Nicotine metabolised at a faster rate among HIV-positive smokers – implications for quitting smoking

This article is reprinted from www.aidsmap.com by Michael Carter and was published on  18 February 2019

HIV-positive smokers metabolise nicotine at a significantly higher rate than HIV-negative individuals, investigators from the United States report in the online edition of AIDS. The finding could explain why people with HIV have more difficulty quitting smoking than their HIV-negative peers. A second study involving the same HIV-positive smokers and published in the Journal of Acquired Immune Deficiency Syndromes showed that a higher nicotine metabolism ratio (NMR) was associated with symptoms of anxiety and treatment with efavirenz.

The researchers say their findings have important implications for the use of smoking cessation medication by individuals with HIV, and that more intensive therapy with varenicline (Chantix and Champix, an oral prescription medication), rather than nicotine replacement patches, is warranted.

“The mean NMR of this sample resembles levels reported among those with opioid dependence,” comment the authors. “Although the nature of the relationship between NMR and HIV is uncertain, these results suggest that the nicotine patch would have limited therapeutic benefit for most smokers with HIV, which has been reported, and that varenicline would be more beneficial.”

People with HIV are more likely to smoke and have more difficulty quitting than individuals in the general population. Smoking-related diseases are now a leading cause of serious illness and death among people with HIV and supporting smoking cessation should be part of routine HIV care.

The rate at which the body metabolises nicotine could explain why people with HIV are more likely to become smokers and find it harder to stop. Nicotine is metabolised by the body using the CYP2A6 liver enzyme. Research has shown that people with reduced CYP2A6 function (slow nicotine metabolisers) smoke fewer cigarettes, are less dependent on nicotine and are more likely to succeed in quitting smoking. NMR is a widely used measure of CYP2A6 function.

Investigators from the University of Pittsburgh hypothesised that smoking behaviours in people with HIV were influenced by NMR. They therefore designed an observational study comparing NMR between 131 HIV-positive smokers and 199 closely matched HIV-negative smokers.

Data were collected on factors known to impact on NMR, including sex, race, gender and body mass index (BMI).

Most of the participants were male (70-74%), African American (72-79%) and were living on an annual income below $35,000.

Almost all the HIV-positive participants were taking antiretroviral therapy (ART). Eighty per cent had an undetectable viral load and the average CD4 cell count was 714 cells/mm3.

The individuals with HIV smoked significantly fewer cigarettes daily than the matched population (13 vs 15, p = 0.003). Despite this, mean NMR was significantly higher in the people with HIV than the HIV-negative individuals (0.47 vs 0.39, p < 0.001).

Participants were divided into four groups according to NMR speed: people living with HIV were twice as likely as HIV-negative individuals to be placed in the fourth quartile, the fastest metabolisers (35% vs 17%).

“These findings suggest that HIV-infected smokers metabolize nicotine faster than HIV-uninfected smokers, even after controlling for relevant demographic and behavioral factors,” write the authors. “Understanding the mechanisms that contribute to faster nicotine metabolism among PLWH [people living with HIV] is necessary to understand tobacco’s role in undermining clinical outcomes in HIV, and identifying novel therapeutic interventions.”

The second study examined whether there were any specific characteristics associated with a higher NMR in the 131 HIV-positive people.

The investigators collected demographic data, information on CD4 cell count and viral load, CD4 cell count, ART type and adherence and symptoms of anxiety and depression. Breath carbon monoxide was also evaluated.

The initial analysis showed that race, symptoms of anxiety and depression, greater smoking intensity, breath carbon monoxide and therapy with efavirenz were all associated with higher NMR values.

After taking into account known potential confounders, a higher NMR remained associated with smoking more cigarettes per day (p = 0.050), higher levels of symptoms of anxiety (p = 0.054), and therapy with efavirenz (p = 0.003). Treatment with efavirenz accounted for 5% of the variance in NMR.

