POZ's Washington Post World AIDS Day Insert

Surviving the Virus november 2009

Your guide to preventing, treating and living with HIv/aids

HIV = AIDS

*

*(HIV can cause AIDS. But it doesn’t have to.)

Debunking the myths of AIDS. From the editors of

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INDICATIONS ISENTRESS is an anti-HIV medicine used for the treatment of HIV. ISENTRESS must be used with other anti-HIV medicines, which may increase the likelihood of response to treatment.

The safety and effectiveness of ISENTRESS in children has not been studied.

It is important that you remain under your doctor’s care.

ISENTRESS will NOT cure HIV infection or reduce your chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system.

Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage.

When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included nausea, headache, tiredness, weakness, and trouble sleeping.

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You are special, unique, and different from anyone else.

And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle.

In clinical studies lasting 48 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada:

Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 6 mg/dL with ISENTRESS plus Truvada versus 16 mg/dL with Sustiva plus Truvada

Ask your doctor about ISENTRESS. isentress.com People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed because their babies could be infected with HIV through their breast milk.

Tell your doctor about all the medicines you take, including prescription medicines like rifampin (a medicine used to treat infections such as tuberculosis), non-prescription medicines, vitamins, and herbal supplements.

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.

For more information about ISENTRESS, please read the Patient Information on the following page.

Need help paying for ISENTRESS? Call 1-866-350-9232

ISENTRESS is a registered trademark of Merck & Co., Inc. Copyright © 2009 Merck & Co., Inc. All rights reserved.

20953087(12)(106)-ISN-CON Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc.

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Had a low rate of side effects — In 4% of patients taking ISENTRESS plus Truvada versus 3% taking Sustiva plus Truvada, the most commonly reported side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping

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Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Tablets

Registered trademark of MERCK & CO., Inc. COPYRIGHT © 2007, 2009 MERCK & CO., Inc. All rights reserved

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Approvals MIS-M9158A Merck Isentress

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Distributed by: MERCK & CO., Inc. Whitehouse Station, NJ 08889, USA Revised October 2009 9795106 U.S. Patent Nos. US 7,169,780

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IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: • The amount of virus (HIV) in your blood may increase if the medicine is stopped for even a short period of time.

• The virus may develop resistance to ISENTRESS and become harder to treat.

• Your medicines may stop working to fight HIV. • The activity of ISENTRESS may be reduced (due to resistance).

If you fail to take ISENTRESS the way you should, here’s what to do: • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do NOT take two tablets of ISENTRESS at the same time. In other words, do NOT take a double dose.

• If you take too much ISENTRESS, call your doctor or local Poison Control Center.

Be sure to keep a supply of your anti-HIV medicines.

• When your ISENTRESS supply starts to run low, get more from your doctor or pharmacy.

• Do not wait until your medicine runs out to get more.

What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, the most common side effects included: • nausea • headache • tiredness • weakness • trouble sleeping Other side effects include rash, severe skin reactions, feeling anxious, depression, suicidal thoughts and actions, paranoia, low blood platelet count.

A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when combination antiretroviral treatment is started. Signs and symptoms of inflammation from opportunistic infections that a person has or had may occur as the medicines work to treat the HIV infection and help to strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS with other anti-HIV medicines.

Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions, muscle problems can be serious and can lead to kidney damage.

Tell your doctor if you have any side effects that bother you.

These are not all the side effects of ISENTRESS. For more information, ask your doctor or pharmacist.

How should I store ISENTRESS? • Store ISENTRESS at room temperature (68 to 77°F).

• Keep ISENTRESS and all medicines out of the reach of children.

General information about the use of ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets.

• Do not use ISENTRESS for a condition for which it was not prescribed.

• Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them.

This leaflet gives you the most important information about ISENTRESS. • If you would like to know more, talk with your doctor.

• You can ask your doctor or pharmacist for additional information about ISENTRESS that is written for health professionals.

• For more information go to www.ISENTRESS.com or call 1-800-622-4477.

What are the ingredients in ISENTRESS? Active ingredient: Each film-coated tablet contains 400 mg of raltegravir.

Inactive ingredients: Microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. In addition, the film coating contains the following inactive ingredients: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide.

Read the patient information that comes with ISENTRESS1 before you start taking it and each time you get a refill. There may be new information. This leaflet is a summary of the information for patients. Your doctor or pharmacist can give you additional information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.

What is ISENTRESS? • ISENTRESS is an anti-HIV (antiretroviral) medicine used for the treatment of HIV. The term HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). ISENTRESS is used along with other anti-HIV medicines. ISENTRESS will NOT cure HIV infection.

• People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that happen with HIV infection.

• Stay under the care of your doctor during treatment with ISENTRESS. • The safety and effectiveness of ISENTRESS in children has not been studied.

ISENTRESS must be used with other anti-HIV medicines.

How does ISENTRESS work?

• ISENTRESS blocks an enzyme which the virus (HIV) needs in order to make more virus. The enzyme that ISENTRESS blocks is called HIV integrase.

• When used with other anti-HIV medicines, ISENTRESS may do two things: 1. Reduce the amount of HIV in your blood. This is called your “viral load”.

2. Increase the number of white blood cells called CD4 (T) cells.

• ISENTRESS may not have these effects in all patients.

Does ISENTRESS lower the chance of passing HIV to other people?

No. ISENTRESS does not reduce the chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

• Continue to practice safer sex.

• Use latex or polyurethane condoms or other barrier methods to lower the chance of sexual contact with any body fluids. This includes semen from a man, vaginal secretions from a woman, or blood.

• Never re-use or share needles.

Ask your doctor if you have any questions about safer sex or how to prevent passing HIV to other people.

What should I tell my doctor before and during treatment with ISENTRESS? Tell your doctor about all of your medical conditions. Include any of the following that applies to you: • You have any allergies.

• You are pregnant or plan to become pregnant.

- ISENTRESS is not recommended for use during pregnancy.

ISENTRESS has not been studied in pregnant women. If you take

ISENTRESS while you are pregnant, talk to your doctor about how

you can be included in the Antiretroviral Pregnancy Registry.

• You are breast-feeding or plan to breast-feed.

- It is recommended that HIV-infected women should not breast-feed their infants. This is because their babies could be infected with HIV through their breast milk.

- Talk with your doctor about the best way to feed your baby.

Tell your doctor about all the medicines you take. Include the following: • prescription medicines, including rifampin (a medicine used to treat some infections such as tuberculosis) • non-prescription medicines • vitamins • herbal supplements Know the medicines you take.

• Keep a list of your medicines. Show the list to your doctor and pharmacist when you get a new medicine.

How should I take ISENTRESS? Take ISENTRESS exactly as your doctor has prescribed. The recommended dose is as follows: • Take only one 400-mg tablet at a time.

• Take it twice a day.

• Take it by mouth.

• Take it with or without food.

Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

surviving the virus

Risky Business One of the most dangerous things about HIV—and a core reason the virus continues to spread—is the myth that only certain kinds of people who engage in certain types of behavior can get HIV/AIDS.

CONTENTS

5 Risky Business 6 HIV/AIDS: The Basics 7 The Top 10 Myths About

HIV/AIDS

12 Get Tested For HIV 13 Surviving–And Thriving—

With HIV/AIDS

13 The Horizon Of HIV Care 14 Why Safer Sex Can Be Sexy Sex 15 Regan Hofmann Interviews

Jeffrey S. Crowley

Surviving the virus Publisher: Bobby Huebner bobby.huebner@mediaplanet.com

T

he truth is, anyone can get HIV/AIDS. HIV/AIDS is not a gay disease, not an African-American disease and not a disease of poor people. It is not the exclusive domain of sex workers, injection drug users or promiscuous people. It is a disease, period. And the only way you can know for sure that you don’t have it is to get tested.

