bearbandit

Bearbandit, sounds like you know a thing or two about Stribild . One thing I am just curious about, you said in your response, "Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill." What do you mean when you say it preoccupies the liver into getting rid of it? It serves the same purpose as ritonavir and uses the exact same enzyme to be metabolised. Bit of history: I don't know if they happened in the USA, but in the UK we had a rash of deaths because of ecstasy poisoning. It turned out that these ecstasy poisoning deaths had one common factor: ritonavir. In those days the standard dose of ritonavir was up to 800mg or more per day and, yes it pushed its way to the front of the queue for processing through the liver, leaving other drugs, whether prescribed or not, behind. Ritonavir in that sort of dosage has a bad record: it can also cause metabolic syndrome and diabetes. Hence the search for a P450 blocker like cobicistat to pre-empt the processing of other drugs, meaning that they can be prescribed at loser doses. Cheaper for everybody and less strain on the system. If you've never experienced high dose ritonavir, believe me, you don't want to!

You're getting the truth as I know it from me: I'm already on salvage therapy - where they patch together the best therapy they can from that you're not allergic/resistant to. My being known as the local drugs whore at "work" refers only to the fact that I have greater experience than anyone else of prescribed ARVs: last time I took something illegal was over ten years ago when I rubbed some charlie on my gum to call a halt to the to toothache I was enduring. May I recommend www.aidsmap.com or www.tht.org.uk for information in further detail?

Stribild is the new kid on the block. It's a combination of four separate drugs, two of which (Tenofovir and Em.. FTC is the name I name I know it by!) are the components of truvada. What's new in stribild is elvitegravir and cobicistat. It's just been authorised here, so there's little I can say about its effects, however, elvitegravir is a integrase inhibitor, the latest in a new family of drugs. Something that's been observed about integrase inhibitors is that they keep HIV locked up in its hidey-holes for a damn sight longer than any other class of drugs; it's long been known that serological viral load tends to be lower than that of semen, so that someone with an undetectable viral load (serologically) may yet have a detectable amount of HIV in his semen. It seems to be less likely with the integrase inhibitors. Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill. Ritonavir, in other combinations serves the same purpose. It doesn't matter how old an HIV drug is: I stopped responding to nevirapine about ten years ago, but my virus has had time enough to revert to non-nevirapine resistance. Old drugs can be recycled. If you were to consider Atripla, first question I'd ask is what job do you do? There's a urban legend in London about a crane driver who did half a million' worth of damage before he could be stopped. Another friend (who's a pharmacist) has been told that under no circumstances would his doctor prescribe efavirenz (the part of atripla that affects the CNS). Atripla is likely to be pushed in the next year or or so as efavirenz comes out of patent soon, meaning the drug company that developed it don't see a cent of the profits, and it's liable to be pushed because it's cheap. For the same reason Stribild is likely to be pushed: lotsa money there. If you possibly can, take a friend who has a good knowledge of ARVs with you to your next appointment...

It's not unknown for guys to "inherit" their giver(s)' resistance when they get infected in the first place. Equally it's not uncommon for that resistance to disappear, hence the ability to "recycle" drugs after a few years. The rule is that the virus will always, over time, revert to "wild type" virus. Being resistant to Sustiva is a mixed blessing: on the one hand it has pretty much the best record for getting the viral load down to undetectable in the shortest time. On the other hand, two of its constituent drugs, efavirenz and tenofovir have amongst the worst side effect records. Efavirenz can affect the central nervous system - a friend used to call it "free acid" while I know of a a number of doctor who will not prescribe it if their profession lives involve any sort of concentration. Tenofovir (I admit my bias!) can cause severe kidney damage and osteopenia (thinning of the bones). Left unattended to for long enough it can kill. It's rare to get a strain of HIV that's resistant to more than one drug, if any. Super-infection refers to already having one strain of HIV and then getting another: last time I talked to the health advisor where I work (an HIV charity) super-infection was happening at a rate of about once per year in the entire world. It really is that rare. My thoughts on what's happened is that you've picked up HIV from someone who's become resistant to one of the three antiviral components of sustiva. You say "this is new to me" so I guess that sustiva is your first antiretroviral (ARV). The only way to sort out which of the three drugs you're resistant to is to split them into their separate components, and try you for some months on two, plus another, then swap one of the the sustiva drugs for another.... You see where I'm going? It would be a damn sight easier just to make a note on your records that TFC, tenovir or efavirenz don't fit. The trouble is that we're going to see a lot of promotion of efavirenz as, psychedelic side effects aside, it's one of the most effective drugs at lowering the viral load fast and it's about to go out of patent, which makes for a massive price reduction.