“Taking efavirenz was associated with higher NMR, rather than lower NMR as expected for a drug interaction (efavirenz would be predicted to inhibit CYP2A6), which needs to be understood further,” comment the authors. “This suggests that efavirenz therapy should be considered when addressing tobacco use among PLWH.”

Reference

Ashare RL et al. Differences in the rate of nicotine metabolism among smokers with and without HIV. AIDS, online edition, DOI: 10.1097/QAD.0000000000002127, 2019

Schnoll RA et al. Rate of nicotine metabolism and tobacco use among persons with HIV: implications for treatment and research. J Acquir Immune Defic Syndr, 80: e36-40, 2019.

Smoking Pot Related to Higher Lung Disease Risk in HIV-Positive Men

Researchers compared lung disease diagnoses among groups of HIV-positive and HIV-negative men who reported marijuana use.

This article points to some interesting research and was written by Benjamin Ryan from Poz.com   


Among men who have sex with men (MSM) living with HIV, smoking marijuana is associated with a higher risk of both infectious and noninfectious lung diseases.

Publishing their findings in EClinicalMedicine, researchers studied 1996 to 2014 data on men from the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort of HIV-positive and HIV-negative MSM. Participants eligible for this particular prospective cohort study were 30 years old or older and had provided self-reported data on marijuana and tobacco smoking during biannual study visits.

The study included 1,352 HIV-positive men who were matched with the same number of HIV-negative men according to race and the age at which they entered the study. Between them, the cohort members made 53,794 study visits and were followed for a median of 10.5 years.

Twenty-seven percent of the HIV-positive men and 18 percent of the HIV-negative men reported smoking marijuana daily or weekly during one or more years of follow-up, for use that lasted for a median of 4.0 and 4.5 years, respectively.

The cohort members received 1,630 diagnoses of lung diseases during follow-up. A total of 33.2 percent of the HIV-positive men and 21.5 percent of the HIV-negative men were diagnosed with infectious lung disease, and a respective 20.6 percent and 17.2 percent were diagnosed with noninfectious lung disease.

Among the men living with HIV, recent marijuana smoking was associated with a 43 percent higher risk of infectious lung disease and a 54 percent higher risk of noninfectious lung disease independent of tobacco smoking and other risk factors for lung disease. When HIV-positive men smoked both marijuana and tobacco, these risks were higher.

There was no association between recent marijuana smoking and lung disease risk among the HIV-negative men.

The study’s strength included its large sample size, the high number of lung diagnoses and the lenghty follow-up time.

“These findings could be used to reduce modifiable risks of lung disease in high-risk populations,” the study authors concluded.

To read the study, click here.

Lovin’ with HIV

It’s no secret that when it comes to sex, an HIV diagnosis has been known to throw a wrench in the works. But navigating this new landscape is possible—with the right information and support. Allison Carter talks sexual satisfaction with two HIV-positive women.

Margarite Sanchez, a self-described artist, activist and agriculturist who lives on Salt Spring Island, was in her mid-30s when she was diagnosed with HIV. She was newly married at the time, with a partner who was HIV negative. Today, at 60 years young, she is still in that relationship, and her partner is still HIV negative. He is also a loving and caring husband and father to their two children. Their life is good, Margarite tells me. And sex is a very important part of their relationship.

This is not to say that Margarite didn’t face challenges after being diagnosed. “I went through all those things women go through,” she says. “At first I felt like I was damaged goods. I told my husband to leave. I figured I would be alone for the rest of my life. I just didn’t think there would be much more of that.” Sex, she explains.

But her husband wouldn’t hear of it. “Why should I leave the best relationship of my life?” he said. Margarite goes on to reveal something that many women with HIV have experienced as a barrier to achieving a pleasurable and satisfying sex life: her huge fear of transmitting HIV.

A small but growing number of studies document such feelings and the impact of HIV on women’s sexuality and sexual well-being. A 2017 review of surveys involving 11,552 women living with HIV around the world found that after being diagnosed, it is common for women to experience reduced pleasure during sex. Fear of transmitting HIV to their partners, anxiety and depression, and broader societal stigma and discrimination are just some of the factors that can put a damper on the deed. Never feeling safe enough, it seems, is a common theme.