The beliefs that “people like me don’t get HIV” or “the people I have slept with couldn’t have HIV” translated into 56,300 new HIV infections in the United States in 2006 alone. That same thinking has led to the 33 million people estimated to be living with HIV around the world today—and the 25 million the virus has already laid to rest. It’s also responsible for the fact that more than 15,000,000 children worldwide are AIDS orphans. Yes, 15 million.

In collaboration with POZ Magazine: Editor-in-Chief, Regan Hofmann Publisher, Megan Strub Editor, David Evans Editor, Tim Horn Editor, Jennifer Morton

Designer: Carrie Reagh carrie.reagh@mediaplanet.com Photos: ©iStockphoto.com Printer: The Washington Post For more information about supplements in the daily press, please ­contact Kayvan Salmanpour, 1 646 922 1400 kayvan.salmanpour@mediaplanet.com

Another challenging aspect of HIV/ AIDS is the stigma surrounding the disease. Stigma prevents people from getting tested and from accessing the care, treatment and emotional support they need to survive.

It keeps people from taking medications that can keep them alive and can lower their viral loads so they are rendered less infectious (regardless of whether or not they practice safe sex and drug injection). Stigma also hampers awareness and education efforts, perpetuating grave misperceptions about HIV/AIDS. AIDS stigma also makes it harder for us to raise the funds and secure the political capital we need to successfully beat this pandemic.

For all these reasons—and for how it breaks the spirit of the people fighting for their lives—HIV-related stigma is every bit as deadly as the virus itself.

Because many people living with

by: regan Hofmann, editor-in-chief, poz magazine / poz.com

HIV fear shame, rejection and discrimination, they are, understandably, less inclined to disclose that they are living with HIV. As the editor of POZ— a magazine for people living with and affected by HIV/AIDS—I hear this every day. According to a recent POZ survey, 65 percent of people said that the fear of HIV-related stigma prevented them from disclosing to family members. When people living with the virus remain hidden, HIV/AIDS remains unseen—and disembodied. And if people have an inaccurate impression of who is living with HIV, they are less likely to take the necessary precautions to prevent getting it.

When we don’t think HIV can enter our lives, it may. I know this is true; it happened to me. After the AIDS hysteria of the late ’80s subsided, I let down my guard and had unprotected sex with a man in the mid ’90s who didn’t know he had HIV and who gave the virus to me. For 10 years, I told no one but my immediate family. I lived in isolation and secrecy. A decade later, I realized I had done nothing wrong, or, if I had, it was the same thing hundreds of millions of people around the world do every day—make the choice to have unprotected sex with someone you know, trust and care for.

Feeling it was not right for me to have to die silent and alone, and wanting to help people understand that everyone who has unprotected sex is at risk for contracting the HIV, I decided to tell my story.

I wrote anonymously for five years for POZ, and then in 2006, I became its editor-in-chief. I took the position because I wanted to convince Americans that the AIDS epidemic is far from over—and that HIV sometimes

looks like me. Our hope in writing this special HIV/AIDS supplement is that you will realize that HIV could look— or may already look—like you, too. As frightening as it is to face a diagnosis of HIV—it is more frightening to face severe illness and death caused by AIDS. The key to avoiding AIDS is to find out your HIV status and get into care and treatment, if needed, as soon as possible. As with many life-threatening diseases, early detection of HIV can increase your chance of survival.

On the occasion of this year’s World AIDS Day—marked annually December 1—we ask that every American get tested for HIV. Those of you who are parents should also get your children tested for HIV. It can take as little as 20 minutes, it’s painless, and it can save lives—not to mention reduce health care costs.

Knowing your HIV status is also a social responsibility; if you don’t get tested and are having unprotected sex, you are endangering the lives of others. If you are having unprotected sex with people who haven’t shown you their HIV test results, you are risking your own life. So please do yourself, your family, your friends and America a favor—get tested for HIV today. For information on where to get a test for HIV, what to do if you’re newly diagnosed and how to prevent the spread of HIV, visit poz.com.

I am living proof that HIV/AIDS is alive and well in America. Please stand with me in defiance of denial, fear and ignorance—for the sake of your own longevity and for the health of all people around the world.

All editorial content is ©2009 POZ/CDM Publishing LLC and has been licensed for use in this publication and did not involve The Washington Post News ­ or Editorial Departments.

www.mediaplanet.com www.poz.com

Regan Hofmann, Editor-in-Chief

© 2009 Bill Wadman

POZ Magazine / poz.com

Regan Hofmann

surviving the virus

HIV/AIDS: The Basics

The difference between the virus and the disease If you have HIV, you may not necessarily have, or ever get, AIDS. But if you have AIDS, then you are definitely HIV positive. In short, HIV is the virus that can cause AIDS. But being HIV positive does not mean that you will necessarily get sick or die of an AIDS-related illness. immune system. “Syndrome” refers to a group of health problems that make up a disease.

HIV stands for “human immunodeficiency virus.” The virus, discovered in 1983 as the cause of AIDS, is most commonly spread through the exchange of bodily fluids during sexual contact or by reusing an HIV-

AIDS Is Not (Just) an African Disease The infection rate in District of Columbia is the same as that of some sub-Saharan African countries.

The United Nations Joint Program on HIV/AIDS (UNAIDS) and the U.S. Centers for Disease Control and Prevention (CDC) define an HIV epidemic as generalized and severe when the overall percentage of disease among residents of a specific geographic area exceeds 1 percent.

The HIV infection rate in the District of Columbia is 3 percent.

HIV/AIDS is not just a disease that happens in Africa. In fact, HIV rates in Washington, DC, surpass those of West Africa and are on par with Uganda and parts of Kenya.

Increased HIV testing of people all over the United States will provide the most accurate picture of current infection rates nationwide.

Currently the Centers for Disease Control and Prevention reports data collected from 33 states.

positive person’s drug-injection equipment. HIV-positive women can transmit the virus to their child before or during birth, or through breast feeding. HIV can also be spread through blood transfusions, transplanted organs and tissue, or blood clotting factors. However, this is now very rare in most countries.

suppressed immune systems.

Being HIV positive is not the same as having AIDS. Many people are HIV positive—meaning that they have HIV—but don’t get sick for many years, if at all. Without treatment, it can take 10 to 12 years for a person to progress to AIDS from the time of HIV infection.

With care and treatment, HIV progression can be delayed or reversed—but not cured—for many years. Today, people with HIV who take effective antiretroviral therapy without missing any doses can expect to live a nearly normal lifespan.

HIV Is Still on the Rise—And It Is Still Deadly More people are living with HIV/AIDS than ever before—including an estimated 1.1 million people in the United States and 33 million people worldwide. Of the 1.1 million Americans living with HIV/AIDS, nearly one quarter of them—or more than 250,000 are not aware they are living with the virus. And it is estimated that the majority of new HIV infections are passed on by people who don’t know that they themselves are living with the virus. Which means your statistical odds of getting HIV are higher than ever before. Consider these facts: • In 2007, 14,561 people died of an AIDS-related illness in the United States. The same year, 2 million people died of an AIDS-related illness worldwide.

• More than 25 million people have died of an AIDS-related illness since the beginning of the epidemic.

• HIV/AIDS is the leading cause of death and disease among women between the ages of 15 and 44 worldwide.

