editor in chief, out traveler JACOB ANDERSON-MINSHALL digital director, pride TAYLOR HENDERSON director of podcasts & special projects JEFFREY MASTERS

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EDITORIAL

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chief executive ANDERSON-MINSHALL

AT 45 YEARS old, I am part of the generation that lived through the devastation of the AIDS epidemic during the 1980s and ’90s. My childhood best friend and I both lost uncles to HIV-related complications. And stigma and fear was so great at the time around HIV, neither of them wanted anyone to see them in the end. It was heartbreaking.

In this issue of Plus, we present our annual Treatment Guide, which brings you the latest info on all the HIV treatment and prevention methods that are now available (page 29). In it, you’ll ﬁnd a complete list of the most common FDA-approved drugs currently used to treat HIV. We also go over things like possible drug side e ects, what new treatments are in development, and reasons why you may want to switch up your regimen.

Peace & Blessings,

One of the best parts of this development has been the fact that antiretroviral meds, when taken as prescribed, typically bring one’s viral load down to undetectable. And when one’s viral load is undetectable, the virus has a zero chance of being transmitted to a partner through sex — even without the use of a condom. This is also known as U=U, or undetectable equals untransmittable,

DESIRÉE GUERRERO EDITOR IN CHIEF

And then there’s PrEP, or pre-exposure prophylaxis (page 42). This HIV prevention method has also been revolutionary for people living with HIV and their sexual partners. Currently, there are three forms of PrEP approved by the Food and Drug Administration: Truvada and Descovy, which are pill versions, and Apretude, the new injectable that only needs to be taken every two months. When taken as prescribed, PrEP is 99 percent e ective in preventing an HIV-negative partner from acquiring HIV through sex.

HIVPLUSMAG.COM 5 ÉDESIRCOURTESYEGUERRERO EDITOR ’ S BYLETTER DESIRÉE GUERRERO

But then, after over a decade of toxic AZT meds often hurting those living with HIV more than helping them, a miracle happened. In the mid-1990s, scientists developed antiretroviral drugs that were ﬁnally able to successfully combat HIV. Thanks to this incredible breakthrough, people with HIV are now living full and healthy lives, with life expectancies the same as people who are HIV-negative. So when I learned in the early 2000s that a close friend of mine was living with HIV, it was a very di erent experience. Though for an instant my heart skipped a beat while remembering the painful losses of my youth, this time there were no tears or tragic feelings. He simply said, “I take two pills a day and am going to be ﬁne.”

Also in this issue, we chat with two well-known gay men who have bravely shared their personal journeys of living with HIV with the world: our cover star Danny Roberts of The Real World Homecoming: New Orleans (page 16) and four-time Olympic gold-medalist diver Greg Louganis (page 46). Roberts was diagnosed well after the new e ective meds were developed while Louganis struggled on AZT treatment during the 1988 Olympics, but both men speak of the stigma and discrimination they dealt with.

and has allowed people living with HIV, and their partners, to enjoy joyful sex lives.

We also chat with Dr. Catherine Kibirige (page 24), a British scientist who developed a new, more sensitive HIV test to help diagnose and treat folks in Africa and further advance in HIV research. “Women in science, we have a unique voice, we have a unique perspective,” she says. “We have the skills for sure — we tend to be detail oriented, we work hard, so we are well suited forYes,science.”we’ve come a long way since those dark early days of the epidemic. Thanks to the dedication of folks like Dr. Kibirige and the many others in the research community, as well as the stigma-smashing visibility of men like Louganis and Roberts, life will only continue to get better for those living with HIV and their loved ones.

Oliver Sim of The xx performs onstage

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“Since writing ‘Hideous,’” Sim continued, “I’ve spent the last two years having conversations, which was difficult and uncomfortable to start with, but has allowed me to feel a lot freer and has only strengthened my relationship with myself and with the people in my life.”

OLIVER SIM, VOCALIST and bass player for acclaimed British electronica group The xx (no relation to the author), became the latest high-proﬁ le person to speak openly about living with HIV.

Beat’s Jimmy Somerville also sang on “Hideous,” with Sim recruiting the musician partly because of his long history of HIV advocacy.

15,539 likes

MUSICIANTRUTHHISSINGING

BY BERNARDO SIM

Despite still being an active member of The xx, Sim has also been releasing music in 2022 as a solo artist; a new album, Hideous Beast, is out in September. In “Hideous,” released in late May, the 33-year-old musician wrote lyrics such as, “Why don’t you leave me in the dirt? / That I’ve been sick and I’m perverse / Oh, I’m hideous.”

“I’ve been living with HIV since I was 17 and it’s played with how I’ve felt towards myself, and how I’ve assumed others have felt towards me, from that age and into my adult life,” he wrote. “So, quite impulsively, I wrote about it on a song called ‘Hideous.’”

HIVPLUSMAG.COM 7 BUZZ WORTHY SHUTTERSTOCK

OLIVER SIM OF THE XX OPENS UP ABOUT LIVING WITH HIV SINCE AGE 17.

The song’s outro goes, “Radical honesty / Might set me free / If it makes me hideous / Been living with HIV / Since seventeen / Am I hideous?”Bronski

commissioning and brings an end to the military’s ongoing discrimination against the approximately 2,000 service members currently serving while living with HIV.”

“We are grateful for the opportunity to...overturn the military’s outdated and unconstitutional policies concerning people living with HIV,” added John Harding, a co-counsel from Winston & Strawn. “Our pro bono efforts, in both the district court and the Fourth Circuit, have brought about a meaningful — and long overdue — change for service members living with HIV.”

The move directly contradicts a federal judge’s recent rulings against this type of discrimination.

It’s not clear if the cadet, who is being represented by Boston-based Lawyers for Civil Rights and is known only as “John Doe,” is still attending Norwich University. As of press time, the DOD and the Vermont National Guard have not released any statements to the media about the suit.

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“Until these lawsuits, the Department of Defense was the only entity in the U.S. that was still legally permitted to discriminate against people living with HIV, despite the existence of the Americans with Disabilities Act and the Rehabilitation Act,” said Kara Ingelhart, senior attorney at Lambda Legal and co-counsel for the plainti s, in a statement. “This ruling knocks down the barrier preventing people living with HIV from

DETOUR OF DUTY

DESPITE A FEDERAL judge’s recent landmark rulings in two separate cases involving the United States military’s policy of discharging service members living with HIV, another individual has been booted due to his status. The cadet was cut from both the Reserve O cers’ Training Corps and the Vermont Army National Guard after testing positive for HIV, even though he is on treatment with an undetectable viral load (which means the virus cannot be passed on to a sexual partner, even without the use of a condom).

The student received official paperwork saying he was “not medically qualiﬁed” to serve because of his HIV status. Even in 2022, when those living with HIV can keep their viral loads undetectable through a treatment regimen (a medical fact known as U=U, or undetectable equals untransmittable), the Defense Department still disqualiﬁes anyone with HIV from enlisting or being appointed as a commissioned o cer at a military academy or enrolling as an ROTC scholarship cadet.

The unnamed cadet from Massachusetts was attending Norwich University in Northfield, Vt., the oldest private military college in the nation. He tested positive for HIV in October 2020 during his sophomore year, according to NBC News. After o cials recently became aware of his status, the student was dropped from the Reserve O cers’ Training Corps and the Vermont Army National Guard. He also lost his ROTC scholarships and health and dental insurance and has now ﬁled suit against the Defense Department and the Vermont National Guard.

In April, Judge Leonie Brinkema of the U.S. District Court for the Eastern District of Virginia ruled

the Air Force must rescind its prior decision to discharge two unnamed plainti s — and the Army must do the same for Sergeant Nick Harrison who was also denied a commission, stating that their policies were at odds with known medical science and treatment methods.

BY NEAL BROVERMAN, WITH ADDITIONAL REPORTING BY DONALD PADGETT

DESPITE A RECENT COURT RULING AGAINST HIV DISCRIMINATION IN THE MILITARY, AN ASPIRING NATIONAL GUARD CADET IS DENIED HIS RIGHT TO SERVE.

Although they’re two separate cases, Harrison v. Austin and Roe & Voe v. Austin were combined for the purposes of discovery and argument.

“It’s ironic — the movie’s called Anything’s Possible but I didn’t believe it,” Reign said to Them. “My whole life, I’d wanted to be an actress but even after I got that call, I was telling myself, I’m a Black trans girl — I’m not going to be the lead in a movie.”

Making diverse films and shows isn’t just about having a good script, Porter says, it’s also about hiring the right“Whenpeople.you’re telling stories from a marginalized group of people, when you’re telling stories of a people who have been voiceless for so long, you’ve got to be the right person telling it,” Porter told Billboard on the Grammy redWrittencarpet.by

Anything’s Possible debuts on Prime Video July 22.

EVERYTHING’S POSSIBLE

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The coming-of-age romantic comedy, which has already been compared to Love, Simon and Booksmart, follows Khal, a straight cis boy and Kelsa, a trans girl, as they navigate their budding relationship in high school.

ntroducing director Billy Porter. The rumors are true — the Emmy-winning actor is making his feature directorial debut with the upcoming film

“I’m thrilled to be part of this new space in Hollywood for telling all types of stories from all types of people,” Porter recently told Variety.

BILLY PORTER, ONE OF THE MOST PROMINENT CELEBRITIES LIVING OPENLY WITH HIV, MOVES INTO THE DIRECTOR’S CHAIR THIS FALL.

BY CARA GLASS

Anything’s Possible

Billy Porter attends the 64th Annual Grammy Awards at MGM Grand Garden Arena in Las Vegas

Alvaro Garcia Lecuona and starring trans writer and actress Eva Reign, Anything’s Possible is telling viewers, and even the ﬁlm’s star, just that.

But to Porter, the need for accurate representation is not only important, it’s blatant. “If you’re going to tell a story about a transgender person, you might need a transgender person to help you tell that story,” Porter a rmed.

Following four years of storytelling on FX’s hit show Pose , as well as coming out about his HIV status last year, Porter is now taking a seat in the director’s chair, using a new medium to give a voice to the “voiceless.”

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However, Capital Beat reported that under the revised law, people living with HIV can still be charged with a

felony and serve up to five years in prison if they show intent to transmit HIV and if there is “significant risk of transmission based on current scientifically supported levels of risk

Georgia follows the lead of many other states that have updated their HIV-related laws to better align with modern science, particularly the U=U movement. U=U, or “undetectable equals untransmittable,” is the globally-accepted scientiﬁc consensus that a person living with HIV who is on treatment and achieves an undetectable viral load has zero chance of transmitting the disease to a sexual partner — even when they engage in condomless sex.

REPUBLICAN GEORGIA GOVERNOR Brian Kemp recently signed a bill into law that updates the state’s policy on HIV disclosure. Now it is no longer a felony — previously punishable by up to 10 years in prison — to not tell someone your HIV status before sexual activity.

“Astransmission.”apersonliving with HIV, I’m encouraged that the legislature understands the advances in HIV science,” said Malcolm Reid, cochair of the Georgia HIV Justice Coalition and federal policy chair for the People Living with HIV Caucus, in a press statement. “Ending the stigma around HIV is a necessity to ending the HIV epidemic and I look forward to continuing e orts that supportKamariaPLWH.”La rey, project director at the Sero Project, an advocacy group that ﬁghts HIV criminalization, added, “This e ort is the product of the power of the people.” People living with HIV “will have a lessened layer of stigma. The mobilization and centering of the voices that are most impacted by these laws in partnership with the strategic relationship building with legislative champions is the key piece to how people living in Georgia have made this amazing achievement possible.”

The bill, SB 164, was ﬁrst introduced by Republican state senator Chuck Hufstetler and supported in the House by Republican Rep. Sharon Cooper. According to Georgia Equality, the legislation had received “almost unanimous support” in both chambers.