Sorry, my stupidity: I meant of course the strain local to the body it's in (you can tell I spent the weekend at an HIV conference!). In the early eighties safer sex (in London) meant not fucking with Americans, then after a while safer sex came to mean not fucking with Londoners, simply because we'd been exposed to this infectious agent. For what it's worth, I believe my virus goes back to SF. Then the condoms arrived. As drugs have developed so have resistances to those drugs, though most remain resistance-free, but it's important to remember that that HIV always seems to revert to wild type virus as resistant virus has . We end up with with small local pockets where guys are first infected with a strain that has some resistance to one drug or another. It's rare but it does happen. Eventually, their virus reverts to "the ideal", the virus that doesn't understand the blocks medication puts in its way. It's long enough since I took nevirapine that I could probably take it again as the virus that became resistant to nevirapine should have died out by now. Travel is too wide-spread to account for a local, geographical, strain: you have to start taking into account the local "within this body" strain, which also looks at the genetics of the person involved. Abacavir, to which my virus is supremely vulnerable would, it turns out, also kill me.

FFS sake make sure that he knows his nephrology: okay, 1 in a hundred thousand makes for pretty low odds, but they happen and failing kidneys does not make for a fun time - had I not gone to hospital willingly they were prepared to section me under the Mental Health Act. Make sure too, to have an HIV antibody test at least every three months: PrEP is a fraction of full ARV. To take just that subset, should PrEP fail, runs the risk of resistance to some of the most commonly used (ie cheapest) ARVs. Finally, I'd say "know your enemy": get to know more guys with HIV and learn more about how it affects our lives. Personal opinion: if you're going to take a preventative drug (as PrEP is), surely it makes more sense to carry on taking it even in "dry spells"? You never know when you're going to hit lucky, and re-starting PrEP is a slow business compared to the urgency of sexual desire. Actually waiting for the bus is a slow business in that situation! Best of luck to you...

Whatever it is, we have to remain in control of it. I think it's telling that that you set a parameter (nude) for last night's party. I've been to parties where the most action was in the kitchen: the basic requisites of life (food and sex) in such close proximity ;-) That said, I fail to see the point of the hour long journey to either the "local" leather bar or the sauna: I'm afraid I do have a problem about my walking stick, which I, rightly or wrongly, which I need in areas that are unfamiliar to me. If however, party hosts like my friends in Devon, say "sure come down a few days ahead to learn the layout of the house", that's fuckin' brilliant. And I have to add the when I was near death in summer 2012, it was support from you guys that kept me going...

Ideally what happens is that the local strain takes over. It's rare for a, say FTC-resistant strain, to take over from a local strain that isn't FTC-resistent. What doesn't happen is that you create a new superstrain of HIV. I knew we were marching into trouble when we seperated HIV disease into asymptomatic, persistent generalised lymphandenothapy, aids-related complex and finally aids. In the UK we use degrees of HIV disease to reflect the changeability of the illness. Some of those categorisations are permanent (such as my osteoepenia), others, change (like when I had cryptosporidiosis five years ago or so). I fully understand the US's definition of aids is a political, rather than a medical, decision, to advance people who need it through the welfare system. The downside of the UK system is that you can recover and relapse - saves on the welfare bills! Two different solutions, from two different eras, to the same problem. I can only speak for myself: I don't want to get sick again, but I regard HIV as the least of the things I could pick up with a man up my ass (y'never know - I might pick him up as well!)