• Accessing care and treatment is key to avoiding AIDS-related illnesses and death. Worldwide, at least 5 million people living with HIV who require treatment do not have access to that treatment. And in the United States, a recent analysis found that in 2003, only 55 percent of those who needed treatment were receiving it. Across the country the AIDS Drug Assistance Program (ADAP) of the federal Ryan White program provides assistance to people living with HIV who have limited or no prescription drug coverage. There are currently 247 people on ADAP waiting lists in eight states.

“Other than its stigma, HIV is no different from any other health issue.”

Leatrice Simpson, diagnosed in 1992

© 2009 Katrina Wittkamp

A

IDS stands for “acquired immune deficiency syndrome.”

“Acquired” means that the disease does not occur naturally in the body, but develops after contracting something that can cause the disease—in this case, HIV. “Immune deficiency” means that it is associated with a weakening of the body’s

HIV attacks the immune system, notably its CD4 cells (also known as “T cells” or “T-helper cells”). CD4s are white blood cells that command other white blood cells to fight disease.

If HIV kills enough CD4 cells, the immune system loses its ability to protect the body from serious infections and cancers. These are called “opportunistic infections” (OIs) because they take advantage of a weakened immune system. People don’t actually die of AIDS, but rather the OIs that can develop and prove very difficult to treat in people with

surviving the virus

The Top 10 Myths About HIV/AIDS

1 2 3 4 5

HIV/AIDS is under control in America.

Truth: More Americans are living with HIV than ever before, and new infection rates were recently shown to be 40 percent higher than previously reported. The most recent data show that in 2006 alone, there were 56,300 new cases of this preventable disease. HIV/AIDS is the No. 1 killer of African-American women ages 25 to 34. While access to care has rendered HIV a survivable disease for many, there are people who are diagnosed too late in the progression of the disease to save them. And there are people who can’t afford access to drugs and whose lives hang in the balance while they wait for federal funding to provide care and medicine.

Magic Johnson has been cured of HIV. Truth: Magic Johnson is taking one of the antiretroviral (ARV) drug regimens available in the United States. Though the drugs may have reduced his viral load to an undetectable level (meaning that the amount of virus in his blood is too small to be detected using sensitive tests), the virus lies quietly in reservoirs in the immune system tissue and organs and can and will begin to replicate again if treatment is stopped permanently. An undetectable viral load does not mean you have been cured of HIV, nor does it mean you are noninfectious (though you may be less infectious than if your viral load is detectable, especially if it is high).

HIV-positive people can’t have HIV-negative children.

Truth: Not only is it possible for an HIV-positive woman to deliver an HIV-negative baby, but it is also possible for serodiscordant couples—in which one partner is HIV positive and the other is HIV negative—to conceive safely. Conception requires careful use of HIV treatments, ideally combined with the help of a fertility clinic that specializes in helping people with infectious diseases. If a woman receives ARV treatment while she is pregnant—and keeps her viral load undetectable—the risk of her passing the virus to her baby is 2 percent (or less).

I donated blood or had my blood work done by my doctor so I have been tested for HIV. Truth: Just because you have given blood, say to the Red Cross, or your doctor has ordered blood work, you have not necessarily been tested for HIV. Donor blood is screened for HIV, but the system for tracking donors who give HIV-positive blood is imperfect and you might not be contacted even if you are HIV positive. In some states, in order for your doctor to test you for HIV, it is legally required that you provide written consent. So, unless you have signed a form saying you agree to be tested for HIV, you might not have been tested.

6 7 8 9 10

I am not gay and have never slept with someone who is gay or bisexual so I can’t have HIV/AIDS. Truth: HIV/AIDS is not a disease that affects only gay people. In fact, of the estimated number of HIV/AIDS cases that were reported in 2007, 32 percent were transmitted through heterosexual contact. Anyone can have HIV/AIDS. I am married and in a monogamous relationship so I am not at risk for HIV/AIDS. Truth: Given the infidelity rates worldwide, marriage isn’t necessarily a safeguard against HIV/AIDS because many married couples do not use condoms. Plus, many couples do not get tested before getting married. So, it is possible that one, or both, partners could have contracted HIV before the marriage. Even married couples should get regularly screened for HIV. I only date “nice” people so I won’t get HIV/AIDS. Truth: There is no way to tell whether or not someone has HIV/AIDS. It can take years for symptoms to develop after the initial exposure. A person’s moral character or pedigree plays no role in whether or not he or she has been exposed to HIV. Anyone who has ever had unprotected sex may have come into contact with HIV and should be tested.

You can get HIV from hugging someone who has the virus, from kissing them, from swimming in a pool with them or from drinking from their glass.

Truth: None of these things transmits HIV. Nor does sharing a hair brush, makeup brush, towel, bed or pillow. However, it’s probably best to avoid sharing a toothbrush or a razor with someone who is HIV positive because these items can cause cuts and scrapes and blood left on the objects could potentially transmit HIV. HIV doesn’t cause AIDS; AIDS is a conspiracy theory created by the government to kill off unwanted segments of the population and to make pharmaceutical companies rich.

Truth: The relationship between HIV and AIDS has been empirically, scientifically proved. The small minority of people who still question whether this is true are often referred to as “AIDS denialists.”This line of thinking has led to the deaths of hundreds of thousands of people around the world whose lives could otherwise have been saved through ARV treatment.

“We should get rid of the term ‘high-risk’ and just talk about any risk for HIV.” © 2009 Collin Erie

© 2009 Katrina Wittkamp

HIV is totally manageable and, thus, no longer a big deal.

Truth: Though HIV is much easier to manage than it once was, the fine print is significant. For starters, people continue to be infected with drug-resistant strains of HIV, potentially limiting the number of treatment options available to them. Second, HIV treatment is not without potential side effects, some of which can be serious

and debilitating. Third, HIV treatment is a lifetime commitment and must be taken like clockwork to avoid the emergence of drug-resistant HIV. It is also very expensive.

Finally, research shows that people living with HIV—even those being treated successfully with ARV medications—appear to be at a higher risk for certain age-related diseases earlier in life, including some cancers, cardiovascular disease and weakened bones. So, HIV/AIDS can be manageable, yes, but with a large number of serious issues remaining.

myths/truths

What you don’t know about HIV/AIDS could be killing you.

Yvette Ogletree, diagnosed in 2003

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IMPORTANT INFORMATION ABOUT REYATAZ® (atazanavir sulfate) INDICATION: REYATAZ is a prescription medicine used in combination with other medicines to treat people who are infected with the human immunodeficiency virus (HIV). REYATAZ has been studied in a 48-week trial in patients who have taken anti-HIV medicines and a 96-week trial in patients who have never taken anti-HIV medicines.

REYATAZ does not cure HIV or lower your chance of passing HIV to others.

IMPORTANT SAFETY INFORMATION: Do not take REYATAZ if you are allergic to REYATAZ or to any of its ingredients.

Do not take REYATAZ if you are taking the following medicines due to potential for serious, life-threatening side effects or death:Versed® (midazolam) when taken by mouth, Halcion® (triazolam), ergot medicines (dihydroergotamine, ergonovine, ergotamine, and methylergonovine such as Cafergot®, Migranal®, D.H.E. 45®, ergotrate maleate, Methergine®, and others), Propulsid® (cisapride), or Orap® (pimozide).

Do not take REYATAZ with the following medicines due to potential for serious side effects: Camptosar® (irinotecan), Crixivan® (indinavir), Mevacor® (lovastatin), or Zocor® (simvastatin).

Do not take REYATAZ with the following medicines as they may lower the amount of REYATAZ in your blood, which may lead to increased HIV viral load and resistance to REYATAZ or other anti-HIV medicines: rifampin (also known as Rimactane®, Rifadin®, Rifater®, or Rifamate®), St. John’s wort (Hypericum perforatum)-containing products, or Viramune® (nevirapine).