Georgia Gov. Brian Kemp speaks at a news conference

Her time as AIDS czar — where she was chosen by President Clinton — was controversial, however, lasting little more than a year. She was not the ﬁrst choice for the position, and some activists claimed she did not possess the qualities necessary to battle bureaucrats and the prevailing homophobic sentiments relating to AIDS at the “Wetime.needed Jurassic Park and we got Sleepless in Seattle,” ACT UP founder Larry Kramer once famously commented on Gebbie’s role as Gebbieczar. resigned as AIDS czar in July 1994 after 13 months on the job. Clinton praised her work at the time, saying she helped increase funding “for prevention and research, sped the research and approval process for new drugs, and required every federal employee to receive comprehensive workplace education.”

Dr. Anthony Scarsella, chief of research at the Paciﬁc Oaks Medical Group where he helped pioneer health care for gay men and people living with HIV, has died. A native of Newton, Mass., Scarsella, 77, passed away in early May from injuries su ered in an accident; he died at West Hollywood’s Cedar Sinai Medical Center. Scarsella was the last surviving original member of the 40-year-old POMG, which was instrumental in focusing on the general health care needs of gay men and HIVrelated“Timecare.and fate changed and shaped my career as an M.D. and gave my journey new meaning as a pioneer and ﬁrst-generation doc in AIDS caregiving,” he was quoted as saying in a statement from POMG announcing his passing. “Eventually, I was able to poke my head out from the AIDS mountain and I could take care of people who were gay and not HIV-positive. It was clear that the gay community, my community, had some ordinary medical problems and some unique ones having nothing to do with

—DONALD PADGETT

Before serving as the country’s ﬁrst AIDS czar in 1993, Gebbie served as Oregon’s state health administrator (1978 to 1989) and the Washington state secretary of health (1989 to 1993). Although an opponent of then-President Ronald Reagan’s policies on AIDS testing, she agreed to serve on his Commission on the HIV Epidemic in the late 1980s after she was personally lobbied by commission chairperson, Adm. James D. Watkins.

[HIV]. That condition was always in the background, but for many of my patients there was and is a lot related to being Originallygay.”a primary care physician who also cared for folks living with infectious diseases, Scarsella joined POMG and helped grow the group as a leader in providing health care for gay men and those living with HIV. In the early years of the HIV crisis, POMG opened AIDS units at Sherman Oaks Hospital and Midway Hospital in California. A decade later, as new drugs greatly increased both the length and quality of life for folks living with HIV, POMG closed its AIDS units and instead innovated long-term care for folks living with HIV. Today, the group continues to conduct clinical trials and research new HIV treatment modalities.

—DP

KRISTINE GEBBIE, THE UNITED STATES’ FIRST AIDS CZAR, HAS PASSED.

“She was a great asset to me, especially since we were outnumbered,” Watkins said in 1993 in reference to conservative members on the commission. “She was very tough when there was nonsense coming out of some of the other commissioners.”

HEALTHADOCTORGOODGOODBYE,PIONEERINGAYMEN’SHASPASSEDON.

Scarsella is survived by his partner of 44 years, Terry Williams. The couple was renowned for their support of nonproﬁt organizations including Being Alive and Project Angel Food.

Kristine Gebbie, a registered nurse and epidemiologist who later served as the country’s ﬁrst AIDS czar, died May 17 in Adelaide, Australia. Her daughter, Eileen Gebbie, reported to The New York Times that the cause of death was cancer. She was 78.

HISTORY MAKER

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Gebbie had three children with her ﬁrst husband, Neil Gebbie, before they divorced. Her second husband, musician Lester Nils Wright, passed away earlier this year.

Gebbie was born Kristine Elizabeth Moore on June 26, 1943, in Sioux City, Iowa. She later attended Minnesota’s St. Olaf College where she earned her Bachelor of Science degree in nursing in 1965, the University of California, Los Angeles, where she obtained her master’s in community health in 1968, and, later, the University of Michigan where she earned her doctorate in public health in 1995.

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here have been several hundred new cases of monkeypox reported in over a dozen countries during the last few months — and some experts are pointing to gay gatherings in Spain as the possible origin of the current outbreak.

The largest clusters of the virus so far have occurred in Europe, particularly Spain. This had led some health experts to hypothesize that the outbreak originated in the country at two speciﬁc hot spots where gay and bisexual men had recently gathered: a Pride event in the Canary Islands in early May that drew about 80,000 people, and a gay sauna in Madrid.

There is a newer vaccine, Jynneos, which was approved in 2019 for the prevention of smallpox and monkeypox. It is safer for immuno-compromised folks, but only 1,000 doses are currently held in the U.S. stockpile, said Dr. Jennifer McQuiston, a deputy director at the CDC.

Monkeypox is not usually considered a sexually transmitted disease, but close physical contact with

The United States emergency stockpile consists of two FDA-approved vaccines that could be used to combat a monkeypox outbreak, according to a press statement from the Centers for Disease Control and Prevention. The stockpile holds more than 100 million doses of the original smallpox vaccine, however it is associated with certain side e ects and isn’t recommended for those who are immuno-compromised, such as people living with HIV.

“We expect that level to ramp up very quickly in the coming weeks, as the company provides more doses to us,” noted Dr. McQuiston.

Others are concerned about whether the world’s stockpiles of monkeypox vaccines are plentiful enough, in the event of a wider-spread outbreak.

GAYMONKEYPOXTROUBLEMONKEYOUTBREAKTRACEDTOHOTSPOTSINSPAIN.

To learn more about monkeypox, including its symptoms, treatment, and prevention visit CDC.gov/poxvirus/monkeypox.

Experts warn, however, that monkeypox is not just a concern for men who have sex with men. Dr. Boghuma Titanji, an infectious disease physician at Emory University in Atlanta, recently told The New York Times that we “must keep a broad deﬁnition, so as not to leave out other groups which may emerge as being important.”

someone who has the virus (or their clothes) is known to spread it, and the CDC says contact with bodily ﬂuids can also transmit the disease. It’s still too early to tell what impact this outbreak will have on the U.S. but those with ﬂu-like symptoms and a rash are encouraged to seek medical attention.—DG

the estimated percentage of people living with HIV in the U.S. who don’t know their status.

the approximate amount of people in the U.S. living with HIV.

13%

Source: the latest statistics on HIV testing rates in the United States from HIV.gov/hiv-basics

HIVPLUSMAG.COM 13 BUZZ WORTHY 1.2 million

Important information for people who receive

APRETUDE is a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg). It’s an injection given every other month, instead of a pill you take every day † Studied in HIV-1 negative cisgender men, transgender women, and cisgender women at risk of getting HIV-1 APRETUDE is the first and only long-acting, injectable PrEP for reducing the risk of getting HIV-1 LONG-ACTING* PrEP Eligible patients may pay as little as a $0 co-pay per injection on prescribed APRETUDE.accompanying Important APRETUDE, including anImportantWarning. Savings Program Eligible patients may pay as little as a$0 co-pay perinjection on prescribed APRETUDE. Learn more at APRETUDE.com Reasons to ask your doc tor about PRE TUDE

to help reduce their risk of getting human immunodeﬁciency virus-1 (HIV-1) infection, also called pre-exposure prophylaxis or “PrEP”:

This is only a brief summary of important information about APRETUDE and does not replace talking to your healthcare provider about your MOSTAP-reh-toodmedicine.IMPORTANT

* APRETUDE is given every other month by a healthcare provider after initiation injections have been given 1 month apart for 2 consecutive months. † Your healthcare provider may prescribe about a month of once-daily starter pills.

INFORMATION ABOUT APRETUDE APRETUDE

MOST IMPORTANT INFORMATION ABOUT APRETUDE (cont'd)

• Some HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have ﬂu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a ﬂu-like illness within the last month before starting APRETUDE or at any time while receiving APRETUDE. Symptoms of new HIV-1 infection include: tiredness; joint or muscle aches; sore throat; rash; enlarged lymph nodes in the neck or groin; fever; headache; vomiting or diarrhea; night sweats. see additional Important Facts About APRETUDE at right.

Please

• Do not receive APRETUDE for HIV-1 PrEP unless you are conﬁrmed to be HIV-1 negative.

IMPORTANT FACTS ABOUT APRETUDE

• You must be HIV-1 negative to start APRETUDE. You must get tested to make sure that you do not already have HIV-1 infection.

Before receiving APRETUDE to reduce your risk of getting HIV-1:

IMPORTANT FACTS ABOUT APRETUDE (cont'd)

It is not known if APRETUDE is safe and eﬀective in children younger than 12 years of age or weighing less than 77 pounds (less than 35 kg).

Do not start a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to receive APRETUDE with other medicines.

DO NOT RECEIVE APRETUDE IF YOU:

° Know your HIV-1 status and the HIV-1 status of your partners.

While you are receiving APRETUDE for HIV-1 PrEP:

° If you think you were exposed to HIV-1, tell your healthcare provider right away. They may want to do more tests to be sure you are still HIV-1 negative.

• have or have had liver problems.

• are allergic to cabotegravir.

Tell your healthcare provider about all your medical conditions, including if you:

• already have HIV-1 infection. If you are HIV-1 positive, you will need to take other medicines to treat HIV-1. APRETUDE is not approved for treatment of HIV-1.

° Get tested for HIV-1 with each APRETUDE injection or when your healthcare provider tells you. You should not miss any HIV-1 tests. If you become HIV-1 infected and continue receiving APRETUDE because you do not know you are HIV-1 infected, the HIV-1 infection may become harder to treat.

• APRETUDE does not prevent other sexually transmitted infections.

• You must stay HIV-1 negative to keep receiving APRETUDE for HIV-1 PrEP.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines may interact with APRETUDE. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine. You can ask your healthcare provider or pharmacist for a list of medicines that interact with APRETUDE.

Call your healthcare provider right away if you develop any of the following signs or symptoms of liver problems: your skin or the white part of your eyes turns yellow (jaundice); dark or "tea-colored" urine; light-colored stools (bowel movements); nausea or vomiting; loss of appetite; pain, aching, or tenderness on the right side of your stomach area; itching.

° Get tested for other sexually transmitted infections such as syphilis, chlamydia, and gonorrhea. These infections make it easier for HIV-1 to infect you.

APRETUDE may cause serious side eﬀects, including:

° Ask your partners with HIV-1 if they are taking anti-HIV-1 medicines and have an undetectable viral load. An undetectable viral load is when the amount of virus in the blood is too low to be measured in a lab test. To maintain an undetectable viral load, your partners must keep taking HIV-1 medicine as prescribed. Your risk of getting HIV-1 is lower if your partners with HIV-1 are taking eﬀective treatment.

• Depression or mood changes. Call your healthcare provider or get medical help 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.

APRETUDE is a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg). HIV-1 is the virus that causes Acquired Immune Deﬁciency Syndrome (AIDS).

GET MORE INFORMATION

December 2021 APR:1PIL

CBTADVT220007 May 2022 Produced in USA.

• are taking any of the following medicines: carbamazepine; oxcarbazepine; phenobarbital; phenytoin; rifampin; rifapentine.

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

• Go to APRETUDE.com or call 1-877-844-8872 where you can also get FDA-approved labeling.

ABOUT APRETUDE

• Allergic reactions. Call your healthcare provider right away if you develop a rash with APRETUDE. Stop receiving APRETUDE and get medical help right away if you develop a rash with any of the following signs or symptoms: fever; generally ill feeling; tiredness; muscle or joint aches; trouble breathing; blisters or sores in mouth; blisters; redness or swelling of the eyes; swelling of the mouth, face, lips, or tongue.

° If you do become HIV-1 positive, you will need to take other medicines to treat HIV-1. APRETUDE is not approved for treatment of HIV-1.

• are breastfeeding or plan to breastfeed. It is not known if APRETUDE can pass to your baby in your breast milk. Talk with your healthcare provider about the best way to feed your baby while receiving APRETUDE.

Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting sexually transmitted infections.

MOST IMPORTANT INFORMATION ABOUT APRETUDE (cont'd)

BEFORE RECEIVING APRETUDE (cont'd)

POSSIBLE SIDE EFFECTS OF APRETUDE

• have ever had mental health problems.

If you have HIV-1 and receive only APRETUDE, over time your HIV-1 may become harder to treat.

• are pregnant or plan to become pregnant. It is not known if APRETUDE will harm your unborn baby. APRETUDE can remain in your body for up to 12 months or longer after the last injection. Tell your healthcare provider if you become pregnant while receiving APRETUDE.

• do not know your HIV-1 infection status. You may already be HIV-1 positive. You need to take other medicines to treat HIV-1. APRETUDE can only help reduce your risk of getting HIV-1 infection before you are infected.

° Get information and support to help reduce sexual risk behaviors.

The most common side eﬀects of APRETUDE include: pain, tenderness, hardened mass or lump, swelling, bruising, redness, itching, warmth, loss of sensation at the injection site, abscess, and discoloration; diarrhea; headache; fever; tiredness; sleep problems; nausea; dizziness; passing gas; stomach pain; vomiting; muscle pain; rash; loss of appetite; drowsiness; back pain; upper respiratory infection

• Liver problems. Liver problems have happened in people with or without a history of liver problems or other risk factors. Your healthcare provider may do blood tests to check your liver function.

• Talk to your healthcare provider or pharmacist.

These are not all the possible side eﬀects of APRETUDE.

° Do not miss any injections of APRETUDE. Missing injections increases your risk of getting HIV-1 infection.

• have ever had a skin rash or an allergic reaction to medicines that contain cabotegravir.

Trademark is owned by or licensed to the ViiV Healthcare group of companies.

BEFORE RECEIVING APRETUDE

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BY NEAL BROVERMAN

Two decades after he set tongues wagging, The Real World star DANNY ROBERTS is back on TV — and he’s wiser, warmer, and more handsome than ever.

HIVPLUSMAG.COM 17

anny roberts has packed a lot in his 44 years. He’s been a TV star (twice), publicly come out as gay, took on the mantle of LGBTQ+ rights advocate at the tender age of 20, got involved in a high-proﬁle relationship, moved around the country, circled in and out of the corporate world, and became a father. With all that life experience, Roberts says it was something else that really super-charged the personal growth and wisdom he displays on the Paramount+ reunion series The Real World Homecoming: New Orleans.

“The biggest lynchpin of my personal development journey was being diagnosed as HIV-positive several years ago,” Roberts says from his home in Vermont.

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A warm Southern sensibility, paired with movie star looks and a taboo-shattering sexual conﬁdence, endeared him to Gen X and millennial audiences when he starred on The Real World: New Orleans in 2000. Though the reality franchise was nearly a decade old at the time, Roberts — along with memorable castmates like wise and hilarious Melissa Beck and combustible Mormon student Julie Stoffer — helped make New Orleans one of The Real World’s most beloved seasons. Roberts was out on the show, revolutionary enough, but he also had a sex life that he didn’t hide onscreen — even though he and his boyfriend took a major risk by appearing in front of the Roberts’scameras.partner at the time, Paul Dill, was a highranking service member during the time of “don’t ask, don’t tell,” when LGBTQ+ people had to hide their sexual orientation and gender identity — or be dishonorably discharged from the military, lose their beneﬁts, and have a stain on their careers. The Real World producers blurred out Dill’s face, but Roberts lived with the fear of Dill’s identity becoming public during the show and after. Roberts’s role on The Real World turned him into an immediate symbol of DADT and its costs, while the role of gay rights advocate was thrust on his young shoulders.

CLOCKWISE FROM TOP The Real World Homecoming: New Orleans cast on a bayou boat ride; Roberts; Roberts, Melissa Beck (middle), and Julie Stoffer together again on Homecoming

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“It was not an easy transaction in discovering that and the journey

ABOVE Roberts (seated, left) with The Real World castmembers from various seasons

“Facing your mortality is a huge changing factor in anyone’s life and you can go two paths with it — you can let it destroy you or you can use it as a gift to inspire you,” he says.

“I feel like we’re really stretching the definition of sex symbol,” Roberts says of the queer fixation on him that remains to this day. “I’m like a big old nerd. There was a real confidence [sexually and otherwise] there, at least from the perspective of a really naive 20, 21-year-old. Most of us at that time think we have the world strapped down; the confidence that comes from not actually having lived a lot of life yet and had the truth actually shown to you. But the deeper truth is, no, I was not really confident about my sexuality.”

ending the relationship, Roberts would be challenged again, this time with his HIV diagnosis, which came as a complete shock.

“I had to go back and face those deep subconscious truths in myself and unload it as not my own baggage,” he says. “Unloading it was the most amazing pivot for me. It ﬂipped the script in my mind. Those weren’t my burdens to carry anymore. I had a whole new conﬁdence in myself and being able to absolutely own and love myself for every bit of who I am, with all the faults and broken pieces.”

20 JULY / AUGUST 2022 PAGES)(BOTHVESPA/WIREIMAGEJ

The show served as a catalyst for Roberts, who grew up in Georgia, to come out to his family. There wasn’t much time to think about whether he made the right decision or not: “It happened really quickly and I was actually terriﬁed.” Roberts’s relationship with Dill continued for several years after the show, but grew toxic. Roberts stayed in it for too long because, as a gay rights activist, he felt he owed it to the LGBTQ+ community. After ﬁnally

ACROSS Roberts during his ﬁrst stint of TV fame

Roberts had decades of baggage to unload about HIV, especially as a gay man coming of age in the ’90s when the disease was still thought of as a death sentence and many believed it was punishment for sin.

Doing the inner work — which occurred at the same time he was adopting his daughter — was neither quick nor simple, though.

“I didn’t have the tools or the real conﬁdence [to handle it],” says Roberts, who appeared on the cover of The Advocate during that time. “I took on a subject much, much bigger than me and that was a very wild ride.”

Now, more than two decades later, Roberts has reunited with his six castmates — and Dill! — to revisit their time in New Orleans and see what has and hasn’t changed in their lives and in larger society. What remains constant is Roberts’s role as activist. Proudly, he speaks about his HIV diagnosis on the show, as well as the trauma that so many people living with HIV, especially gay and bisexual men, live with. What’s different this time around is Roberts’s genuine conﬁdence; he says the boldness he displayed in 2000, both in his activism and his sexuality, was the result of youth.

HIVPLUSMAG.COM 21

22 JULY / AUGUST 2022

Those frank discussions were front and center on Homecoming Of course, there were personal squabbles over long-simmering (and understandable) resentments, but the castmates also touch on white privilege, Christianity, and homophobia. Roberts is happy with how the show came out, saying he was hesitant to sign on at ﬁrst.

RIGHT The Real World: New Orleans cast at the 27th annual People’s Choice Awards

I went on,” Roberts says. “But on the other side of it, it made me the person I am now, which is very conﬁdent in talking about difﬁcult conversations.”

ABOVE The Real World Homecoming: New Orleans cast, (standing, from left) Matt Smith, Beck, Jamie Murray, Stoffer and (seated, from left) Kelly Wolf, Roberts, and David “Tokyo” Broom

bringing together people of different backgrounds and forcing them to confront society’s biases and their own.

“

On the series, Roberts initiates a discussion about complex post-traumatic stress disorder, or CPTSD. Roberts talks about suffering from the condition, which is caused by repeated trauma, as opposed to PTSD, which is usually sparked by a single event. Roberts believes most HIV-positive people and many LGBTQ+ people suffer from CPTSD, which can affect how we respond to almost everything in life.

The Real World was the ﬁrst mainstream reality TV that set the groundwork for the genre,” Roberts says. “Our [original New Orleans] season was kind of the end of that documentary reality television; that same year, Survivor came out. The next generation of reality TV became about salacious personalities, competition, taking people down, and crazy drama. [ Homecoming] is a nostalgic type of reality TV that does address social issues, emotional issues, interpersonal issues.”

“The world has enough reality garbage and all [the cast] agreed we didn’t want to throw more garbage into the world,” Roberts says. The show harkens back to the original intent of The Real World,

“I’m sitting here right now talking to you; thank God for medicine,” he says. “I just frame [HIV] now in a logical way. It’s a virus; it’s nature at work. There is no morality about it, and I think that’s the hardest thing for people to let go of. Thank God, with this type of medicine, we can live entirely different lives than what we expected and were taught back then.”

“[The fear and shame] stunted our growth as gay men and held me back in my coming out process,” Roberts says. “What we were really taught at the time, ingrained and fed to us, is becoming HIV-positive was a moral punishment for engaging in behavior that’s wrong. That was the largest bag I had to unload. At the end of the day, [HIV is] nature. It’s biology. Mother Nature wants to kill us all and she’s always trying.”

Roberts continues, “Most of us grew up not feeling safe in many ways, and we’re talking about essential safety. When you don’t have essential safety, you end up with loads of coping mechanisms you’re not even aware of and we can all use a dose of shining some light onWhilethat.” those not at high risk of HIV, such as white heterosexual and cisgender people, were able to explore their sexualities as young people, queer people had both sex shame and HIV fears hanging over their heads. Roberts says those hang-ups affected his own sexuality as a young man.

HIVPLUSMAG.COM 23 IMAGESGETTYVIACOLLECTIONGALELLALTD./RONGALELLA,RON

But science and ingenuity now make HIV a manageable condition for millions, something that Roberts marvels at.

The Real World Homecoming: New Orleans is now streaming on Paramount+.

“Everyone in this community, especially with gay men, there is a pervasive sense of expectation of perfection,” he says. “Most of us are not aware of that trauma reaction of always striving for perfection and what it means to have a stain against you; it’s a lot to move beyond. Becoming aware of that and recognizing and steering your reactions and behaviors away from that trauma reaction is incredibly important for so many people.”

Scientist CATHERINE KIBIRIGE developed a newand-improved HIV test that will be more accessible to those who need it most.

HIVPLUSMAG.COM 25 KIBIRIGECATHERINECOURTESY

BY DESIRÉE GUERRERO

“It was very, very devastating…. We ended up losing a lot of people, even within the Uganda community in Kenya, so it really did affect me… [we] lost close cousins, relatives,” she recalls. “And science being my strongest subject…it just piqued myKibirigeinterest.”says life in Kenya sharply contrasted the chaos and devastation her family had ﬂed from in “ItUganda.wasa safe haven,” she says. “A lot of Ugandans ﬂed to Nairobi, to Kenya, so there was a big Ugandan community — a lot of relatives, friends, extended family…. And it was a very idyllic upbringing, lots of really pleasant memories.”

“It was a rarity meeting other African people in the town,” she recalls. “And people were just getting used to us being there as a Black family. Even in the school…it was just me and another Jamaican girl in my class. It was a lot of adapting and then a lot of explaining.”

After completing college, Kibirige traveled to her family’s homeland of Uganda as a volunteer with the

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Dr. Ca ine Kibirige

She explains that civil wars had only exacerbated the problem of HIV in the country, and could have possibly been the origin of the virus in the “Thearea.ﬁrst cases of HIV were actually recorded or reported in Uganda, in a town called Rakhi — tents near the border with Tanzania,” she says. “And it really devastated our country because we’d just come through a series of civil wars. And actually, I think they trace the way the virus spread to some troops that had come in to help depose one of the dictators, so the route it followed into the country was associated withShethat.”adds that, even though she had not been raised in Uganda, she felt the ripple effect of HIV through her Ugandan loved ones.

From there, Kibirige pursued her career in science, working and going to school just outside of London. “I worked in West Bromwich, which was an old coal mining town. I lived in a chemical factory for a chemical company for a year before going to university…. I did my undergrad [there], and I did biochemistry.”