But times are changing, and so is Margarite. Science now shows that it is possible for people living with HIV who take their medication as prescribed and maintain an undetectable viral load to have condomless sex without risk of passing HIV. This reality is captured by the slogan U=U (undetectable=untransmittable). After 15 years of using condoms religiously with no viral breakthrough, Margarite and her husband decided, as a couple, to do without them. Margarite was also fully menopausal at that time and in a long-term, monogamous relationship, so she wasn’t worried about getting pregnant or getting other sexually transmitted infections.

“It was really nice, for once in our relationship, to have one less obstacle between us,” Margarite says. The problem wasn’t so much the physical barrier of the condom, but what it signified. “To have something lifted, instead of another concern added on top, felt really good.”

Now Margarite describes her sex life as more relaxed and spontaneous, free from her previous worries about passing HIV. This medical strategy of treatment as prevention, she points out, has de-medicalized her sexuality.

Valerie Nicholson is 62 years old and lives in the Downtown Eastside of Vancouver. She is an Indigenous woman and a proud grandmother. Like Margarite, Valerie describes the scientific discovery of U=U as liberating—not only when it comes to her ability to have close relationships with an HIV-negative partner but also for how she feels about herself as a sexual being. But the changes she went through to get to this point—the kind that happen internally and externally—didn’t happen overnight.

“When I was first diagnosed, I don’t think my sexuality changed at all,” Valerie says, “because I wasn’t really dealing with it.” She was in a relationship at the time, and it was in that relationship that she acquired HIV. She was also struggling with substance use. She describes her sex life back then as routine: “Do drugs, have sex, do drugs, have sex.” The drugs, she says, numbed any feelings she had about her diagnosis and about her sense of sexual well-being.

Valerie decided to stay in that relationship because she felt it was easy even though, she says, “it was an abusive relationship.” But the risks of having to disclose her HIV status to someone new, which could open up a whole host of different harms, felt greater to her at the time than the dangers of staying with her partner. “It’s kind of a weird feeling,” Valerie says, reflecting on the tensions she faced. And, unfortunately, it’s one that far too many women have to grapple with.

Of the 1,422 women who participated in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), 80 percent reported having experienced some form of violence and 67 percent said they believe that most people with HIV are rejected when others learn of their status. Over 50 percent reported suffering from depression. These social factors—violence, stigma and depression—can increase stress levels and greatly affect women’s sexuality, reducing both sexual desire and arousal as well as increasing pain and anxiety with sex. On the flip side, this means that women’s sexual well-being can be improved if their social context is improved.

When I ask Valerie about her experiences with sex and sexuality today, she replies, with joyful laughter, “Well, that’s changed a lot.” For many years after leaving her abusive relationship, she immersed herself in her HIV research and advocacy work and became known and much loved for her activism and her teaching as an Elder. This work led her to re-evaluate what it could look like and how it could feel to be single, HIV positive and happy with her sex life. “I had my toys, of course,” Valerie says confidently, “because it was easier to have a toy than a man some days.”

Valerie has since started dating again and has enjoyed a few meaningful relationships, with both HIV-positive and HIV-negative men. Currently, she is rekindling a romance from her past. Whether it’s because of a new partner, a broader range of sexual activities or her reduced self-criticism and shame, she finds it much easier to climax during sex nowadays. She also attributes her newfound sexual freedom to U=U. And she’s not alone. Many women she has spoken to describe “getting a piece of their sexual life back.”

What’s clear in both Valerie and Margarite’s stories—and likely those of many other women—is that women are on a sexual journey. From coming of age to the golden years, dating to marriage to divorce, diagnosis to today, women’s experiences of love, sex and relationships are diverse and always evolving. There is not one path, but rather, many paths.

What advice do Margarite and Valerie have for other women who are newly diagnosed and struggling with their sexuality?