That would be high if it weren't for the fact that you seroconverted very recently. When HIV infects, it goes through a massive cycle of reproduction (and corresponding rise in the Viral Load, and drop in the CD4 count). At its peak, the VL can be way higher than 70k. Without a second test we don't know whether you're going up or down at present. If it follows pattern, you'll have a very high viral load for a while which will then fall naturally. As the VL falls, the CD4 count will rise as they're not being turned into virus factories. After three months or so you should have a clearer picture of what's going on. By all means, start meds as soon as you're ready: what I'm saying is it doesn't have to be just yet if you feel the need for a bit of breathing space first. Just as long as when you decide to go on meds, you feel you can keep up the adherence side of things (ie not miss doses). 70k isn't that high if you're on the original spike of the graph: I had a drug holiday (NOT something I recommend people try!) six or seven years ago - nearly twenty years into treatment - and got to 65k in six months. Best of luck on Friday...

PrEP Study: http://www.proud.mrc.ac.uk/ Only 47 (of 500) places left - As far as I understand it, they aren't taking in replacements for guys who drop out...

It's called conversation: (A) says something and (, © and you respond in your own manners. Like any longstanding community, you have to be aware that there are in-jokes going on that you won't necessarily get. What you do is go through the forums, see a subject title that appeals, read the conversation so far and decide if you can add to the conversation. If you can, great! Be prepared for guys to dis/agree with you and try not to talk about things you don't know about unless it's to say "I don't understand how... ...can anyone help me out?" Some guys drops by once a week or less (I can think of some who I haven't seen here for months: hope you're ok guys). Think of this as a neighbourhood bar where guys drop in as and when the mood takes them and you won't be fat off the truth. See? You asked a question and within an hour had an answer... we aren't usually that fast about things. Read over old posts: there's not only a wealth of advice there but also some pretty horny reading to keep you going.

Still the only option for many - there may be a few places left on the UK PrEP trial (PROUD Study) but they may have decided to go ahead without as many guys as they'd hoped.

I think the idea comes from the fact that the general public think that diabetes is simply a matter of taking you insulin/your pills/or sticking to your diet and you can live a normal life. They're trying to project a similar image onto HIV. Wrong in both cases. Many of us know someone who was diagnosed with HIV late and has had appalling health problems since. Similarly, I spent much of last year zoned out and asleep because my blood sugar was out of control, but allowing that lack of control was the only way I could get enough calories into myself so that I didn't waste away. Both HIV and diabetes have their dark sides. With both it's a question of early intervention before too much is done. And unfortunately comparatively little is known about co-morbidity of HIV and diabetes. Blood glucose should be part of any HIV blood workup because there's still the (admittedly slight) possibility of the ARVs causing diabetes.

I'll believe in the diabetes/HIV comparison the day a diabetologist turns round and says "it's not so bad, a bit like having HIV, really" I got diabetes as a result of early HIV treatment (two drugs that are barely used and the other at an eighth of the dose it's now used at). It might be that I've lived with HIV for far longer (34 years) than diabetes (10 years) but I'm far more attuned to what HIV can do to me than I am to what diabetes can do. For most of last year I walked around with my blood glucose several times higher than it ought to be because I couldn't eat properly and was using nutritional supplements. No wonder I couldn't pass a settee without it mugging me for a nap or concentrate on what I was doing. Doctors who use the HIV/diabetes comparison are being lazy: they are two very different conditions and progression of each is also very different. But for the record, if I could get rid of just one of them, it would be the diabetes.

Basically what you're talking about is the other side of PrEP: Treatment as Protection (TasP). Together they're probably better than condoms at preventing infection since the PrEP protects the neg guy and the poz guy is to all intents and purposes shooting blanks. As a general rule the VL in semen tends to be a bit higher than in blood, but still not enough virus to establish an infection. They've also noted that integrase inhibitors (raltegravir, dolutegravir) seem to reach further into HIV's places to hide so a guy on an integrase inhibitor can achieve an even lower VL, which would presumably include the VL in his cum.

Apparently when I was having a colonoscopy, as the tube went in I said the (female) doctor "You do realise that for a gay man this is foreplay?"