“I was born and raised in Kenya,” says Dr. Kibirige. “My parents are both of Ugandan heritage but ﬂed to Kenya during the civil war. So, I was born and raised in Nairobi [Kenya’s capital].”

knew she wanted to work in the area of HIV research at an early age. In addition to being very interested in science as a child, she also witnessed ﬁrsthand HIV’s devastation on her family’s homeland of Uganda.

The family would relocate to the U.K. after her father began working as an engineer in London. Kibirige says suddenly being in a different culture took some getting used to, but she was eventually able to really dive into her education there.

While working on her first postdoctoral fellowship with the U.S. military’s HIV research program, which at the time was administering a vaccine trial in Thailand, Kibirige noticed a problem. The trial was using an assay, a lab test used to find and measure the amount of a specific substance, but it did not detect all of the circulating HIV subtypes.

“I would say to minorities [in science and tech], to just keep going,” she says. “There is a lot of discouragement for women, a lot of discouragement for people from my background — but I’m glad that I stuck it through because it’s good to get to the point where you can see the impact. And us women in science, we have a unique voice, we have a unique perspective. We have the skills for sure — we tend to be detail oriented, we work hard, so we are well suited for science. Every scientist struggles to ﬁnd their niche. And I think we tend to work on things that we’re passionate about, so we have an important voice.”

“I was working in a technology assessment laboratory,” she says,

“and my supervisor had been involved in developing viral load tests and other kinds of tests for HIV…and was involved in helping the different companies test out new versions of the assays and making sure that they covered all the different strains. The military, having troops deployed all around the world, had a very diverse repository [of HIV strains], so they were able to provide all sorts of different strains for companies to kind of test and upgrade their assays.”

This began her work on redeveloping the assay so it would be more sensitive and able to detect more of the various HIV subtypes and variants — which she has now successfully done. But Kibirige adds that another issue is cost. Now that the more sensitive test has been developed, she says that finding ways to produce and distribute it cheaply in places like Uganda is vital.

“I’m actually focusing on the cheapest, easiest version, which is the version that detects cellular DNA…so you don’t actually have to do any DNA extraction,” she says of the new assay. “It’s very low tech.”

Dr. Kibirige explains that this will enable the assays to be produced and distributed on location in places like Uganda, rather than needing to import expensive high-tech versions. This not only means that more people will have access to testing where it’s needed most, it will also greatly improve research capabilities in the area. Ultimately, this will lead to improving life for all people living with HIV worldwide.

Kibirige, who is also a mental health advocate, says the fact that she is an immigrant and a woman of color making great strides in the world of science and technology is not lost on her. Visibility is important she says, and she’s now enjoying being a mentor and inspiration to young budding scientists.

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KIBIRIGECATHERINECOURTESY

Rakai Health Sciences Program — a collaboration between researchers at Makerere, Columbia, Johns Hopkins Universities, and the Division of Intramural Research at the National Institute of Allergy and Infectious Diseases. Just a few months later, she was offered a research job there. Two years after that, she was sponsored to come to the U.S. to obtain her doctorate from the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health.

Our breakdown of the most commonly-prescribed, FDA-approved medications for the treatment (and prevention) of HIV and its related conditions.

COTTONBRO/PEXELS GUIDETREATMENTHIVANNUAL10OURTH

BY PLUS EDITORS

generic name: rilpivirine class of drug: nonnucleoside reverse transcriptase inhibitor maker: Janssen who is it for? For treatment of HIV-1 in adults and children 12 and older weighing at least 35 kg who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per mL or less.

generic name: dolutegravir and lamivudine class of drug single-tablet regimen maker: ViiV Healthcare who is it for? For adults new to HIV medication. Not recommended for those with severe liver impairment. traditional dosage: One tablet per day. Each tablet contains 50 mg dolutegravir (Tivicay, an II) and 300 mg lamivudine (Epivir, an NRTI).

traditional dosage: One tablet once daily. Tablet contains 600 mg efavirenz (Sustiva, an NNRTI), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

traditional dosage: One tablet once daily. Adult tablet includes 50 mg of bictegravir (an INSTI), 200 mg of emtricitabine (Emtriva, an NRTI), and 25 mg of tenofovir alafenamide (an NRTI). This year, the FDA approved a new low-dose tablet (30 mg bictegravir/120 mg emtricitabine/15 mg tenofovir alafenamide) for pediatric patients weighing at least 14 kg to less than 25 kg who are virologically suppressed or new to antiretroviral therapy. Does not need to be taken with other HIV drugs.

generic name: bictegravir, emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed (less than 50 copies per mL) on a stable antiretroviral regimen for at least three months with no history of treatment failure and no known resistance to the components of Biktarvy. Not recommended for those with creatinine clearance below 30 mL per minute, hepatitis B, or severe liver impairment.

Descovy

generic name: efavirenz, emtricitabine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 years and older weighing at least 40 kg as an initial regimen. Should not be used for those with moderate or severe kidney or liver impairment, those with neuropsychiatric issues, or women who are pregnant or may become pregnant.

Biktarvy

Delstrigo

generic name: cabotegravir and rilpivirine class of drug: single-injection regimen maker: ViiV Healthcare who is it for? Those 12 and older

Complera

weighing at least 35 kg who have no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine.

generic name: emtricitabine, rilpivirine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? Those 12 and older who are new to antiretroviral drugs who have viral loads of 100,000 copies per mL or less; or as a replacement regimen for individuals with a viral load of 50 copies per mL or less and no resistance to any components. Use caution if also positive for hepatitis B. traditional dosage: One tablet once daily. Tablet includes 25 mg rilpivirine (Edurant, an NNRTI), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Dovato

generic name: doravirine, lamivudine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Merck who is it for? For adults new to HIV medication. Not recommended for those with creatinine clearance below 50 mL per minute and should not be used by those with moderate to severe kidney

generic name: lamivudine and tenofovir disoproxil fumarate class of drug: combination of two nucleoside reverse transcriptase inhibitors maker: Mylan who is it for? For adults and children weighing at least 35 kg. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis. traditional dosage: One tablet once daily in combination with other antiretrovirals. Tablet contains 300 mg lamivudine (Epivir/3TC) and 300 mg tenofovir disoproxil fumarate (Viread).

generic name: emtricitabine and tenofovir alafenamide class of drug: two nucleoside reverse transcriptase inhibitors maker: Gilead Sciences who is it for? For adults and children who weigh at least 35 kg, as well as for children who weigh 25 to 34 kg when used with certain other antiretrovirals. Should not be used for those with creatinine clearance below 30 mL per minute or those on dialysis. for hiv treatment: One tablet per day in combination with other antiretrovirals. Each tablet contains 200 mg emtricitabine (Emtriva) and 25 mg tenofovir alafenamide (TAF). A lower-dose option (120 mg Emtriva, 15 mg TAF) is also now available. for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices. Descovy for PrEP is not currently FDA-approved for individuals assigned female at birth.

traditional dosage: One 25 mg tablet once daily with meal. It is always taken with

Atripla

Cimduo

30 JULY / AUGUST 2022

Unless

traditional dosage: Monthly injection of 400 mg of cabotegravir and 600 mg of rilpivirine, after an initial injection of 600 mg of cabotegravir and 900 mg of rilpivirine. As of this year, an oral lead-in period of one month prior to your ﬁrst injection is no longer required.

impairment or severe liver impairment. traditional dosage: One tablet once daily. Tablet contains 100 mg doravirine (Pifeltro, an NNRTI), 300 mg lamivudine (Epivir, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

otherwise noted, all dosages are the traditional adult dose.

Edurant

Cabenuva

Epivir

generic name: atazanavir and cobicistat class of drug: a protease inhibitor and

Odefsey

traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg tenofovir alafenamide (an NRTI).

generic name: emtricitabine class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function. Use caution if also positive for hepatitis B. traditional dosage: One 200 mg capsule once daily. There is also a 10-mg/ mL oral solution available (daily dosage is adjusted depending on patient’s current creatinine levels).

generic name: etravirine class of drug: nonnucleoside reverse transcriptase inhibitor maker: Janssen who is it for? For treatmentexperienced HIV-1 patients with viral strains resistant to an NNRTI and other antiretroviral agents. For adults, children 6 years or older weighing at least 16 kg. traditional dosage: One 200 mg tablet (or two 100 mg tablets) twice daily following meal. Pediatric patients (6-18 years old) should be dosed by medical professionals based on body weight.

generic name: elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older who weigh at least 25 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least six months, with no previous virologic failure, and no drug resistance to the components of Genvoya. Not recommended for those who have a creatinine clearance below 30 mL per minute.

who is it for? For those new to treatment or treatment experienced, as a component of a regimen. For adults and children weighing at least 2 kg. Tell your doctor if you have tuberculosis, or liver problems or phenylketonuria. traditional dosage: One 400 mg tablet twice daily for those with treatment experience. Those new to treatment or with undetectable viral loads may either take one 400 mg tablet twice daily or two 600 mg tablets once daily.

traditional dosage: One tablet once daily. Tablet contains 200 mg of emtricitabine (Emtriva, an NRTI), 25 mg of rilpivirine (Edurant, an NNRTI), and 25 mg of tenofovir alafenamide (an NRTI).

Epzicom

Juluca

generic name: lamivudine or 3TC class of drug: nucleoside reverse transcriptase inhibitor maker: ViiV Healthcare who is it for? For adults and children at least 3 months old, as a component of an initial regimen. Dosing needs to be adjusted for those with decreased kidney function. traditional dosage: One 300 mg tablet once daily, or one 150 mg tablet twice daily. A 10-mg/mL oral solution is also available for children or others who have diﬃculty swallowing tablets (daily dosage based on patient’s weight).

a pharmacokinetic enhancer/booster maker: Bristol-Myers Squibb who is it for? For those initiating treatment as a component of a regimen. Not recommended for those with liver impairment. Use with caution if you have heart or kidney problems; diabetes; hemophilia; or are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed. traditional dosage: One tablet once daily, in combination with other antiretroviral drugs. Tablet includs 300 mg atazanavir (Reyataz, a PI) and 150 mg cobicistat (Tybost, a PKE).

Genvoya

Isentress generic name: raltegravir class of drug: integrase inhibitor maker: Merck

generic name: dolutegravir and rilpivirine class of drug: single-tablet regimen who is it for? For adults who are virally suppressed for at least six months. maker: ViiV Healthcare traditional dosage: One tablet once daily, with a meal. Each tablet contains 50 mg dolutegravir (Tivicay, an II) and 25 mg rilpivirine (Edurant, an NRTI).

Norvir

other antiretrovirals. Is also a component in single-tablet regimens Complera, Odefsey, and Juluca.

generic name: abacavir sulfate and lamivudine class of drug: two nucleoside reverse transcriptase inhibitors maker: ViiV Healthcare who is it for? For adults and children weighing 25 kg or more as a component of an initial regimen. Not recommended for those with decreased kidney function. traditional dosage: One tablet once daily. Tablet contains 600 mg abacavir sulfate (Ziagen) and 300 mg lamivudine (Epivir).

Evotaz

generic name: emtricitabine, rilpivirine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For adults and children 12 years and older weighing at least 35 kg who are new to antiretroviral drugs, who have a viral load of 100,000 copies per mL or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies per mL or less, who have been virologicallysuppressed for at least six months.

HIVPLUSMAG.COM 31

Intelence

Emtriva

generic name: ritonavir class of drug: protease inhibitor maker: AbbVie who is it for? For adults and children, used only in combination with other antiretrovirals, as a component of initial regimen. Reduced dosage recommended for people taking other protease inhibitors. traditional dosage: Six 100 mg tablets taken twice daily.

are new to antiretroviral therapy; or as a replacement regimen for those virologically suppressed on their current regimen for at least six months, who have no previous virologic failures, and no drug resistance to Stribild components. Not recommended for use during pregnancy and for those with a creatinine clearance below 70 mL per minute, severe liver problems, or hepatitis B.