Do not take Vfend® (voriconazole) if you are taking REYATAZ and Norvir® (ritonavir).

The above lists of medicines are not complete. Taking REYATAZ with some other medicines may require your therapy to be monitored more closely or may require a change in dose or dose schedule of REYATAZ or the other medicine. Discuss with your healthcare provider all prescription and non-prescription medicines, vitamin and herbal supplements, or other health preparations you are taking or plan to take.

Tell your healthcare provider if you are pregnant, breast-feeding, planning to become pregnant or breast-feed, or if you have end-stage kidney disease managed with hemodialysis or severe liver dysfunction.

Tell your healthcare provider right away if you have any side effects, symptoms, or conditions, including the following: • Mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started, and usually goes away within 2 weeks with no change in treatment.

• Severe rash has occurred in a small number of patients taking REYATAZ.This type of rash is associated with other symptoms that could be serious and potentially cause death. If you develop a rash with any of the following symptoms, stop using REYATAZ and call your healthcare provider right away: – Shortness of breath – Conjunctivitis (red or inflamed eyes, like “pink-eye”) – General ill-feeling or “flu-like” symptoms – Blisters – Fever – Mouth sores – Muscle or joint aches – Swelling of your face • Yellowing of the skin and/or eyes may occur due to increases in bilirubin levels in the blood (bilirubin is made by the liver).

• A change in the way your heart beats may occur. You may feel dizzy or lightheaded. These could be symptoms of a heart problem.

• Diabetes and high blood sugar may occur in patients taking protease inhibitor medicines like REYATAZ. Some patients may need changes in their diabetes medicine.

• If you have liver disease, including hepatitis B or C, it may get worse when you take anti-HIV medicines like REYATAZ. • Kidney stones have been reported in patients taking REYATAZ. Signs or symptoms of kidney stones include pain in your side, blood in your urine, and pain when you urinate.

• Some patients with hemophilia have increased bleeding problems with protease inhibitor medicines like REYATAZ. • Changes in body fat have been seen in some patients taking anti-HIV medicines.The cause and long-term effects are not known at this time.

• Gallbladder disorders (including gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ.

On REYATAZ, Wedn e Ma rysda y birth ’s d pa rty a y

Thursda y 5:30 C h oi r practice Bu y new shoes for Latish a

Fight HIV your way.

Other common side effects of REYATAZ taken with other anti-HIV medicines include: nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.

You should take REYATAZ once daily with food (a meal or snack). Swallow the capsules whole; do not open the capsules. You should take REYATAZ and your other anti-HIV medicines exactly as instructed by your healthcare provider.

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

Please see Important Patient Information about REYATAZ on adjacent pages.

how you spend your time is up to you.

Individual results may vary.

Once-daily REYATAZ can fit into your schedule and help fight your HIV. REYATAZ, a protease inhibitor (PI), in HIV combination therapy: Can help lower your viral load and raise your T-cell (CD4+ cell) count ◆ Has a low chance of diarrhea (shown in clinical trials)* ◆ Is taken once a day with a snack or meal

◆

* REYATAZ in combination therapy had a 1%-3% rate of moderate-to-severe diarrhea.

REYATAZ is one of several treatment options your doctor may consider.

Ask your healthcare team about REYATAZ. www.REYATAZ.com REYATAZ does not cure HIV, a serious disease, and has not been shown to reduce the risk of passing HIV to others.

REYATAZ is a registered trademark of Bristol-Myers Squibb. SUSTIVA is a registered trademark of Bristol-Myers Squibb.

All other trademarks are the property of their respective owners and not of Bristol-Myers Squibb. © 2009 Bristol-Myers Squibb, Princeton, NJ 08543 U.S.A. 687US09AB10107

11/09

687US09AB10107_20.5x12_Spread_v7:- 11/16/09 1:11 PM Page 3

FDA-Approved Patient Labeling Patient Information

REYATAZÂŽ (RAY-ah-taz) (generic name = atazanavir sulfate) Capsules

ALERT: Find out about medicines that should NOT be taken with REYATAZ (atazanavir sulfate). Read the section “What important information should I know about taking REYATAZ with other medicines?�

Read the Patient Information that comes with REYATAZ before you start using it and each time you get a refill. There may be new information. This leaflet provides a summary about REYATAZ and does not include everything there is to know about your medicine. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is REYATAZ? REYATAZ is a prescription medicine used with other anti-HIV medicines to treat people who are infected with the human immunodeficiency virus (HIV). HIV is the virus that causes acquired immune deficiency syndrome (AIDS). REYATAZ is a type of anti-HIV medicine called a protease inhibitor. HIV infection destroys CD4+ (T) cells, which are important to the immune system. The immune system helps fight infection. After a large number of (T) cells are destroyed, AIDS develops.

REYATAZ helps to block HIV protease, an enzyme that is needed for the HIV virus to multiply. REYATAZ may lower the amount of HIV in your blood, help your body keep its supply of CD4+ (T) cells, and reduce the risk of death and illness associated with HIV. Does REYATAZ cure HIV or AIDS? REYATAZ does not cure HIV infection or AIDS. At present there is no cure for HIV infection. People taking REYATAZ may still get opportunistic infections or other conditions that happen with HIV infection. Opportunistic infections are infections that develop because the immune system is weak. Some of these conditions are pneumonia, herpes virus infections, and Mycobacterium avium complex (MAC) infections. It is very important that you see your healthcare provider regularly while taking REYATAZ. REYATAZ does not lower your chance of passing HIV to other people through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom or other barrier to lower the chance of sexual contact with semen, vaginal secretions, or blood. Never use or share dirty needles.

Who should not take REYATAZ? Do not take REYATAZ if you: t are taking certain medicines. (See “What important information should I know about taking REYATAZ with other medicines?�) Serious life-threatening side effects or death may happen. Before you take REYATAZ, tell your healthcare provider about all medicines you are taking or planning to take.

These include other prescription and nonprescription medicines, vitamins, and herbal supplements. t are allergic to REYATAZ or to any of its ingredients. The active ingredient is atazanavir sulfate. See the end of this leaflet for a complete list of ingredients in REYATAZ. Tell your healthcare provider if you think you have had an allergic reaction to any of these ingredients.

What should I tell my healthcare provider before I take REYATAZ? Tell your healthcare provider: t If you are pregnant or planning to become pregnant. It is not known if REYATAZ can harm your unborn baby. Pregnant women have experienced serious side effects when taking REYATAZ with other HIV medicines called nucleoside analogues. You and your healthcare provider will need to decide if REYATAZ is right for you. If you use REYATAZ while you are pregnant, talk to your healthcare provider about the Antiretroviral Pregnancy Registry. t If you are breast-feeding. You should not breast-feed if you are HIV-positive because of the chance of passing HIV to your baby. Also, it is not known if REYATAZ can pass into your breast milk and if it can harm your baby. If you are a woman who has or will have a baby, talk with your healthcare provider about the best way to feed your baby. t If you have liver problems or are infected with the hepatitis B or C virus.

See “What are the possible side effects of REYATAZ?� t If you have end stage kidney disease managed with hemodialysis. t If you have diabetes. See “What are the possible side effects of REYATAZ?� t If you have hemophilia. See “What are the possible side effects of REYATAZ?� t About all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Keep a list of your medicines with you to show your healthcare provider. For more information, see “What important information should I know about taking REYATAZ with other medicines?� and “Who should not take REYATAZ?� Some medicines can cause serious side effects if taken with REYATAZ.

