E-mail your questions to aahivm@tpan.com, or send a letter in care of “Ask the HIV Specialist,” TPAN, 5537 N. Broadway St., Chicago, IL 60640. The American Academy of HIV Medicine (AAHIVM) is an independent organization of physicians, nurse practitioners, physician assistants and others dedicated to advancing excellence in HIV care through the HIV Specialist™ credentialing program, advocacy work and continuing education opportunities.

Megace, hep C in prison

Chewing tobacco

Hep C treatment side effects

Megace, hep C in prison

I am a 32-year-old inmate in Texas. I am HIV-positive and HCV-positive. As you can imagine, medical information that is accurate is hard to come by in here. I have two questions.

One, I’ve been HIV-positive for 14 years and am currently on Atripla, doing well. Due to difficulty gaining and maintaining weight, I’ve been placed on megestrol (Megace) 40 mg twice a day, as an appetite stimulant. I am aware that this is a progesterone and am wondering how long I can take this safely?

Two, I underwent interferon treatment in 2004 and did well to “clear” it from my system. I am genotype 3. I am wondering if it is possible to be re-infected with a different genotype?

Michael, Dallas, TX

Treatment of men with HIV-associated decreased appetite with megestrol has been associated with reduced testosterone. Additionally, most of the weight gain is fat. This and the expense of this medication has made it less popular. Testosterone deficiency itself is a significant cause of being underweight in men with HIV. In general, it is best to identify and correct the specific cause for the loss of appetite or weight.

Infection with more than one genotype of hepatitis C is rare but has been reported. Infection with different genotypes, one after the other, has also been reported in a few children who received multiple transfusions before the careful testing of the blood supply was begun. Even though this is unusual, you should still be very careful to avoid exposing yourself to any blood-borne infections.

Back to top

Chewing tobacco

I was standing with this person who was chewing tobacco. While talking he spit and some of it went into my eye, about the size of a rice grain. I almost immediately wiped my eye from outside with a cloth and found a tiny browninsh spot. I have heard that these guys often have bleeding gums and assuming that his spit contained saliva mixed with blood, is it capable of transmitting HIV? Although there was no burning sensation and I washed my eye thoroughly after 15 minutes, I am getting stressed out thinking about the possibility of HIV.

Karl, Greenbelt, MD

According to the U.S. Centers for Disease Control and Prevention (CDC), “HIV has been found in the saliva and tears of some persons living with HIV, but in very low quantities. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.”

Saliva without obvious blood is saliva, so you don’t need to be concerned about bleeding gums unless you actually saw the blood.

Back to top

Hep C treatment side effects

Does hepatitis C treatment with interferon or ribavirin damage the immune system? Many of the people I know who have done the treatment experienced big drops in their CD4 counts. This seems to indicate that it could be very dangerous for persons with HIV. Have there been any studies on this?

Also, how harmful are antibiotics to the immune system?

Joe, Oakland, CA

Treatment of hepatitis C with pegylated or standard interferons usually causes a drop in the CD4 counts of patients with HIV co-infection. Because of this, and also because the hepatitis C treatment does not work as well with CD4 counts below 300-400, it is best to start the hepatitis C treatment with the CD4 as high as possible. Sometimes that means treating the HIV first, until the CD4 peaks, before beginning hepatitis C treatment.

Certain HIV medication combinations can be used along with the hepatitis C treatment in some patients. My preference is to avoid this if possible, but sometimes the CD4 drops enough that I have to use the HIV medications during the hepatitis C treatment. It is important to follow the CD4 count and percentage closely during the hepatitis treatment.

Most antibiotics do not damage the immune system. However, your body’s defenses against misbehaving microbes go beyond the immune system. Antibiotics can change the balance among the many types of microbes on your skin as well as in your mouth and gut. This can allow overgrowth and even toxin production by microbes that are usually kept in check by competition and by the immune system. A common example is the yeast (fungus) infection in the mouth or vagina that occasionally occurs in people with normal immunity when they take an antibacterial antibiotic. In addition to killing the bacteria it was prescribed for, it can kill many other harmless bacteria that normally compete with the yeasts. On your body, just like in any marketplace, a monopoly is a bad thing.

Back to top