Selzentry

generic name: maraviroc class of drug: entry inhibitor maker: ViiV Healthcare who is it for? For the treatment of only CCR5-tropic HIV-1 infection in adults and children 2 years or older, weighing at least 10 kg, and having a creatinine clearance of at least 30 mL per minute. Not recommended as a component of an initial regimen. Tell your doctor if you have heart or kidney problems, or if you have low blood pressure or take medication to lower it.

traditional dosage: One tablet, 100 mg, once daily, taken in combination with other antiretrovirals.

traditional dosage: One tablet, once daily, on an empty stomach. Symﬁ contains 600 mg efavirenz (Sustiva, an NNRTI), 300 mg lamivudine (Epivir, an NRTI) and and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI). Symﬁ Lo contains 400 mg efavirenz, 300 mg lamivudine, and 300 mg TDF.

generic name: doravirine class of drug: nonnucleoside reverse transcriptase inhibitor maker: Merck who is it for? For adults as part of an initial regimen.

Rukobia

traditional dosage: One 800 mg tablet once daily with 100 mg Norvir or 150 mg Tybost for those without resistance. One 600 mg tablet with 100 mg Norvir taken twice daily for pregnant women and those with Prezista-related resistance. Pediatric patients (3 years to less than 18 years old and weighing at least 10 kg) should be dosed by a medical professional based on body weight. Should always be taken with food.

32 JULY / AUGUST 2022

Sustiva

Prezista

traditional dosage: One 600mg tablet, twice daily, around the same time each day, with or without food, and in combination with other antiretroviral drugs.

Stribild

generic name: efavirenz class of drug: nonnucleoside reverse transcriptase inhibitor maker: Bristol-Myers Squibb who is it for? For adults and children 3 months and older weighing at least 3.5 kg as a component of initial regimen. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures. traditional dosage: One tablet of 600 mg once daily. It is also a component in the single-tablet regimen Atripla.

Symtuza

Prezcobix

traditional dosage: 300 mg twice daily; or 150 mg twice daily if taken with CYP3A inhibitors; or 600 mg twice daily if taken with CYP3A inducers.

Pifeltro

generic name: elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Gilead Sciences who is it for? For those 12 or older, who weigh at least 35 kg, and

generic name: darunavir, cobicistat, emtricitabine, and tenofovir alafenamide class of drug: single-tablet regimen maker: Janssen who is it for? For treatment-naive or those with a suppressed viral load on a stable HIV regimen for at least six months

Symfi/Symfi Lo

generic name: darunavir and cobicistat class of drug: protease inhibitor and a pharmacokinetic enhancer/booster maker: Janssen who is it for? For both treatmentnaive and treatment-experienced adults with no darunavir-related resistance. Should be used in combination with other antiretroviral medicines. Use with caution if you have liver or kidney problems; or if you are pregnant, breastfeeding, or plan to become pregnant.

generic name: darunavir class of drug: protease inhibitor maker: Janssen who is it for? For treatment of HIV-1, both those initiating treatment and those who have previously been on antiretroviral therapy, including those with some drug resistance to PIs. For adults and children 3 years or older weighing at least 10 kg. May reduce eﬀectiveness of birth control pills.

generic name: atazanavir class of drug: protease inhibitor maker: Bristol-Myers Squibb who is it for? For both treatment naive and treatment-experienced individuals. traditional dosage: 300 mg capsule, taken with 100 mg of Norvir or 150 mg Tybost, once daily.

traditional dosage: One tablet once daily with food. Tablet contains 800 mg of darunavir (Prezista, a PI) and 150 mg of cobicistat (Tybost, a PKE).

generic name: fostemsavir class of drug: attachment inhibitor maker: ViiV Healthcare who is it for? Adults who have received several antiretroviral regimens in the past, who have virus that is resistant to many antiretroviral drugs, and whose current antiretroviral therapy is either ineﬀective, causing side eﬀects the patient cannot tolerate, or causing other safety concerns.

Reyataz

generic name: efavirenz, lamivudine, and tenofovir disoproxil fumarate class of drug: single-tablet regimen maker: Mylan who is it for? For adults and children weighing at least 40 kg (those weighing at least 35 kg can take Symﬁ Lo).

traditional dosage: One tablet once daily. Tablet contains 150 mg of elvitegravir (an INSTI), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 300 mg tenofovir disoproxil fumarate (Viread, an NRTI).

Trogarzo generic name: ibalizumab class of drug: post-attachment inhibitor maker: Theratechnologies who is it for? For heavily treatmentexperienced adults with multidrug resistant HIV-1 infection who are failing their current antiretroviral regimen, as a component of a regimen.

with no known resistance to darunavir or TAF. Not for those with severe liver or kidney impairment.

traditional dosage: One 300 mg twice daily or two 300 mg once daily. Individuals with mild liver impairment should take 200 mg twice daily.

generic name: emtricitabine and tenofovir disoproxil fumarate class of drug: two nucleoside reverse transcriptase inhibitors maker: Gilead Sciences who is it for? For those with HIV or at high risk of becoming HIV-positive. As treatment for HIV, for adults and children weighing at least 17 kg. As HIV prevention, for adults and adolescents 15 or older weighing at least 35 kg. Dosing adjustments necessary for those with decreased kidney function.

HIVPLUSMAG.COM 33

traditional dosage: One tablet once daily. Contains 300 mg lamivudine (Epivir) and 300 mg TDF.

Triumeq

Truvada

for hiv treatment: One tablet once daily, in combination with other HIV medications. Tablet includes 200 mg emtricitabine (Emtriva) and 300 mg tenofovir disoproxil fumarate (Viread). for hiv prevention: One tablet once daily. Must be paired with regular HIV tests and safer sex practices.

Ziagen

traditional dosage: One tablet once daily. Tablet contains 600 mg

Tivicay

Viread

generic name: tenofovir disoproxil fumarate class of drug: nucleoside reverse transcriptase inhibitor maker: Gilead Sciences who is it for? For adults and children at least 2 years old and weighing at least 10 kg, used in combination with other antiretrovirals to treat HIV-1 infection. Dosage adjustments recommended for those with kidney problems.

generic name: dolutegravir class of drug: integrase inhibitor maker: GlaxoSmithKline who is it for? For both those new to treatment and those who have taken integrase inhibitors previously and may have resistance to such drugs. For adults and children at least 30 kg. Take during pregnancy only if potential beneﬁts outweigh risk.

traditional dosage: One 300 mg tablet once daily.

generic name: cabotegravir class of drug: integrase strand transfer inhibitor maker: ViiV Healthcare who is it for? Adults who have achieved viral suppression on a stable regimen and have no history of treatment failure and no known or suspected resistance to cabotegravir. To be used either as a month-long lead-in to monthly injections of Cabenuva (cabotegravir and rilpivirine) or by patients who will miss an injection.

traditional dosage: A loading dose of 2,000 mg, administered as an injection, followed by a maintenance dose of 800 mg every two weeks.

Tybost

traditional dosage: One 150 mg tablet daily with food, with either 300 mg atazanavir or 800 mg darunavir.

traditional dosage: One 50 mg tablet, once daily for those new to antiretrovirals; twice daily for those who take certain other antiretrovirals or have taken integrase inhibitors and may have resistance.

generic name: abacavir sulfate, dolutegravir, and lamivudine class of drug: single- tablet regimen maker: ViiV Healthcare who is it for? For adults and children weighing at least 40 kg as initial regimen. Not recommended for those with a creatinine clearance below 50 mL per minute or those with liver impairment.

generic name: abacavir class of drug: nucleoside reverse transcriptase inhibitor maker: GlaxoSmithKline who is it for? For adults and children at least 3 months old, as a component of initial regimen. Dosage adjustments not needed for those with kidney problems.

generic name: lamivudine and tenofovir disoproxil fumarate class of drug: Two nucleoside reverse transcriptase inhibitors maker: Celltrion who is it for? For adults and children weighing at least 35 kg as component of an initial regimen. Not recommended for patients with impaired kidney function. Patients should be tested for hepatitis B before beginning treatment.

generic name: cobicistat class of drug: pharmacokinetic enhancer/CYP3A inhibitor/ booster maker: Gilead Sciences who is it for? For adults taking atazanavir (Reyataz) or darunavir (Prezista). Tybost is not an HIV medicine and does not treat HIV: it interferes with the breakdown of these HIV drugs, increasing the blood levels of these drugs and making them more eﬀective.

Temixys

abacavir sulfate (Ziagen, an NRTI), 50 mg dolutegravir (Tivicay, an INSTI), and 300 mg lamivudine (Epivir, an NRTI).

traditional dosage: One 30mg tablet with one 25mg rilpivirine tablet, once daily, with a meal.

traditional dosage: One tablet, once daily, with food. Each tablet contains 800 mg darunavir (Prezista, a protease inhibitor), 150 mg cobicistat (Tybost, a PKE), 200 mg emtricitabine (Emtriva, an NRTI), and 10 mg TAF (an NRTI).

Vocabria

34 JULY / AUGUST 2022

HIV was identified over 40 years ago and medical and scientific advances against the disease continue to roll out on a regular basis. Since AZT was approved in 1987, HIV medications have grown leaps and bounds, alleviating side effects, reducing required dosages, and, most recently, introducing injectable options that end the need for daily pills. Scientists in the HIV field are currently working to utilize lessons learned from COVID-19 in hopes of battling drug resistance and eliminating reservoirs of HIV that still exist in the cells of people on antiretroviral regimens and whose viral loads remain undetectable. Here are some of the HIV drugs that have the most potential for approval by the Food and Drug Administration and could soon be coming to a pharmacy near you.

Brush up on the status of several HIV drugs in development, which could oﬀer new treatments, preventions, and even a cure.

UB-421: In a Phase II trial, this broadly neutralizing antibody targeted domain 1 of CD4, and was shown to maintain viral suppression after treatment ended. Weekly or biweekly intravenous infusions of UB-421 kept the viral loads of all 29 participants suppressed after they stopped taking oral HIV meds. Research is continuing into the antibody’s potential as a functional cure as well as its e ﬃ cacy in patients with multidrug-resistant HIV.

IN PIPELINETHE

VYROLOGIX (LERONLIMAB- PRO 140): CytoDyn’s viral-entry inhibitor is a monoclonal antibody that would be the first self-injectable subcutaneous HIV drug. It works by masking CCR5, a protein on the surface of white blood cells, thus inhibiting HIV’s ability to enter healthy T cells. There have been at least nine clinical trials indicating it could significantly reduce or control viral load. For instance, a Phase III trial involving treatmentexperienced patients showed that in combination with other antiretroviral drugs, it helped 81 percent of participants achieve significant viral suppression (less than 50 copies per mL). The drug was also being studied as treatment for COVID-19, metastatic cancer, stroke, and a chronic liver disease called nonalcoholic steatohepatitis, but that was complicated in March after the FDA placed a partial clinical hold on its HIV program and a full clinical hold on its COVID-19 program in the United States. “CytoDyn is committed to FDA compliance,” Scott A. Kelly, M.D., Chief Medical Officer of CytoDyn, said in a statement. “We are evaluating our clinical programs and are working to resolve the issues underlying the clinical holds as soon as possible in close communication with the FDA. We will provide an update when we have additional information.”

PGT 121: A small study showed that an experimental monoclonal antibody called PGT121 led to viral suppression that lasted for up to six months in HIV-positive people who started with a low viral load. Being developed by a collaboration that includes the International AIDS Vaccine Initiative, the Bill & Melinda Gates Foundation, the Scripps Institute, and Theraclone Sciences, the recombinant monoclonal antibody targets the V3 glycan site on the outer envelope of HIV. At the 2019 Conference on Retroviruses and Opportunistic Infections, researchers reported that two participants with low viral loads experienced treatment-free viral suppression, which for one lasted over ﬁve months and for the other was still ongoing at six months. Then a study published in 2021 reported that PGT121, in combination with other drugs, delayed rebound of simian HIV in monkeys whose antiretroviral treatment had been interrupted. PGT121 could eventually become a very long-acting HIV medication or a functional cure that maintains viral suppression after antiretroviral therapy has ended. A study published early this year showed subcutaneous injections of PGT121 paired with another broadly neutralizing antibody, VRC07-523LS, served as eﬀective protection against HIV among a group of young South African women.