REYATAZÂŽ (atazanavir sulfate) How should I take REYATAZ? t T ake REYATAZ once every day exactly as instructed by your healthcare provider. Your healthcare provider will prescribe the amount of REYATAZ that is right for you.

t 'PS BEVMUT XIP IBWF OFWFS UBLFO BOUJ )*7 NFEJDJOFT CFGPSF UIF dose is 300 mg once daily with 100 mg of NORVIRÂŽ (ritonavir) once daily taken with food. For adults who are unable to tolerate ritonavir, 400 mg (two 200-mg capsules) once daily (without NORVIRÂŽ) taken with food is recommended.

t 'PS BEVMUT XIP IBWF UBLFO BOUJ )*7 NFEJDJOFT JO UIF QBTU UIF VTVBM dose is 300 mg plus 100 mg of NORVIRÂŽ (ritonavir) once daily taken with food. t :PVS EPTF XJMM EFQFOE PO ZPVS MJWFS GVODUJPO BOE PO UIF PUIFS BOUJ )*7 medicines that you are taking. REYATAZ is always used with other anti-HIV medicines. If you are taking REYATAZ with SUSTIVAÂŽ (efavirenz) or with VIREADÂŽ (tenofovir disoproxil fumarate), you should also be taking NORVIRÂŽ (ritonavir). t Always take REYATAZ with food (a meal or snack) to help it work better.

Swallow the capsules whole. Do not open the capsules. Take REYATAZ at the same time each day. t If you are taking antacids or didanosine (VIDEXŽ or VIDEXŽ EC), take REYATAZ 2 hours before or 1 hour after these medicines. t If you are taking medicines for indigestion, heartburn, or ulcers such as AXIDŽ (nizatidine), PEPCID ACŽ (famotidine), TAGAMETŽ (cimetidine), ZANTACŽ (ranitidine), AcipHexŽ (rabeprazole), NEXIUMŽ (esomeprazole), PREVACIDŽ (lansoprazole), PRILOSECŽ (omeprazole), or PROTONIXŽ (pantoprazole), talk to your healthcare provider. t Do not change your dose or stop taking REYATAZ without first talking with your healthcare provider. It is important to stay under a healthcare provider’s care while taking REYATAZ. t When your supply of REYATAZ starts to run low, get more from your healthcare provider or pharmacy. It is important not to run out of REYATAZ. The amount of HIV in your blood may increase if the medicine is stopped for even a short time. t If you miss a dose of REYATAZ, take it as soon as possible and then take your next scheduled dose at its regular time. If, however, it is within 6 hours of your next dose, do not take the missed dose. Wait and take the next dose at the regular time. Do not double the next dose. It is important that you do not miss any doses of REYATAZ or your other anti-HIV medicines. t If you take more than the prescribed dose of REYATAZ, call your healthcare provider or poison control center right away.

Can children take REYATAZ? Dosing recommendations are available for children 6 years of age and older for REYATAZ Capsules. Dosing recommendations are not available for children from 3 months to less than 6 years of age. REYATAZ should not be used in babies under the age of 3 months.

What are the possible side effects of REYATAZ? The following list of side effects is not complete. Report any new or continuing symptoms to your healthcare provider. If you have questions about side effects, ask your healthcare provider. Your healthcare provider may be able to help you manage these side effects.

The following side effects have been reported with REYATAZ: t mild rash (redness and itching) without other symptoms sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started. Rashes usually go away within 2 weeks with no change in treatment. Tell your healthcare provider if rash occurs. t severe rash: In a small number of patients, a rash can develop that is associated with other symptoms which could be serious and potentially cause death.

If you develop a rash with any of the following symptoms stop using REYATAZ and call your healthcare provider right away:

t TIPSUOFTT PG CSFBUI

t HFOFSBM JMM GFFMJOH PS iGMV MJLFw TZNQUPNT

t GFWFS

t NVTDMF PS KPJOU BDIFT

t DPOKVODUJWJUJT SFE PS JOGMBNFE FZFT MJLF iQJOL FZFw

t CMJTUFST

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REYATAZÂŽ (atazanavir sulfate) y ellowing of the skin or eyes. These effects may be due to increases in bilirubin levels in the blood (bilirubin is made by the liver). Call your healthcare provider if your skin or the white part of your eyes turn yellow.

Although these effects may not be damaging to your liver, skin, or eyes, it is important to tell your healthcare provider promptly if they occur. t a change in the way your heart beats (heart rhythm change). Call your healthcare provider right away if you get dizzy or lightheaded. These could be symptoms of a heart problem. t diabetes and high blood sugar (hyperglycemia) sometimes happen in patients taking protease inhibitor medicines like REYATAZ. Some patients had diabetes before taking protease inhibitors while others did not. Some patients may need changes in their diabetes medicine. t if you have liver disease including hepatitis B or C, your liver disease may get worse when you take anti-HIV medicines like REYATAZ. t kidney stones have been reported in patients taking REYATAZ. If you develop signs or symptoms of kidney stones (pain in your side, blood in your urine, pain when you urinate) tell your healthcare provider promptly. t some patients with hemophilia have increased bleeding problems with protease inhibitors like REYATAZ. t changes in body fat. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump�), breast, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known at this time.

Other common side effects of REYATAZ taken with other anti-HIV medicines include nausea; headache; stomach pain; vomiting; diarrhea; depression; fever; dizziness; trouble sleeping; numbness, tingling, or burning of hands or feet; and muscle pain.

Gallbladder disorders (which may include gallstones and gallbladder inflammation) have been reported in patients taking REYATAZ. What important information should I know about taking REYATAZ with other medicines?

Do not take REYATAZ if you take the following medicines (not all brands may be listed; tell your healthcare provider about all the medicines you take).

REYATAZ may cause serious, life-threatening side effects or death when used with these medicines. t &SHPU NFEJDJOFT EJIZESPFSHPUBNJOF FSHPOPWJOF FSHPUBNJOF BOE methylergonovine such as CAFERGOTŽ, MIGRANALŽ, D.H.E. 45Ž, ergotrate maleate, METHERGINEŽ, and others (used for migraine headaches). t 03"1Ž (pimozide, used for Tourette’s disorder). t 13016-4*%Ž (cisapride, used for certain stomach problems). t 5SJB[PMBN BMTP LOPXO BT )"-$*0/Ž (used for insomnia).

M t idazolam, also known as VERSEDÂŽ (used for sedation), when taken by mouth.

Do not take the following medicines with REYATAZ because of possible serious side effects: t $".1504"3ÂŽ (irinotecan, used for cancer). t $3*9*7"/ÂŽ JOEJOBWJS VTFE GPS )*7 JOGFDUJPO #PUI 3&:"5"; BOE $3*9*7"/ sometimes cause increased levels of bilirubin in the blood. t Cholesterol-lowering medicines MEVACORÂŽ (lovastatin) or ZOCORÂŽ (simvastatin).

Do not take the following medicines with REYATAZ because they may lower the amount of REYATAZ in your blood. This may lead to an increased HIV viral load. Resistance to REYATAZ or cross-resistance to other HIV medicines may EFWFMPQ t 3JGBNQJO BMTP LOPXO BT 3*."$5"/&ÂŽ, RIFADINÂŽ, RIFATERÂŽ, or RIFAMATEÂŽ, used for tuberculosis). t 4U +PIO T XPSU (Hypericum perforatum), an herbal product sold as a dietary TVQQMFNFOU PS QSPEVDUT DPOUBJOJOH 4U +PIO T XPSU t 7*3".6/&ÂŽ (nevirapine, used for HIV infection).

Do not take the following medicine if you are taking REYATAZ and NORVIRÂŽ together: t 7'&/%ÂŽ (voriconazole).