“It will get better,” Margarite says assuredly. “When you’re first diagnosed you go through all these feelings—you feel that no one is going to want you, that you’re never going to want to have sex again. But once you start to regain your confidence in living life, get your health straightened out and become stable on your medications, there’s absolutely no reason why you can’t live a complete and fulfilling life in every facet, including your sexuality.”

Valerie, reflecting on her journey, says: “You’re a woman first. HIV is just something that you’re living with. You could be living with a cold, cancer or the flu—it doesn’t matter. You’re a woman first. And we have to honour ourselves as women.”

In terms of supports, both women emphasize the importance of having a safe place to talk with other women about sex and sexual pleasure. “I really envy gay men,” Valerie says, “because they often talk more openly about sex.” This contrasts with traditional female roles in which women are taught to keep their experiences and issues related to sex a secret, behind closed doors. Such talk is necessary, Margarite and Valerie say, for women to know that they’re not alone and to chart the course of their own sexual fulfilment.

Allison Carter is an HIV-negative ally conducting sex-positive research with Margarite, Valerie and other women living with HIV in Canada. She is also working with them to create a new online resource dedicated to building conversation and community around sexuality and relationships for women and couples living with HIV: www.lifeandlovewithhiv.ca.

Photograph of Margarite Sanchez by Stasia Garraway; photograph of Valerie Nicholson by Kamil Bialous.

Brian Belovitch’s Journey Through HIV and His Full-Circle Transgender Experience

This inspiring interview is by JD David from The Body website and I hope you enjoy it. You can search online for Brian’s memoir if you are inspired to find out more about his incredible journey.

February 6, 2019

Everyone wants him to be in a certain category, says Brian Belovitch, which he finds really annoying. But if he had to pick one, reports the author of the new memoir Trans Figured: My Journey from Boy to Girl to Woman to Man, he would say that he’s a cisgender gay male of trans experience.

“And I say that because, you know, I did [live] as a trans woman, for about 15 years … in the ’70s and ’80s, those decades.”

I met Brian years ago — but not so far back that I knew his full story — when he and his husband Jim had a sweet country house in rural Pennsylvania that happened to be next door to my ex-partner’s ex-girlfriend’s place that we’d run off to for long weekends.Advertisement

I’d known Brian had lived as a woman, but it wasn’t until we had overlapping work shifts at the legendary Park Slope Food Coop a few months back that I learned he had published his story. I downloaded it on my phone on the way home and read it straight through.I didn’t know that Brian survived a deeply violent upbringing, came out as queer in high school and began his first transition in Rhode Island, and then moved to New York as an affirmed woman who gained prominence in the club scene as well as playing cisgender female theater roles.

The book opens during the time Brian hit bottom in his drug use, and I felt the peculiar feeling of fearing for someone who I knew had somehow made it through to a beautiful life.

In reality, as well as on the page, Brian is an enticing and unflinching storyteller. He realizes his life doesn’t fit the often-stigmatized but perhaps more acceptable binary narrative of transition to the so-called opposite gender.

But his lived reality affirms that there’s a wider range of possible genders and gender journeys. And, as not only a twice-transitioned person, but also an abuse survivor, a person in recovery, an early recipient of hepatitis C therapy, and a person living long-term with HIV, he realizes his story can be lifesaving to others.

I’m sitting with Brian in the cozy apartment he shares with Jim, a horticulturalist, in a classic pre-war elevator building on a now-gentrified block in Prospect Heights, Brooklyn. I’m here to find out more about his uncommon journey.

JD Davids: You have had a rather amazing, full, and at times very painful life. It was around the same time you began to consider transitioning back to male, your assigned gender at birth, when you found out that you’re living with HIV?

Brian Belovitch: Yes, it was at the beginning of the AIDS crisis, actually, when I had transitioned from transgender to now back to my male gender. I was diagnosed in ’87, and then I transitioned shortly after that in ’88.

It took a while, obviously. It’s not something you can just blink your eye and switch overnight, like some people might think. It’s very involved.