Great news! Just remember that adherence is everything (as are the regular blood tests: truvada's a pretty heavy drug) and if you think anything is wrong see your doctor immediately! Other than that: have fun

Orders 1 through 5: relax... He's a kid who's had a fright and realised that he isn't, perhaps, as invulnerable as everyone else his age. Because everyone knows that once you get HIV even the people you fucked with before you got it , automatically get it. Eat your heart out Dr Who! He panicked. And he responded as teenagers do: with unrestrained immature over-reaction. For a start, he fucked you which puts him at much lesser risk from anything you have and you at greater risk from anything he has. Did he insist on a condom, or did you hold him down and sit right on his dick? I presume he's over the age of consent for where you are, so if he's old enough to fuck you, he's old enough to take responsbility for not using a condom. Has he not looked at a newspaper in his life? Nobody thinks it's going to happen to them (except the chasers): last time someone came in me before I tested, I tested positive a year or two later after lots of condom sex. Turns out that I was years too late as I'd seroconverted years before. He's a frightened little boy. As I keep saying I don't understand America, but if you didn't know you were poz when he fucked you, then there's no legal case. However his threats to you must have some standing in law. Texting wasn't the most tactful way of telling him, but nevertheless you were upfront. How much does 30 minutes of a lawyer's time cost? If it's affordable, see a lawyer before going to the police to tell the whole story. Meanwhile write down everything you can remember about the conversation. If there's been a crime committed it's by the kid. You do not have to put up with that sort of shit.

"Older" at 40 - now there's depressing! Especially when you're closer to 60 than 50 as I am! I find my choices limited more by "will the viagra work?" than anything else - HIV related diabetes hit that nerve so my hardons are unreliable. When the viagra works it works very, very well, except I can't cum till about six hours later. If it doesn't work, I'm happy to take it over and over. Sometime in the next couple of days my dick will catch up and I'll have one hell of a wank. Or else run a D/s type scene where I make him really hurt himself while wanking - in that situation I think my apparent disinterest is more of a turn n for him ("what the fuck do I have to do to get this guy to even touch me?") Yes there are times I'd love to go back to, to have the energy to do that again, but I've still got the memories, if not the photos (no digital cameras then).

Which is why you'd never get my dick up your arse - I don't mean that offensively, just that I don't fuck guys who I don't know are poz. VL should be primary: someone might have just started meds and have a six or seven figure VL, but you're more concerned that he's on meds. That's a recipe for getting knocked up. VL is difficult to understand (and as I confess above, I don't understand it fully myself and rely on others to jump in when I'm working at myHIV), but the bottom line is the lower the number the better. For myself, despite my fiction, the last thing I want to do is pass it on. I wouldn't fuck anyone if my VL got into four figures, not that there's much possibility of infection at that level, more I won't take the chance. From my observations and listening into conversations between staff I wasn't meant to hear at the clinic, it's not till you get to five figures that transmission becomes a real, as opposed to chance, possibility. Neg guys take their chances, so do we poz guys. Maybe the best bet is to have a pair of write in boxes, one for the VL and the second for the date it was recorded.

Fair enough - Who's thinking with their big head at that point anyway? Fuck knows - what I do know is that it panics and confuses people and I end up having to put the pieces back together at myHIV. I got as far as doing sums: maths is a closed book to me! I specialise in the emotional stuff and leave the science to other members of myHIV...

Frankly, not a lot - remember it's a logarithmic scale so that 400 is only 2x40, and we know that it takes a much heavier viral load to establish an infection than that. The blips are, to me, an early warning system that my current drugs may be failing, or, more likely, that it's the colds and flu season. Since the VL test became available erm... fifteen, twenty years ago(?) even with aids defining illnesses I've never had a viral load that would be a threat to others. Maybe thee answer is to have a dropdown box asking if your viral load is blow 100, 1k, 10k, 100k, and so on or maybe leave it as a write in.

Looked there this morning and saw you... good man!

True, if you adherence to the meds isn't 95% (the figure my hospital uses) you stand the risk of viral mutation and therefore resistance, but the reinfection thing is so rare: may one person per year globally. The amount of virus in one load is quickly going to be taken out by the virus already there, if you see what I mean. Ten years ago we were seeing reports of guys presenting with virus resistant to drugs x and y: that's happening much more rarely now, largely thanks to the efficiency of the drugs regimes we have now. I boil it down to the statuses poz and unknown: I don't know what you've been up to in the past few weeks, and even after a retest I don't know what you did on the way home from the clinic. "Poz on meds is the new safer sex." A brilliant line which I'm going to steal for UK usage! Thank you Tiger - kisses wherever (and I mean wherever) you want 'em...

On the other hand it's a safe conversation opener: "born in Bari, lived most of my life in England only just got back home and live just outside Neath..."