The following medicines may require your healthcare provider to monitor your therapy more closely: t $*"-*4ÂŽ (tadalafil), LEVITRAÂŽ (vardenafil), or VIAGRAÂŽ (sildenafil). REYATAZ may increase the chances of serious side effects that can happen with CIALIS, LEVITRA, or VIAGRA. Do not use CIALIS, LEVITRA, or VIAGRA while you are taking REYATAZ unless your healthcare provider tells you it is okay. t -*1*503ÂŽ (atorvastatin) or CRESTORÂŽ (rosuvastatin). There is an increased chance of serious side effects if you take REYATAZ with this cholesterollowering medicine. t .FEJDJOFT GPS BCOPSNBM IFBSU SIZUIN $03%"30/&ÂŽ (amiodarone), lidocaine, quinidine (also known as CARDIOQUINÂŽ 26*/*%&9ÂŽ, and others). t 7"4$03ÂŽ (bepridil, used for chest pain). t

REYATAZÂŽ (atazanavir sulfate) $06."%*/ (warfarin).

5 SJDZDMJD BOUJEFQSFTTBOUT TVDI BT &-"7*-ÂŽ (amitriptyline), NORPRAMINÂŽ (desipramine), SINEQUANÂŽ (doxepin), SURMONTILÂŽ (trimipramine), TOFRANILÂŽ (imipramine), or VIVACTILÂŽ (protriptyline). t .FEJDJOFT UP QSFWFOU PSHBO USBOTQMBOU SFKFDUJPO 4"/%*..6/&ÂŽ or NEORALÂŽ (cyclosporin), RAPAMUNEÂŽ (sirolimus), or PROGRAFÂŽ (tacrolimus). t 5IF BOUJEFQSFTTBOU USB[PEPOF %&4:3&-ÂŽ and others). t 'MVUJDBTPOF QSPQJPOBUF "%7"*3ÂŽ, FLONASEÂŽ, FLOVENTÂŽ), given by nose or inhaled to treat allergic symptoms or asthma. Your doctor may choose not to keep you on fluticasone, especially if you are also taking NORVIRÂŽ.

The following medicines may require a change in the dose or dose schedule of either REYATAZ or the other medicine: t */7*3"4&ÂŽ (saquinavir). t /037*3ÂŽ (ritonavir). t 4645*7"ÂŽ (efavirenz). t "OUBDJET PS CVGGFSFE NFEJDJOFT t 7*%&9ÂŽ (didanosine). t 7*3&"%ÂŽ (tenofovir disoproxil fumarate). t .:$0#65*/ÂŽ (rifabutin). t $BMDJVN DIBOOFM CMPDLFST TVDI BT $"3%*;&.ÂŽ or TIAZACÂŽ (diltiazem), COVERA-HSÂŽ or ISOPTIN SRÂŽ (verapamil) and others. t #*"9*/ÂŽ (clarithromycin). t .FEJDJOFT GPS JOEJHFTUJPO IFBSUCVSO PS VMDFST TVDI BT "9*%ÂŽ (nizatidine), PEPCID ACÂŽ (famotidine), TAGAMETÂŽ (cimetidine), or ZANTACÂŽ (ranitidine).

Talk to your healthcare provider about choosing an effective method of contraception. REYATAZ may affect the safety and effectiveness of hormonal contraceptives such as birth control pills or the contraceptive patch. Hormonal contraceptives do not prevent the spread of HIV to others.

Remember: 1.

Know all the medicines you take.

2.

Tell your healthcare provider about all the medicines you take.

3.

Do not start a new medicine without talking to your healthcare provider.

How should I store REYATAZ? t 4UPSF 3&:"5"; $BQTVMFT BU SPPN UFNQFSBUVSF ÂĄ UP ÂĄ ' ÂĄ UP ÂĄ $

Do not store this medicine in a damp place such as a bathroom medicine cabinet or near the kitchen sink. t ,FFQ ZPVS NFEJDJOF JO B UJHIUMZ DMPTFE DPOUBJOFS t ,FFQ BMM NFEJDJOFT PVU PG UIF SFBDI PG DIJMESFO BOE QFUT BU BMM UJNFT %P OPU keep medicine that is out of date or that you no longer need. Dispose of unused medicines through community take-back disposal programs when available or place REYATAZ in an unrecognizable, closed container in the household trash.

General information about REYATAZ This medicine was prescribed for your particular condition. Do not use REYATAZ for another condition. Do not give REYATAZ to other people, even if they have the same symptoms you have. It may harm them. Keep REYATAZ and all medicines out of the reach of children and pets.

This summary does not include everything there is to know about REYATAZ. Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Remember no written summary can replace careful discussion with your healthcare provider. If you would like more information, talk XJUI ZPVS IFBMUIDBSF QSPWJEFS PS ZPV DBO DBMM What are the ingredients in REYATAZ? Active Ingredient: atazanavir sulfate Inactive Ingredients: Crospovidone, lactose monohydrate (milk sugar), magnesium stearate, gelatin, FD&C Blue #2, and titanium dioxide.

7*%&9ÂŽ and REYATAZÂŽ are registered trademarks of Bristol-Myers Squibb Company. COUMADINÂŽ and SUSTIVAÂŽ are registered trademarks of Bristol-Myers Squibb Pharma Company. DESYRELÂŽ JT B SFHJTUFSFE USBEFNBSL PG .FBE +PIOTPO and Company. Other brands listed are the trademarks of their respective owners and are not trademarks of Bristol-Myers Squibb Company.

64 1BUFOU /PT BOE t t

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1SJODFUPO /+ 64" 1246226A5

F1-B0001B- 3FW /PWFNCFS

surviving the virus

Get Tested For HIV

An HIV diagnosis may be scary, but isn’t it more frightening to think of dying unnecessarily from a disease you can treat and survive?

If you’ve ever—even once—been sexually active without protection, reused an HIV-positive person’s drug injection equipment or were given a blood transfusion or transplant before 1985, getting tested for HIV is a smart thing to do. Not only will knowing your status allow you to stay healthy—it will also help you take action to protect your sexual partners.

© 2009 Amando Bellmas

T

“I want people to get tested because early diagnosis is key.

That’s why I speak out about being positive.”

Chelsea Gulden, diagnosed in 2003

RIU09_MediaPlanetAd.indd 1

he most common diagnostic tool for HIV infection is a blood test that detects proteins created by the immune system to fight infections. If your first test, called an EIA, is positive or indeterminate, your blood will be tested a second time using a more sensitive test known as the Western blot. If that test is also positive, it means you have the virus.

There are also rapid HIV tests that give an answer in as little as 20 minutes, and most use either a swab gently scraped on the inside of your cheek or blood from a finger prick. A positive rapid test needs to be confirmed by a standard blood test.

HIV-antibody test manufacturers are also hoping to sell rapid HIV tests that people can perform themselves at home. The U.S. Food and Drug Administration is now looking into the

potential advantages and drawbacks of this testing approach.

In order to increase the number of people who know their HIV status, the CDC recommends that physicians and emergency rooms perform routine HIV testing on most adults—particularly rapid testing because people sometimes don’t return for their results with standard tests. The idea is to link people who are HIV positive to care and counseling, not only to protect their own health but also to reduce their risk of transmitting the virus.

HIV is invisible. People can be HIV positive and not look sick at all. There is a “window period” of time between initial infection and when antibodies to the virus become detectable in the blood. A person tested for HIV will not show a positive result if his or her body has not yet had a chance to develop antibodies to HIV detected in the HIV

test. So it could be weeks after possible exposure to the virus before a test result will detect HIV antibodies. If your test is negative and you have not had unprotected sex with a partner of unknown status or shared drug injection equipment before, you are likely HIV negative.