JD: In just a few chapters of your fascinating memoir, you talk about learning that you’re living with HIV in the era before effective treatment, just when you were coming into recovery. Then you go into the experiences you had in the bad old days of hard-to-take hepatitis C treatment, and you say there’s a whole other book there about this period.

BB: Oh, yeah, absolutely. You know, I’m trying to come up with the concept or the idea for my next book. And I think that it’s going to have a lot to do with, you know, the opposite side of transitioning, which is really transitioning and coming to terms with how I felt about returning to an identity that was, you know, in the past had been very painful and difficult. So, there’s a whole other aspect to that, that there wasn’t enough room in the book — I was limited to 270 pages.

JD: What was the relationship between your diagnosis of HIV in the early days, and your shifting sense of your own gender?

BB: I did write a little bit about that time in history. And there’s a difficult story in the book about when I received my diagnosis, from a doctor at Stuyvesant Polyclinic on the Lower East Side. I made the mistake of going alone, which … don’t ever do that, kids!

I went alone, and I walked in, and I didn’t even barely touch a chair. And the doctor said, “Oh, so your results are positive,” and I looked at him, like, really?

He’s like, “Well, what did you expect?” He said, “You’re a whore, you’re a prostitute, you’re a sex worker, trans woman, IV drug user,” it was like check, check, check down the list.

And it all felt like it was in slow motion. Like, I’m sitting there thinking, I was newly sober, maybe about six months, and didn’t have the wherewithal to, you know … my activist life didn’t flourish until later.

But, I didn’t know what to say. That had such an effect, a profound impact on me — the overt judgment in the medical profession. And I already knew what my gay brothers and sisters were going through with HIV and AIDS, and there was no treatment, no AZT, no nothing. And it was terrifying, really terrifying, the whole ordeal.

I was already struggling with the trans identity stuff in therapy, and in my early recovery, and so it was already in the forefront in my mind, and the freshness of the obstacles that I had lived so often in the ’70s and ’80s as a trans woman back then. It was like an open wound back then.

So, you know, I kind of thought, “Wow, if he’s treating me like this,” and I’d already had firsthand experiences from my friends, I thought, “Wow, I’m really in deep shit here.”

So I wouldn’t say it was the only reason why I decided to transition again, but it certainly was a part of it. I thought, “I’ll die for sure.” Oh, I went into survival mode. And so part of survival mode was feeling like [I needed to do what it took to] get care that you needed order to be able to make your way as a person with HIV.

Trish Gervais (Brian Belovitch) in 1981

To be a trans woman back then, in the ’80s, was even more difficult than it is now, obviously. We didn’t have the luxury of a lot of the lovely language that we have today, and the medical awareness, the health care awareness that we have dealing with trans patients today, we didn’t have any of that … it wasn’t very forefront in my consciousness for another six months or so — I still had to endure another six months of examination and reflection before I made that ultimate decision.

But that was definitely a turning point or a tipping point. I thought, “Wow, they’ll just leave me dying in the hallway here somewhere.”

Because they’re so afraid, they couldn’t wrap their heads around how to deal with someone of my gender, which I’d already experienced. So I’d already had that [experience of maginalization], but that particular episode was particularly upsetting.

JD: As you went through the first years of coping with your diagnosis, as well as adjusting to your gender decisions, what was that like? Was there a time where either or both gender and life with HIV just felt like, “Okay, I got it now?”

BB: You reminded me, JD, that once I did make that [gender] decision, the pushback that I got from the medical community was another hurdle. They were refusing to remove my [breast] implants for fear of lawsuit. I wrote about this in the book, when I went to some sort of volunteer medical plastic surgery clinic at a hospital, and I’m sitting in front of a bunch of students, and one of the professors started grilling me about my IV drug use, and my sex work. And, “Oh, you’re a sex worker, right?”

So now I want to try to find my truth or find some sense of stability or calm in my life, and now I’m being discriminated against because of that. I totally wasn’t prepared for that at all right. I was like, “Wow, this is really fun.”

JD: So when was it that you found this calm place? How did you find it?