LENCAPAVIR (GS-6207): Developed by Gilead Sciences, this ﬁrst-inclass long-acting capsid inhibitor interferes with the transport of the viral genetic material and replication of HIV’s genetic blueprint into a host cell’s nucleus. It is given subcutaneously. At the 2021 Conference on Retroviruses and Opportunistic Infections, researchers reported that lenacapavir administered subcutaneously every six months helped patients maintain high rates of viral suppression through 26 weeks. The early trials show the drug has potential as a long-acting treatment for HIV, including for people who have developed resistance to multiple drug classes and those who are unable to take a daily pill. An issue with how the drug was stored prompted the FDA to place a clinical hold on lenacapavir’s Investigational Drug Application late last year, but Gilead announced in May the issue was resolved and the hold was lifted, allowing screening and studies to continue.

LEFITOLIMOD (MGN1703): Lefitolimod is a type of latency-reversing agent called a toll-like receptor 9 agonist — toll-like receptors, or TLRs, are proteins that help the immune system recognize dangers, and agonists are used to enhance this activity. Researchers believe lefitolimod may improve the body’s immune response to HIV in addition to its effect on latent virus cells. Researchers in Denmark tested lefitolimod in the TEACH study, which showed it to be safe in early-phase trials. A Phase IIa study, TITAN, began in 2019 at Denmark’s Aarhaus University, in which patients on antiretroviral treatment are being given lefitolimod along with virus-neutralizing antibodies developed by Rockefeller University to see if the therapy can reduce the viral reservoir. Lefitolimod was developed by German company Mologen, and the TITAN study is being funded by Gilead Sciences.

VESATOLIMOD (GS-9620 AND GS-986): These are also TLR agonists, targeting receptor 7 (researchers have identified at least 10 such receptors in humans), and likewise aimed at reducing or eliminating viral reservoirs, which remain even in people who have achieved viral suppression and are an obstacle to curing HIV. Vesatolimod is being researched as part of a potential functional cure. At CROI 2020, Gilead

BY TRUDY RING AND NEAL BROVERMAN

MK-8504 AND MK-8583: These NRTIs being developed by Merck are new prodrugs of tenofovir, itself a component of many HIV treatments; a prodrug is a substance that has to be broken down by the body to become active. MK-8504 and MK-8583 were developed with an eye to them being weekly treatments due to the long half-life of the drugs, but Phase I studies presented at CROI in 2020 showed weekly doses had only modest and transient activity against HIV. Daily doses may produce a better result, researchers said.

GSK3640254: This is a maturation inhibitor from ViiV Healthcare; it prevents HIV from reaching its end stage. It does so by blocking a key step in the processing of gag, a protein that assembles HIV. Results of a proof-of-concept study, presented at CROI 2021, showed that the drug was safe and welltolerated, and helped suppress HIV in treatmentnaive adults. Participants in the study received various doses of GSK3640254 or a placebo over several days; the 140mg and 200mg doses were most effective against the virus. Now GSK3640254 is being studied as part of combination therapy in treatment-naive people; such maturation inhibitors also may offer a new option to people for whom other treatments haven’t worked. A study’s findings,

ELPIDA (ELSULFAVIRINE, VM1500A): This is an NNRTI by maker Viriom. It was approved in Russia in 2017 as a once-daily oral HIV drug. Clinical studies are continuing into its use for dosing daily or weekly and have so far shown e ﬀ ectiveness, safety, and tolerability. Researchers are also looking at its use as part of a combination treatment and for HIV prevention, including as an injectable.

Sciences’ toll-like receptor 7 agonist (TLR7) — an agonist is a chemical that binds to a receptor — was shown to increase the time to viral rebound, enhance immune function, and decrease levels of intact HIV DNA. Later that year, at the International AIDS Conference, one study that was presented indicated that injectable vesatolimod, used with other antiretroviral drugs, helped speed up HIV suppression in monkeys. Another study presented at the latter conference looked at humans who are HIV controllers — those in whom HIV doesn’t replicate for an extended period even if they aren’t on antiretroviral treatment, but who may need to go on treatment eventually. That study found that in controllers who had ﬁnally begun treatment, the addition of oral vesatolimod enhanced the immune system’s response, a promising if early result. A recent study in Spain looked at combining the drug with therapeutic vaccines — vaccines that are given not to prevent an infection but to control one.

ALBUVIRTIDE AND 3BNC 117: Albuvirtide is a fusion inhibitor, meaning it keeps HIV from entering certain cells in the immune system. From Frontier Biotechnologies, it is already approved for use in China. In the U.S., it is being studied in combination with 3BNC117, a broadly neutralizing antibody developed by Rockefeller University, for treatment of patients whose antiretroviral regimen is failing. Broadly neutralizing antibodies can block HIV from entering healthy cells and activate other immune cells to help destroy infected cells. Scientists are also looking into the possibility of using 3BNC117 in HIV prevention. Additionally, Frontier announced in July 2021 a successful study of albuvirtide paired with the antiretroviral drug lopinavir, reporting the two-drug combination was nearly as eﬀective as a lopinavir-based threedrug treatment.

SHUTTERSTOCK

ABX464: This drug being developed by Abivax is a Rev inhibitor, which interferes with the protein of that name to prevent HIV from multiplying. Researchers believe it may reduce or eliminate the HIV reservoir that remains even after the virus is suppressed. A study in humanized mice showed long-term control of the virus even after treatment ended, and a human study showed reduction of viral reservoirs in blood and rectal tissue in virally suppressed patients.

released early this year, showed GSK3640254 to be safe, eﬀective, and welltolerated among people living with HIV with little or no exposure to treatment.

TIME SWITCHTO GEARS

If your HIV medication is working well for you without any signi cant side effects or issues, there may be no need to consider switching up your regimen. However, it is safe — and sometimes highly advantageous — to switch from one HIV treatment to another. With more options than ever before, it can be challenging to choose which regimen might be right for you — which is why it’s important to discuss it with your doctor rst.

10 reasons to change HIV medications now.

36 JULY / AUGUST 2022 COTTONBRO/PEXELS

BY JACOB ANDERSON - MINSHALL AND DESIRÉE GUERRERO

Read on for our tips to know when it may be a good time to discuss switching with your doc (and don’t forgot to bring our annual Treatment Guide with you!):

If you are already undetectable, you can switch without risking your viral suppression. Tell your prescribing doctor the concerns you have and let them help ne-tune your treatment so it ts your speci c needs.

IF YOU ALSO HAVE HEPATITIS C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but some HCV drugs interact with HIV drugs, so it’s important for your doctor to carefully consider which medications you can take while treating them simultaneously.

YOU ARE PREGNANT. Some HIV medications may increase risks of birth defects and the effect of others, like cabotegravir, on fetuses haven’t been well studied. In updated guidelines, the Department of Health and Human Services’ Panel on Treatment of HIV During

IF YOU TAKE YOUR MEDS WITHOUT FOOD. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (with protein or a hearty meal, rather than just a snack). If you don’t eat big meals or prefer to take your meds at bedtime instead, or you often forget to take your meds when you go out to lunch with work friends, you should consider a drug that has no food intake requirements, such as Biktarvy (bictegravir/ emtricitabine/tenofovir alafenamide) or Triumeq (dolutegravir/abacavir/lamivudine).

9IF

10IF

YOU WANT TO STOP TAKING PILLS ALL TOGETHER. Last year the FDA approved Cabenuva (rilpivirine and cabotegravir), making it the first complete antiretroviral regimen that comes in an injection. Doses are administered every two months at your doctor’s office.

IF YOU CAN’T DEAL WITH THE SIDE EFFECTS. Every medication has potential side effects — some minor, some life-threatening. Not everyone taking a certain medication will experience the same side effects, and some people experience them more intensely. Only you can decide if the side effects aren’t worth the benefits you’re getting from a particular medication. With so many treatment options now available, don’t hesitate to talk to your doctor if you feel side effects are negatively affecting your daily life.

5IF

2IF

HIVPLUSMAG.COM 37

IF YOU ARE WORRIED ABOUT DRUG RESISTANCE. Some drugs offer more protection against resistance developing. Darunavir (a component of both Prezista and Prezcobix) stops the virus from mutating, and thus developing resistance. A threeyear study of those taking (bictegravir/emtricitabine/tenofovirBiktarvyalafenamide)foundnodrugresistance.Ifyoudodevelopadrugresistance,otherHIVmedscanstillworkforyou.Forexample,Trogarzo(ibalizumab),along-actinginjectable,fightsmultidrug-resistantHIVwhenaddedtoapreviouslyfailingantiretroviralregimen.

6IF

YOU HAVE KIDNEY OR LIVER PROBLEMS. Tenofovir disoproxil fumarate (TDF, brand name Viread, and a component of drugs including Atripla, Complera, Delstrigo, and Stribild) has been linked to kidney problems in susceptible individuals, so those with kidney issues might consider regimens that instead use tenofovir alafenamide (TAF), such as Biktarvy, Genvoya, Odefsey, or Descovy. Overall, Juluca has fewer side effects, but has seen some users develop new or worse liver problems.

IF YOU ARE AFRICAN-AMERICAN. A sad truth is that few drug trials test the impact of a treatment on people of color, especially women. That’s what makes 2020’s BRAAVE study so remarkable. It involved 495 selfidentified Black or African-American HIV-positive people (32 percent were cisgender women) who switched to Biktarvy from a variety of regimens. Virtually all of those who switched maintained viral suppression.

Pregnancy and Prevention of Perinatal Transmission recommend dolutegravir-based regimens for pregnant people, irrespective of trimester, and for people who are trying to conceive. Based on additional data, the panel now also recommends tenofovir alafenamide as a preferred NRTI for antiretroviral regimens in people who are pregnant or trying to conceive.

YOU WANT TO REDUCE THE NUMBER OF MEDS YOU TAKE. Although three-drug regimens were once considered essential in preventing drug resistance, twodrug regimens have proven to be just as effective. Their advantages include fewer side effects, and a reduction in toxicity associated with long-term drug therapies. Juluca (dolutegravir/rilpivirine), Dovato (dolutegravir/lamivudine) and Cabenuva (rilpivirine/cabotegravir) are all two-drug regimens now approved by the Food and Drug Administration.

YOU ARE CONCERNED ABOUT GAINING WEIGHT. At CROI 2021, researchers shared more data confirming that some HIV drugs lead to weight gain. Taking integrase inhibitors (dolutegravir or raltegravir) was previously associated with greater weight gain than taking nucleoside reverse transcriptase inhibitors. Recent studies indicate, however, that tenofovir alafenamide, an NRTI, is linked to weight gain. Weight gain can also raise your risks of diabetes and heart disease, so if these are concerns of yours, remember to discuss them with your doctor.

38 JULY / AUGUST 2022

BY PLUS EDITORS

ENTRY AND FUSION INHIBITORS (EIS AND FIS): Drugs in this class help block HIV from binding, fusing, and entering T cells. They are always taken with other HIV medication.

CAPSID INHIBITORS (CIS): These drugs are still in trials and not yet FDA-approved, but meds in this class help inhibit the proteins that protect HIV’s genetic material. CIs are currently being used as a component in experimental long-acting regimens such as injectables. They may not need to be taken with other HIV medications.

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS, ALSO KNOWN AS NONNUKES): Drugs in this class also block reverse transcriptase, as NRTIs do, but in a different way. They are always taken with at least one other HIV medication.