Parents should also test their children for HIV. While many parents believe their children are not sexually active, reports show some children are engaging in sexual activity as young as 11 years old. Given that 34 percent of all new HIV cases in America were in people aged 13 to 29, it is critical that children, teens and young adults get tested regularly for HIV. In short, anyone can contract HIV, and testing is the only way to know your status for sure. If you’re positive, you’ll be able to access care that will help ensure a long, healthy life with the virus. If you’re negative, the experience of testing and counseling will provide you with the opportunity to stay that way.

To find an HIV testing facility near you, visit poz.com/directory. Just type in your zip code to see a list of places.

You can also search the directory by company name, organization type, service provided and groups served.

11/11/09 10:30:02 AM

surviving the virus

Surviving—And Thriving—With HIV/AIDS The earlier you detect the virus and treat your body, the greater your chances for survival.

Being diagnosed with HIV is no longer necessarily a death sentence. Over the past 20 years, a global network of researchers, scientists, drug manufacturers and AIDS activists has succeeded in bringing more than two dozen HIV medications (known as antiretrovirals, or “ARVs”) to market. We also have a better understanding of when and how ARVs should be used. HIV treatment is, however, a work in progress; as new drugs are being developed and tested, research continues to explore the best way to treat HIV to maximize health and survival with the fewest drug side effects possible.

H

IV treatment works. In New York City, for example, annual AIDS deaths have decreased by 75 percent since 1994. What’s more, mother-to-child transmission of the virus in the United States has been nearly eliminated—largely due to mothers taking ARVs during pregnancy and children being administered ARVs just after birth.

Because HIV mutates rapidly and is skillful at developing resistance to available medications, a combination of ARVs from different classes of drugs

is used together to attack the virus in different stages of its life cycle. The six classes of HIV drugs are: • Fusion and entry inhibitors that prevent HIV from entering immune system cells.

• Nucleoside analogues, non-nucleoside analogues and integrase inhibitors that prevent HIV from taking over a cell’s genetic machinery.

• Protease inhibitors that prevent cells from releasing new virus.

There are currently other classes of drugs in development.

This is not to say that treating HIV is easy. Once ARV therapy is started, it is generally continued for life. This can seem particularly daunting, especially when therapy might cause side effects—sharp increases in fat and sugar levels in the blood, body shape changes and liver problems, to name a few. And to avoid the development of drug resistance, people must adhere strictly to their treatment regimen without missing doses. Not to mention the costs of treatment, especially if you don’t have health insurance and/

or a prescription plan. Luckily, there are government assistance programs— such as Medicaid, Medicare and the AIDS drug assistance programs (ADAPs) —as well as programs offered by some pharmaceutical companies to help offset the cost of lifesaving medications.

Fortunately, many new drugs are much better tolerated than their earlier predecessors. Treatment is also much easier to take. Whereas combination therapy used to involve multiple pills taken two or three times a day, many people are now benefiting from a single tablet containing three different drugs that is taken each day.

But there is no one right regimen; each person must decide with his or her doctor which regimen is best.

The U.S. Department of Health and Human Services—the federal agency overseeing health care policy in America—currently recommends that ARV therapy be started when people’s CD4 count—the amount of white blood cells targeted by HIV—falls below 350

cells per cubic millimeter of blood (a normal CD4 count is between 500 and 1,200). This recommendation is expected to be revised this winter, on account of new research showing that people with HIV who are not on ARVs because their CD4s are above 350 still face a higher risk of certain non-AIDSrelated health problems, like cardiovascular disease and various cancers.

The scientific exploration of HIV’s unpredictable effects on the human body continues. This research will continue to produce new medications that are safer, easier to take and effective for those with few remaining options because of drug resistance.

Most importantly, this research could produce a cure.

For a list of what to do if you’ve just tested positive and for tips on selecting an HIV/AIDS doctor, visit poz.com/ newlydiagnosed. To connect with others living with the virus visit mentor.poz.com/.

The Horizon Of HIV Care The future of HIV management is brighter than ever.

Expanded knowledge of HIV and how our bodies are vulnerable to the virus has yielded an unprecedented number of new avenues that could lead to better therapies and, perhaps, a cure.

H

IV is a difficult virus to remove from the body because of its ability to thwart the effects of antiretroviral (ARV) treatment by sequestering itself in “silent” immune system cells. Once ARV therapy is stopped altogether, even after decades of use, the virus rebounds with a vengeance.

A number of research teams are in hot pursuit of drugs that could smoke HIV out from where it hides, thus allowing existing ARV medications to disable the virus. Scientists recently announced a method of screening agents that may work in this regard. There are nine potential candidates now awaiting laboratory and human testing.

If this approach proved successful,

it could constitute a cure.

Another possible path to eradication was identified when an HIVpositive German man with leukemia received a transplant of immune system cells that were resistant to HIV and was apparently cured. However, this approach won’t likely be a routine offering for other people living with HIV since the high-dose chemotherapy and radiation necessary to prepare the body for such a transplant is potentially deadly. Instead, potentially less toxic approaches that work in a similar fashion are being explored, such as gene therapies capable of reprogramming immune cells so that they will be able to resist, or destroy, HIV. On the front of developing new

approaches to treatment, some biotech and pharmaceutical companies are experimenting with nanoparticles to produce medications that break down slowly in the body, allowing for dosing once every few weeks or months.

Therapeutic vaccines are also in development. These compounds train the immune system to better control HIV, potentially allowing HIV treatment to be avoided or stopped. And scientists are also exploring the possibility of preventive vaccines that would keep HIV-negative people from contracting the virus.

A number of ARV drugs that hold great promise for people with virus resistant to current options appear closer on the horizon. These include antibodies that target HIV and drugs that further block the virus’s ability to infect healthy cells.

One thing is certain: Though HIV may be with us for the foreseeable future, so too will the concerted research effort to remain one step ahead of the virus.

© 2009 Ryan Dorsett

Recent research breakthroughs bring new hope.

“I’m undetectable [on my viral load tests] and in good health.”

Leslie Williams, diagnosed in 1993

surviving the virus

“The more you empower yourself with knowledge the more fun you can have and the more you can do. I have a far better sex life knowing what I’m dealing with.”

Bob Bowers, diagnosed in 1984

Why Safer Sex Can Be Sexy Sex

How conversations and condoms can heighten your pleasure.

Practicing safer sex does more than protect you from HIV, unintended pregnancies and other sexually transmitted infections. If you already have HIV, safer sex protects you from additional strains of the virus and other sexually transmitted infections and it protects your partner. Plus, the conversations that must occur in order to ensure that you are having the safest sex possible are a great way to develop intimacy, respect and trust. And emotional intimacy can be very sexy indeed.

A

ccording to the CDC, of the 56,300 Americans who became infected with HIV in 2006, the group most at risk was “men who have sex with men,” also called MSM. Heterosexual men and women also contracted HIV in significant numbers.

Short of total abstinence, safer sex is the best way to protect against

transmitting—and contracting—HIV. Practicing safer sex is pretty simple: Essentially, condoms should be used for both vaginal and anal sex with all sexual partners except those with whom you have a long-term monogamous relationship and whose HIV status you know for certain.

Unprotected vaginal and anal sex

are the highest risk behaviors for transmitting HIV, other than using contaminated needles. The key is protection from genital fluids and blood. Other sexual activity, such as oral sex, can also expose a person to HIV, though the risk is far less than it is for vaginal and anal sex—especially for those on the receiving end of those two sex acts.

It might be tempting to assume that you or your prospective sex partner isn’t living with HIV/AIDS, but the only way to know for sure is to get tested.