BB: Well, luckily, I didn’t give up. And I eventually found a lovely gay surgeon who was completely sympathetic, lovely fellow, and he helped me with the top surgery, which was all I really needed to have at the time. He knew I was HIV positive, and that wasn’t an issue for him. So that was nice that I found that, but I guess the sense of calm didn’t come for a long time after that, because it takes a lot of effort to get people on board with where you are, what you’re presenting yourself as. It doesn’t just happen instantly, as I think some of us would like it to happen.

So, it was very long, gradual. I remember walking into the men’s locker room for the first time in 15, 20 years, and it was jaw-dropping for me. Yeah, penises swinging around!

JD Davids is a former senior editor and director of strategic communications at TheBody and TheBodyPRO. A longtime HIV/AIDS activist and communication strategist, he is a co-founder of Project TEACH at Philadelphia FIGHT, was a longtime member of ACT UP Philadelphia, and founded Community HIV/AIDS Mobilization Project (CHAMP) and the HIV Prevention Justice Alliance.

The forgotten: Living with HIV in war-ravaged Yemen

This article comes from Al Jazeera and highlights the plight that people in Yemen have to deal with daily.

Most Yemenis living with HIV/AIDS face stigma and discrimination, even from their own families.by Naseh Shaker & Faisal Edroos22 Jan 2019

The patients names have been changed to protect their identity.

Sanaa, Yemen – With each breath, the red rashes on Ahmad’s cheeks appeared to get brighter and brighter.

The eight-year-old had just made his way up the stairs of the al-Jumhurriya hospital in the Yemeni capital Sanaa, one of the few health centres in the war-ravaged country that still provides free medical treatment to people living with HIV.

As he took his seat in the waiting room next to his ailing father, the sound of static from an old analogue TV appeared to startle the tired young boy, further heightening his anxiety as he waited for doctors to call him in for his latest blood test.

Three years ago, Ahmad was healthy and playful, his father Zakariyya told Al Jazeera.

“When he became sick, we took him to the hospital where doctors carried out tests and told us he had problems with his immune system,” he said.

“They later told us it was HIV. 

“My wife and I also took the tests and we also tested positive.”

An acronym for the human immunodeficiency virus, HIV attacks important cells that help the body fight off infections, disease, and other viruses.

When the infection goes untreated, it causes AIDS. This typically causes fever, weight loss, recurrent diarrhoeal infections and other symptoms.

While both are seen as treatable, a cure has yet to be found.

‘I take a red pill every day’

Zakariyya said his family moved to Sanaa sometime in 2016 for treatment when fighting engulfed his neighbourhood in the southwestern city of Taiz.

As Houthi fighters were being expelled from the city, air attacks and street clashes devastated Taiz, forcing at least 37 of its 40 hospitals and medical institutions to close.

According to local authorities, Doctors without Borders, best known by its French initials MSF, was one of the few aid agencies that continued providing free antiretroviral (ARV) treatment to the 600 people living with HIV/AIDS in the capital.

The situation was so dire, that some of the patients began rationing their medicines because of the difficulty associated with reaching clinics and hospitals.

Citing the case of one woman, MSF said that she began taking half a tablet instead of a whole one and even began taking them on alternate days so she didn’t have to completely stop her treatment.

Zakariyya said he and his family were among the fortunate ones and received their intended doses. 

“The doctors have given us medicine,” he said. “I don’t know its name, but it’s a red pill. I take one every day.”

The government has zero funds allocated for HIV and AIDS

TAHA AL-MUTAWAKEL, MINISTER FOR HEALTH IN THE HOUTHI-RUN ADMINISTRATION

Thrown out of their homes

According to the World Health Organization, the first HIV case appeared in Yemen in 1987, and the number of people living with it was estimated to be around 9,900.

While prevalence was only 0.2 percent of the population, most Yemenis living with either of the viruses faced stigma and discrimination, even from their families.