TOLL LIKE RECEPTORS (TLR): Drugs in this class stimulate the immune system’s T cells, activating a more robust response to the viral invader. They are always taken with other HIV medications.

Drugs in this class block reverse transcriptase, an enzyme that HIV needs in order to reproduce. HIV uses reverse transcriptase to convert its RNA into DNA; blocking the process prevents HIV from replicating. They are always taken with at least one other HIV med.

A major reason that HIV had been historically difficult to combat in terms of treatment is because it is a retrovirus. This means it contains single-stranded RNA (ribonucleic acid) instead of the typical doublestranded DNA that human cells carry. Retroviruses also carry an enzyme called “reverse transcriptase,” which allows it to copy RNA into DNA — and then use that DNA copy to invade human Fortunatelycells.

NUCLEOSIDE INHIBITORSTRANSCRIPTASEREVERSETRANSLOCATION(NRTTIS): Drugs in this class also block reverse transcriptase but do so by preventing translocation of an enzyme. They are always taken with other HIV medication.

SINGLE TABLET REGIMENS (STRS): Drugs in this category are xeddose pills that combine multiple anti-HIV medications (often from more than one class of drug) into a single tablet, which is usually taken just once a day. They do not need to be taken with other HIV medication.

HIVPLUSMAG.COM 39

INTEGRASE STRAND TRANSFER INHIBITORS (INSTIS): Drugs in this class block integrase, an enzyme HIV needs in order to reproduce. HIV uses integrase to insert its viral DNA into the DNA of T cells. Blocking the integration process prevents HIV from replicating. They are always taken with other HIV medication.

PROTEASE INHIBITORS (PIS): Drugs in this class block activation of protease, an enzyme HIV needs to develop. Blocking protease prevents immature forms of HIV from becoming a mature virus capable of infecting other T cells. They are always taken with other HIV medication.

PHARMACOKINETIC ENHANCER/ CYP3A INHIBITORS (PKES, ALSO KNOWN AS BOOSTERS): Drugs in this class boost the effectiveness of antiretroviral medication. When the two are taken together, the pharmacokinetic enhancer slows the breakdown of the other drug, which allows the drug to remain in the body longer at a higher concentration. They are always taken with other HIV medication.

SHVETS/PEXELSANNA

HIV treatment regimens include drugs from multiple classes to improve their combined effectiveness, decrease toxicity, and help prevent the development of drug resistance. Here’s brief descriptions of these classes and how they work.

POST-ATTACHMENT INHIBITORS (PAIS): Drugs in this class bind to CD4 cells after HIV has attached to them but still inhibit the virus from infecting those cells. They are always taken with other HIV medications.

CCR5 ANTAGONISTS (CAS): Drugs in this class block the CCR5 coreceptor on the surface of CD4 cells preventing HIV from binding and entering the cells.

scientists developed antiretroviral drugs in the mid-1990s that were able to prevent HIV from replicating in the human body. This breakthrough was truly miraculous, in that it changed HIV from an often fatal disease to a manageable chronic condition much like diabetes. Since then, HIV drugs have only improved.

NUCLEOSIDE (TRANSCRIPTASEREVERSEINHIBITORSNRTIS,ALSOKNOWNASNUKES):

ACTSCLASS

BROADLY NEUTRALIZING ANTIBODIES (BNABS): Drugs in this class are antibodies that can recognize and block HIV or activate other immune cells to help destroy the virus. Some hold potential to treat HIV without other medications.

Each class of HIV drugs ﬁghts the virus in unique ways.

40 JULY / AUGUST 2022 SHUTTERSTOCK

Here’s what you need to know about the most common HIV medication side eﬀects and comorbidities — and how to treat them.

BY DIANE ANDERSON MINSHALL

treatment : Selective serotonin reuptake inhibitors (SSRIs) are most eﬀective. According to the National Institutes of Health, medications that have shown eﬃcacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, nefazodone, trazodone, bupropion, and mirtazapine.

Comorbidity: Cardiovascular Disease

how common: It’s the second leading cause of death among people living with HIV. treatment : It may include a variety of approaches. There are cholesterol-lowering statin drugs such as Crestor, Lipitor, Zocor, Vytorin, Lescol, Mevacor, Altoprev, Livalo, Pravachol, Advicor, and Simlup. Programs that help you stop smoking, shed excess pounds, and exercise more are all useful. Reduce alcohol and sodium consumption. If your blood pressure is not in a healthy range, your doctor may prescribe medication. Among the options are ACE inhibitors (Vasotec, Prinivil, Zestril, Altace); angiotensin II receptor blockers (Cozaar, Atacand, Diovan); beta blockers (Lopressor, Toprol XL, Corgard, Tenormin); or calcium channel blockers (Norvasc, Cardizem, Dilacor XR, Adalat CC, Procardia).

Side Effect: Injection Site Pain

how common: Osteopenia and osteoporosis are both forms of bone density loss, with the latter being more severe. Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it. treatment: Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast. And just this year, a study presented at the virtual Conference on Retroviruses and Opportunistic Infections indicated that a “short course of alendronate” (the generic term for Fosamax and Binosto) at the beginning of tenofovir-based antiretroviral therapy can help prevent bone loss.

Side Effect: Diarrhea

HIVPLUSMAG.COM 41

treatment: Stop smoking. Medications include vasodilators (hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE inhibitors (Prinivil, Lotensin), calcium channel blockers (Norvasc, Procardia, Plendil), and diuretics (Microzide, Diuril, Zestoretic).

Comorbidity: Diabetes

how common: Very. The U.S. Department of Veterans Affairs, for example, reports that 45 percent of its patients with HIV also have a hypertension diagnosis. A report from last year found that a quarter of all people with HIV also have hypertension, with the comorbidity most prevalent in North America and Western Europe. A 2018 review of findings, published in Hypertension, suggests that chronic inflammation associated with HIV and antiretroviral therapy is a major factor in the high rates of hypertension.

how common: There’s a type of diabetes caused by pancreatic damage brought on by HIV medications. It’s less common than the other two types, Type 1 and Type 2, but equally damaging. treatment : Controlling blood sugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easy-to-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more.

Side Effect:HighHypertension/BloodPressure

Side Effect: Mood Changes, Including Depression and Anxiety

Comorbidity: Osteoporosis and Osteopenia

treatment: Three options: over-the-counter anti-diarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Mytesi (crofelemer), the only Food and Drug Administration-approved drug to relieve noninfectious diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Mytesi is only the second botanical prescription drug approved by the FDA.

how common: Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their HIV meds.

how common : According to a 2019 study published in International Journal of Environmental Research and Public Health, 39 percent of people living with HIV were currently experiencing depression. AIDS Beacon previously reported that 63 percent of HIV-positive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.”

how common: Very, with Cabenuva (cabotegravir and rilpivirine), the FDA-approved once-monthly or every-two-months injectable treatment for HIV-1 in virologically suppressed adults and adolescents aged 12 and older. According to the FDA, 61 percent of patients using cabotegravir and rilpivirine reported an adverse reaction. The most common of these were pain at the injection site and insomnia, but also included fever (pyrexia), fatigue, headache, musculoskeletal pain, nausea, dizziness, and rash. treatment: Discontinuation of cabotegravir and rilpivirine in the event of Grade 3 reactions such as drug hypersensitivity and severe insomnia.

BY DESIRÉE GUERRERO

In addition to the amazing and lifealtering advancements that have been made in HIV treatment over the decades, there have been some huge strides in terms of HIV prevention as well. A few years back, researchers discovered that some of the drugs they had developed to treat HIV were also eﬀective in preventing the transmission of the virus to an HIV-negative partner. This highly eﬀective method is known as PrEP, or pre-exposure prophylaxis. When taken as prescribed, PrEP reduces the risk of getting HIV from sex by about 99 percent.

42 JULY / AUGUST 2022

There are now more HIV prevention methods available than ever — and it’s putting the joy back into sex for people living with HIV.

PrEP RALLY

SUBIYANTO/PEXELSKETUT

Also always check with your doc about the possible side effects and drug interactions of each type, to make sure you choose the safest option for you. The most common side effects of PrEP include headaches, fever, chills, and other flu-like systems — but for most they lessen and disappear over time.

PrEP is recommended for people considered “at-risk” of contracting HIV. This includes people who’ve consistently had unprotected anal or vaginal sex in the last six months, IV drug users, and those with an HIV-positive partner who want to become pregnant. There may be other reasons one might fall into the high-risk category, so you should talk to your health care provider if you think PrEP might be for you.

Today, there are three FDA-approved forms of PrEP available in the United States: Truvada, Descovy, and Apretude, with the latter being a new one-month injectable version. The best part is most people in high-risk groups can obtain PrEP for free or at a reduced cost. Read on to learn more about each method.

HIVPLUSMAG.COM 43

Descovy for PrEP

In October of 2019, a second pill form of PrEP was approved by the FDA, called Descovy for PrEP (emtricitabine and tenofovir alafenamide). It is just as effective as its predecessor, Truvada. There are some differences though, so you should talk to your doctor about which might work better for you. For example, Descovy is safer for people with bone density or kidney issues, and the pill is much smaller — however, it may slightly raise LDL cholesterol levels. Also, unlike Truvada and Apretude, Descovy is not currently approved for those assigned female at birth due to a lack of research in its effectiveness.

Truvada for PrEP

For more information about PrEP and how to get a prescription, visit PlannedParenthood.org, HIV.gov, or CDC.gov/hiv/basics/prep.

RANGEL/PEXELSANDERSON

A Morning After Pill?

Not everyone at risk of acquiring HIV may know there is an option available to prevent seroconversion (the time between exposure to a virus and when antibodies show up in your blood) after exposure to the Post-exposureHIV. prophylaxis, or PEP, is a medical option to be used in emergency situations to prevent the transmission of HIV. Emergencies that may require the use of PEP include a broken condom, recent needle sharing for intravenous drug use, or in the case of a sexual assault.

dosage info: One tablet once daily, without regard to food. The tablet contains 200 mg emtricitabine and 25 mg tenofovir alafenamide. Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Don’t double up on your next dose.

who’s it for? HIV-negative adults and adolescents assigned male at birth weighing at least 77 pounds (35 kg) for the prevention of HIV.

Apretude

Did you know there’s medicine you can take to prevent HIV transmission after a sexual encounter?

Truvada, our great PrEP pioneer, is now celebrating its 10th year of FDAapproval. It was the ﬁ rst medicine available in the U.S. for use to prevent HIV transmission after it was shown in studies to be highly e ﬀ ective when taken daily. Truvada consists of the drugs emtricitabine and tenofovir. who’s it for? HIV-negative adults and adolescents (male, female, nonbinary, and transgender) weighing at least 77 pounds (35 kg). People with bone density or kidney issues should avoid and consider Descovy instead.

PEP is a combination of three drugs: tenofovir, emtricitabine (these two drugs come in one pill), and either raltegravir or dolutegravir. This combo is typically prescribed to be taken once or twice a day for about a month after exposure. The sooner after exposure PEP is started, the more eﬀective it is. DG

Apretude (cabotegravir extended-release injectable suspension, or CAB LA) is the most recent form of PrEP approved by the Food and Drug Administration. It is gamechanging in that it is an injectable, which makes it a much more attractive option to those at risk of contracting HIV. For many, stopping by the clinic every couple of months for a shot in the booty may be a lot more convenient than trying to remember a daily pill. Unlike the pill forms of PrEP, Apretude is not also used to treat HIV. who’s it for? HIV-negative adults and adolescents (male, female, nonbinary, and transgender) weighing at least 77 pounds (35 kg) for the prevention of HIV.

dosage info: One long-acting intramuscular gluteal (butt muscle) 600 mg injection (3 mL) is given monthly for the ﬁrst two months, and then one injection every two months thereafter. There are no food restrictions, and an oral lead-in period is no longer required.

dosage info: One tablet daily with food. The tablet contains 200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate. Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Don’t double up on your next dose.