In some studies, a large proportion of people who tested positive for HIV did not suspect that they were positive or were at risk. If you are living with HIV, it is legally required—in some states— that you disclose your HIV status before potentially exposing someone to HIV. Many states have severe legal penalties for non-disclosure of HIV before engaging in sexual acts.

In Case of Emergency Did the condom break, or did you forget to use one? Were you stuck with a needle? It is still possible to prevent HIV. Post-exposure prophylaxis, or PEP, involves taking HIV medications for a month after a high-risk exposure to the virus, notably unprotected vaginal or anal sex with someone who is either positive or whose HIV status you do not know. It is an approach that is used by health care © 2009 Scott Pasfield

workers around the world. To be most effective, PEP should be started immediately after possible exposure, waiting no more than 72 hours.

To protect yourself or your partner in instances where you fear one or both of you may have been exposed to HIV, contact your health care provider or nearest emergency room as soon as possible.

HER method

to help prevent HIV/AIds! FC2 is now available at CVS District of Columbia stores and soon to be available in neighborhood clinics.

surviving the virus

Regan Hofmann, POZ Editor-in-Chief, interviews Jeffrey S. Crowley, Director of the White House Office of National AIDS Policy Hofmann: President Obama’s reinstatement of the Office of National AIDS Policy, the extension of the Ryan White CARE Act and the lifting of the travel ban for HIVpositive people traveling to the United States all seem to indicate that this administration is uniquely committed to fighting HIV/AIDS in America. Can Americans expect to see the development of a National AIDS Strategy to effectively address the complexity of today’s domestic epidemic?

Crowley: The President is committed to addressing the domestic HIV/AIDS epidemic. He has tasked us with developing a National HIV/AIDS Strategy to reduce HIV incidence, get all people living with HIV/AIDS into care and improve their health outcomes, and reduce HIV-related health disparities.

What the American people can expect is a strategy that identifies the specific policies, practices, and actions that offer the greatest potential to achieve maximum results.

© 2009 Bob Gatty

Hofmann: You are traveling around the nation speaking with people living with and affected by HIV/AIDS, listening to their

needs, hopes and concerns. What is the most poignant thing you have learned in your town hall-style meetings with the HIV community? How will the insight you’ve gleaned help shape the National AIDS Strategy?

Crowley: My staff and I are grateful for the many people living with HIV who have shared their stories with us during the community discussions and have trusted us enough to disclose personal information, such as HIV status, past history of drug use, incarceration, or other activities that help give context for their experiences. We know that HIV stigma remains pervasive in our society, and having positive individuals publicly share their experiences is both helpful for breaking down stigma and providing a face for the impersonal statistics about the domestic epidemic. In many communities we have visited, the pain that individuals and communities are facing is raw. This derives from cuts in services resulting from the economic downturn, as well as the fact that many communities continue to feel undervalued and ignored. Sometimes the biggest challenges expressed by HIV-positive people during our community discussions were not directly tied to their HIV status, but associated with living in under-resourced areas or rural areas, the inability to find stable, safe, and affordable housing, or simply not always having enough to take care of their basic needs. At the same time, the community discussions have also been uplifting experiences because we have seen people from all walks of life coming together to recommend concrete solutions for moving forward.

Hofmann: What will the National AIDS Strategy allow us to do differently as a country when it comes to fighting HIV?

Jeffrey S. Crowley

Crowley: The strategy will provide a roadmap to executing a coordinated approach to HIV prevention and care across the federal government. The strategy will also provide metrics that we can use to gauge our success in meeting administration goals. Last, the strategy will provide a mechanism for accountability in meeting stated objectives.Last year, the Centers for Disease Control and Prevention announced that new HIV infection rates in the United States were 40 percent higher than previously estimated. And while the rate of new infections, though higher than previously believed, has been flat for several years, we are not seeing a decline in new infection rates. Which means our past prevention strategies have failed to stop the spread of the epidemic.

Hofmann: What is the biggest challenge to effective HIV prevention in America?

Crowley: HIV incidence in the United States was once over 150,000 new infections per year. The fact that there are now slightly more than 56,000 new infections each year both shows us the work that we yet have to do, but it also shows that significant success is achievable. As we assess how we are doing in 2009, it is important to recognize that our successes have not been evenly shared. We have made major strides in preventing HIV infection among injection drug users, for example. Perinatal transmission from mother to child is quite low in this country. Gay and bisexual men have always been the largest risk group in this country, but have received comparably fewer resources than other groups. We must do a better job of giving the LGBTQ communities evidencebased tools for preventing HIV and the resources to be effective. Although women remain at relatively low risk for HIV infection, far too many become infected with HIV because they do not perceive that they are at risk, or they are placed in situations where they are not able to take steps to protect themselves. The enormous racial disparities in infection patterns—with black women having a fifteen times greater chance of becoming infected than white women, and Latinas also being at comparably high risk—also

demonstrates the work that remains before us. Our prevention efforts have been historically underfunded and future prevention successes will likely entail new financial investments, at all levels of government and from all sectors of society.

Hofmann: Do you believe we can stop the spread of HIV/AIDS in America?

Crowley: We have many of the necessary tools to slow and eventually stop the spread of HIV/AIDS in the United States. We know that individuals who test positive for HIV are less likely to place HIV-negative partners at risk of infection, and that HIV therapies improve life expectancy and reduce HIV transmissibility. However, 21 percent of HIV-positive individuals in the United States are not aware of their HIV infection. We know from several studies that individuals who are unaware of their HIV-positive status are proportionally responsible for more new HIV transmissions in the U.S. than individuals who know their status.

In addition, we know that 42 percent or more of people diagnosed with HIV are not connected to or utilizing regular HIV care services. Until we do a better job diagnosing individuals with HIV and getting known positives into care, we will not be able to slow or halt the spread of HIV in the United States.

We must also recognize that success at stopping HIV/AIDS will also require greater community mobilization. A National HIV/AIDS Strategy will not be a success if people sit back and wait for the administration to solve their problems. The most significant gains we have ever experienced in fighting HIV/ AIDS have come when communities have stepped up and shown that we all have a stake in promoting healthier communities and taking steps through personal behavior change, volunteering, or providing financial support for worthy causes to collectively work to end the HIV/AIDS epidemic.

Hofmann: The stigma surrounding the disease prevents people from getting tested, seeking care and treatment, seeking the emotional support they need and deserve and, in some cases, disclosing their HIV status. Do you agree with the statement “the stigma surrounding HIV/AIDS can prove as deadly as

the virus itself”? Will a National AIDS Strategy have as one of its goals the reduction of stigma, and if so, what approaches might be recommended?

Crowley: The President has spoken about the need to eliminate HIV stigma, and he has acknowledged that we do not do enough to talk about HIV in our churches, schools, and that there is a link between HIV stigma and lingering homophobia in many communities. The President and First Lady were both tested for HIV in Kenya during the Presidential campaign, in part, to reduce the stigma associated with testing for HIV. Addressing HIV/AIDS stigma is a top priority for the Office of National AIDS Policy. There are no easy answers for ending HIV stigma, and while the strategy will help us address this issue, it is also an issue we will have to spend tackling on an ongoing basis by educating the general public, even after the National HIV/AIDS Strategy is written.

Hofmann: As the Director of the Office of National AIDS Policy, what do you consider your highest priority today?

Crowley: Re-engaging the American people in responding to the domestic HIV/AIDS epidemic is my top priority. The opportunity created by President Obama’s leadership is to educate and remind the public that we have a continuing serious epidemic in our midst, but also that we have the capacity to make a major difference with regard to HIV prevention, care, and research.

The President has spoken about the need to eliminate HIV stigma, and he has acknowledged that we do not do enough to talk about HIV...

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