According to the most recent report by Stigma Index, the world’s largest social research project implemented by people living with HIV, most HIV-positive Yemenis had been thrown out of their homes by family members due to fears of infection.READ MORE

The research said that all the people they interviewed experienced some form of stigma because of their HIV status, with one third saying they had to “change their residence or could not rent a place” because of their condition.

Ibrahim al-Babli, a doctor at the HIV/AIDS laboratory at the al-Jumhurriya hospital, said those patients were not the only forgotten victims of this war.

A staggering 1.2 million civil servants living in Houthi-held areas had not received their salaries after the Yemeni government stopped paying them in late 2017 in an effort to start a popular uprising.

The effects were devastating, with health, education and sanitation services left without the people needed to run them.

Resources were stretched so thin, Babli said, that patients were lucky to enter a manned hospital.

“I haven’t received my salary in months, I get paid sporadically,” said Babli.

“If doctors aren’t cared for, then that means there’s no care for the patients.”

‘Zero funds for HIV/AIDS’

The United Nations has repeatedly described Yemen’s humanitarian situation as “catastrophic” and, on Wednesday, Mark Lowcock, the under-secretary-general for Humanitarian Affairs, said the situation had worsened in the past year with “more than 24 million people now needing humanitarian assistance”.

Taha al-Mutawakel, the minister of health in the Houthi-run administration, told Al Jazeera that the war had crippled the health system with “zero funds allocated for HIV and AIDS”.

HIV/AIDS: Fewer deaths, but infections still rising

INFOGRAPHIC

HIV/AIDS: Fewer deaths, but infections still rising

“We’re currently operating with a grant of $800,000 provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria,” he said.

“Medicines are readily available and offered free of charge and distributed to each of the governorates … but the siege has had a major impact on patients seeking treatment.”

Saudi Arabia, which has been conducting an air campaign in Yemen since March 2015, intensified its embargo on the country in 2017, restricting both humanitarian aid and commercial goods from entering Houthi-held ports.

The kingdom said the blockade was a necessary precaution aimed at preventing weapons from being smuggled into Yemen by Saudi Arabia’s regional rival, Iran.

The inadequacy of services … may increase the vulnerability to HIV/AIDS transmissions

ELTAYEB ELAMIN, REGIONAL PROGRAMME ADVISER AT UNAIDS MIDDLE EAST

‘Race against time’

Eltayeb Elamin, the Regional Programme adviser at UNAIDS Middle East said the situation in the country had greatly affected the movement of HIV and AIDS patients, with the “disruption to the supply system … leading to difficulties in the accessibility for available services”.

“The effect of the war on the health infrastructure is also greatly stressed with inadequate supplies hampering HIV/AIDS prevention efforts especially counselling and testing,” he said.

“The inadequacy of services … may increase the vulnerability to HIV/AIDS transmissions through lack of universal precautions and inadequacy of needed services.”READ MORE

Zakariyya said while he was still in the dark about his son’s future, he was confident that with some treatment, he could go on to live a full life.

“My son nearly died. But now, all praise to God, he is doing much better,” he said. “We believe in God and have faith that our lives and our fate are in his, not our, hands.”

Meritxell Relano, UNICEF’s resident representative in Yemen, said that with the fighting showing no signs of abating, aid agencies were in a “race against time” to save children such as Ahmad.

“We urge for an end to the war on children, not tomorrow, but today,” she said. “Parties to the conflict must work to reach a negotiated political solution, prioritising and upholding the rights of the children.

“The longer this war continues, the more children are going to die on the world’s watch.”

Resources are stretched so thin, that according to Dr Babli, patients are lucky to enter a manned hospital [Al Jazeera]

Integrase Inhibitors May Be Tied to Weight Gain

Poz.com explores an issue that needs more research but at present is pointing to this being real for many.

More high-quality evidence is needed to determine how this class of HIV medications may affect weight gain.


The integrase inhibitor class of antiretroviral (ARV) medications may be associated with weight gain, aidsmap reports. A review of observational studies and clinical trials found the risk to be pronounced among women and Black people.