Remembrance is inspired by a meeting I had with a South Philadelphia funeral home director, Ron Piselli. As a master of his craft, Ron wanted to make sure that every person who came through his funeral chapel received the digniﬁed funeral he believed they deserved. During the early days of the epidemic when most funeral homes were terriﬁed that they might be exposed to HIV, they

BY CHRIS BARTLETT

I am so proud to announce in May and June of this year we have launched Remembrance — an alternative memorial to Philadelphians and the HIV/AIDS crisis — made possible through funding by The Pew Center for Arts & Heritage. While many HIV/AIDS memorials across the country are largely physical in structure, Remembrance is a memorial experience with civic and theatrical performances and oral histories, designed in partnership with local artists, activists, and community leaders.

In May, three-time Obie award-winning writer and director Ain Gordon staged the world premiere of a new play titled, These Don’t Easily Scatter. Gordon’s play is inspired by Remembrance’s oral history project undertaken to chronicle the stories of Philadelphia-area community members who have passed unnoticed, with or without the love and support of families, throughout the HIV/AIDS crisis. And in June, in a stunning and profound “going home” ceremony titled Gone and Forever, a community procession and ceremony took place through the streets of Philadelphia to the Church of St. Luke and the Epiphany, devoted to Philadelphians who died of AIDS complications.

Having studied the Holocaust, I was impressed by the efforts of Jewish historians to preserve and honor Jews who were murdered during the Shoah. Their hope is to ensure that not a single life will be forgotten. Their efforts to create catalogues listing the names of all who were lost throughout each city in Europe during the Nazis’ genocide was my inspiration for a memorial to those we lost to AIDS in Philadelphia.

As a 55-year-old gay man, I am now all too familiar with the pain of living through two epidemics. They have ravaged communities I care deeply about — LGBTQ, Black, Indigenous, people of color and the poor, who are always hardest hit and most ignored. America is a country that loves to build monuments and memorials to its war dead, yet turns its back on the collective trauma and loss caused by epidemics. We quickly brush those dead under the rug, moving full steam ahead, even though those epidemics, too, have multigenerational impacts on our society.

Philadelphia’s LGBTQ+ Center will soon launch Remembrance, a living AIDS memorial that utilizes art, music, and stories.

I began a project in 2005 to memorialize the lives of the over 8,000 gay and bisexual men who died of AIDS in Philadelphia from the early 1980s, when data was ﬁrst available, until now. I was struck that Philadelphia had lost thousands of gay men to the AIDS epidemic, but had no ofﬁcial memorial or effort to remember their stories. Philadelphians we lost to AIDS include world-renowned individuals, such as activist Kiyoshi Kuromiya, haute couture designer Willi Smith, and supermodel Gia Carangi. But also included are everyday citizens — schoolteachers, shop owners, and family members of all generations — who came from one of our Philadelphia neighborhoods.

44 JULY / AUGUST 2022

It’s our collective responsibility to remember the beautiful memories of our LGBTQ family members, and to force others to look when they’d rather forget. Because if we refuse to stop for a moment to give epidemics like HIV/AIDS — and in the future, COVID-19 — the solemnity and reverence they too deserve, we will be forced to relearn these current lessons once again.

HIVPLUSMAG.COM 45 IMAGESLEVINE/GETTYRICHARD

regularly turned away people with the disease. Ron, on the contrary, welcomed people with HIV/AIDS in their dying weeks and made sure that they received supportive and affordable funerals.

In a December 1985 Philadelphia Daily News article, less than four years after the ﬁrst HIV/AIDS cluster in the United States was reported, Piselli was featured publicly with a half-page photo standing up for what he believed, that “no one should be turned away.” In introducing Ron, the article starts, “One undertaker who will handle AIDS cases is Ronald Piselli of Piselli Funeral Home on Ellsworth Street in South Philadelphia.” ONE. As word spread, families from around the

Remembrance builds on Ron’s resilience to provide a keen perspective on life, which treasures the memories of those lost, prioritizes kindness, and seeks to renew even in the face of public scorn and danger of personal harm. This spring, Remembrance applied those same principles to remembering the Philadelphians whose lives were lost to the HIV/AIDS epidemic by sharing lessons we’ve learned from powerful community listening sessions. Those led to the creation of Ain Gordon’s new play, and the deeply moving community procession led by local Philadelphia artist Alex Stadler.

Chris Bartlett is executive director at William Way LGBT Community Center in Philadelphia

One of the versions of Robert Indiana’s “Love” sculpture in Love Park (JFK PLaza) in Center City, Philadelphia

region came to Ron to ensure their loved ones were remembered and honored.

FOUR-TIME LIVING YEARS.

IMAGESWELLS/GETTYTASIA PARTING SHOT

OLYMPIC GOLD MEDAL-WINNER GREG LOUGANIS OPENS UP ABOUT HIS JOURNEY OF

STILL WINNING

WITH HIV FOR NEARLY 35

He became the first man and only the second diver in Olympic history to sweep both diving events in two consecutive Olympics — and he did it six months after learning that he was living with HIV. Louganis was taking AZT at the time, setting his alarm for every four hours, even waking up in the middle of the night during the competition to take the medication.

The way that it was prescribed back then, it was two pills every four hours around the clock. So you’re getting up in the middle of the night, in the middle of the morning, no matter where you are. If I was training, my little alarm would go o , and it’s like, Oh, AZT break. Just like in Rent.

Now at 62, Louganis is proof of what is possible: you can live and compete at the highest levels with HIV. You can win gold medals and be considered one of the greatest divers in the history of the sport.

What did you think about HIV and how it might a ect your diving career back in 1988, when you were ﬁrst diagnosed?

HIVPLUSMAG.COM 47 IMAGESTREML/GETTYDEAN BY JEFFREY MASTERS

THE NEXT TIME you think about what HIV looks like, think about Greg Louganis winning two gold medals at the 1988 Olympics in Seoul.

This was before the meds got good, well before we learned how to appropriately treat HIV. It’s before we knew anything. AZT was an experimental drug. It was initially a cancer drug, and so they didn’t know the toxicity. They didn’t know potential side e ects. We were basically guinea pigs.

As a performer, it’s like, OK, you sprained your ankle? Wrap it up and get back out there. As soon as the music starts, you’ve got to perform. It’s that mentality. I was able to compartmentalize my life. When I was in the pool, when I was competing, when I was training, HIV/AIDS didn’t

I really didn’t know. Now back in ‘88, we thought of HIV/ AIDS as a death sentence. So my thought was, Well, if I’m HIV-positive, I don’t want to waste my coach’s time. I don’t want to waste my teammates’ time. So, I was going to pack up my bags and go back to California and lock myself in my house and wait to die. Because that was what we thought of HIV at that time.

right away because they wanted to treat me very aggressively. Also, at that time there were travel bans, so nobody could know about my HIV status or I wouldn’t have been allowed into the country, into Korea. So it was a well-kept secret.

But my doctor, who was also my cousin, he encouraged me to stay and train. He said that that was the healthiest thing I could probably do for myself. They put me on AZT

Red Bull Sports director competitionduringLouganisGregreactstheﬁnalday of the Red Bull Cli Diving World Series at Downpatrick Head, Ireland

Louganis recently spoke with us about the controversy created by the concussion he received at the 1988 Olympics, sharing his HIV status with the world in 1995, and adjusting to the reality of HIV today — where with access to appropriate treatments, you can live a long, healthy life.

After the 1988 Olympics, you retired. What’s it been like to have to ﬁgure out what you wanted to do next?

48 JULY / AUGUST 2022 IMAGES/GETTYALLSPORT PARTING SHOT

Well, I didn’t think I’d see 30, honestly. Because I was diagnosed in ‘88 and generally they gave you two years…. There was a point there, it’s like, Oh, I’ll do whatever I want because I’m not going to be here. And then a year would go by, [another] year would go by, [and another] year would go by…. So now at 62, it’s like, Wow. Now, what do I do? I’ve got to get a job.

That was huge. When that information hit, it was like, Oh wow... this is deﬁnitely not what it used to be. But I still go to...doctor’s appointments [with] young men who recently seroconverted, because it’s still frightening. You don’t know what it is, what it looks like, and how it’s going to be managed and all that stu . And I’ve probably been on just about every HIV/AIDS medication that’s out there, so I know side e ects and all that stu

Did learning that you were undetectable have a noticeable e ect on your mentality and how you thought about HIV?

No, because what I was conditioned to in my early diagnosis — I’d go to my doctor’s appointment, get my numbers, and then they’d put that file back in the shelves, back in the filing cabinet…. I didn’t know if there were more medications coming down the pipeline. I wasn’t really that stressed over all of that stu because I knew that it was going to be what it was going to be. I didn’t have control over it.… And I just didn’t focus on that. When they put the file away, I put the file away.

Louganis in action

It was at the ’88 Olympics when you hit your head on the diving board and got a concussion. You got stitches and then got back up on the board 30 minutes later. I had wondered how much of getting back up there was your drive and determination, versus you thinking you had a death sentence and had nothing to lose. Well, trying to roll everything up in one little moment, going into the 1988 Olympic Games, I was the odds-on favorite. Going into the competition when I did my reverse two and a half pike and hit my head on the board, in that split-second I became the underdog…. The underdog position is much more comfortable to be in because then you have nothing to lose.

It was a wake-up call to my coach, Ron O’Brien, and myself to pay attention because nothing is guaranteed. Anything can happen,

You’ve seen ﬁrsthand the evolution of HIV meds. What was that moment like when you found out that with the current treatment you were undetectable and could no longer transmit the virus yourself?

exist. That was a sanctuary for me. So, it was a place that I could go to, really to seek refuge from the stress of the HIV diagnosis.

I guess it kind of turned into that. That wasn’t my intent. I was doing Je rey, the play by Paul Rudnick. And I played Darius, so I was able to live out my fantasies and fears on stage because Darius is out and proud. He also, I felt, delivers the most poignant message to the lead character, Je rey, when he turns to Je rey and says, “Je rey, hate AIDS, not life.” And that was a big part of it because I did. I felt isolated. I felt alone. And I was thinking, You know what? Chances are I’m not the only one. So, if I come forward with what I’ve been dealing with, with my HIV, with all of that stu and open that door up, then I would hopefully be letting people in who may be feeling the same way to let them know that they’re not alone.

and so it really forced us to focus in on, OK, let’s just do one dive at a time and not get ahead of ourselves. Because once I hit my head on the springboard, I had no idea if I was going to be strong enough to do my dives on the 10-meter platform. I had to just get through that competition on the three-meter springboard ﬁrst, and then we could look at the other stu later… It really pushed us to focus on the moment, being in the moment.

When you shared with the world in 1995 that you were living with HIV, there was a controversy because in 1988, your head was bleeding while you were in the pool. Did any of the coverage focus on you competing with HIV and winning two gold medals? It seems like a big, very public opportunity to help combat HIV stigma.

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TWO WAYS TREATMENT CAN HELP STOP HIV. Starting HIV treatment as soon as possible and sticking with it every day helps you get to and stay undetectable. That means there is so little virus in the blood that a test can’t measure it. And that’s a good thing, because: BEING UNDETECTABLE HELPS STOP THE DAMAGE HIV CAUSES. CURRENT RESEARCH SHOWS GETTING TO AND STAYING OFPREVENTSUNDETECTABLETHESPREADHIVTHROUGHSEX. There’s no cure for HIV, but if you stick with treatment, you can protect yourself and the people you care about. Talk to a healthcare provider and watch It’s Called Treatment as Prevention at YouTube.com/HelpStopTheVirus GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc. All other marks are the property of their respective owners. © 2020 Gilead Sciences, Inc. All rights reserved. UNBC7537 08/20