Publishing their findings in the Journal of Virus Education, researchers looked for studies that could provide information about weight changes after starting one of the four approved integrase inhibitors: Isentress (raltegravir); Tivicay (dolutegravir), which is included in Triumeq (dolutegravir/abacavir/lamivudine) and Juluca (dolutegravir/rilpivirine); Vitekta (elvitegravir), which is included in Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate) and Odefsey (emtricitabine/rilpivirine/tenofovir alafenamide); and bictegravir, which is not approved as a stand-alone pill and is included in Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide).

The study authors reviewed a handful of randomized clinical trials—in which differences in ARV regimens were the result of randomization—including:

  • The ACTG 5257 study, in which those who received Isentress, in particular Black participants, were more likely to become overweight or obese compared with those who received boosted Prezista (darunavir) or Reyataz (atazanavir). All participants took Truvada (tenofovir disoproxil fumarate/emtricitabine) as a backbone to their ARV regimen.
  • The NEAT-001 study, in which all participants took Isentress and those who took it with boosted Prezista developed higher trunk fat levels after 96 weeks compared with those who took Isentress plus Truvada.
  • The SPRING-1 study, in which weight gain was greater among those who took Tivicay compared with those who took Sustiva (efavirenz).
  • The Gilead 1490 study, in which participants took either Tivicay or bictegravir. Both groups gained 3 kilograms (6.61 pounds) over 96 weeks. All study members took Descovy (emtricitabine/tenofovir alafenamide) as a backbone.

Some research has suggested that the tenofovir alafenamide component of Descovy is associated with weight gain compared with the older version of tenofovir, the tenofovir disoproxil fumarate component of Truvada.

As for observational studies, which are a less robust source of scientific evidence than randomized trials, findings included:

  • Tivicay plus Ziagen (abacavir) was associated with greater weight gain than Tivicay plus Viread (tenofovir disoproxil fumarate). It is not clear whether this indicates that Viread moderates any weight gain linked to integrase inhibitors.
  • Several observational cohort studies saw greater weight gain in those starting or switching to an integrase inhibitor, particularly women.

More research is needed to determine whether integrase inhibitors are associated with weight gain and whether any such gain in body fat is associated with various negative health outcomes. Obesity is associated with diabetes, cardiovascular disease (CVD) and cancer in particular, all of which occur at higher rates among people with HIV compared with the general population.

Tips on Taking Your HIV Medication Every Day



This important article will help everyone who sometimes struggles with taking their medication every day and although it relates to the US experience it is a great guide for us here in Australia…and is from HIV.gov and was printed on The Body website…

January 28, 2019


What Are Some Tips to Help Me Take My HIV Medication Every Day?

If you’re newly diagnosed with HIV, you may be seeking tips and tools to help you keep up with your HIV treatment. That’s because HIV treatment involves taking HIV medication every day, exactly as prescribed to lower the amount of HIV in your body (also called the viral load) to a very low level. This is called viral suppression. If the viral load is so low that it doesn’t show up in a standard lab test, this is called having an undetectable viral load. Getting and keeping an undetectable viral load is the best thing you can do to stay healthy. There is also a prevention benefit: people living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

Learn more: Read the fact sheet about the health and prevention benefits of viral suppression and maintaining an undetectable viral load (PDF 166 KB).

Here are some tips that may help you take every dose of your HIV medication, every day:

  • Follow your treatment plan exactly as your health care provider has prescribed. HIV medication should be taken at specific times of the day, with or without certain kinds of food. If you have questions about when and how to take your medication, talk to your health care provider or pharmacist.
  • Create a routine. Add taking your medication to things you already do each day.For example, if your medical provider prescribes taking your medication every morning with food, make it a habit to take it at breakfast.
  • Try a weekly or monthly pill box with compartments for each day of the week to help you remember whether or not you took your medicine that day.
  • Set an alarm on your clock, watch, or phone for the time you take your HIV medication.
  • Keep a daily log or use a calendar to keep track of the days you have taken your HIV medication.
  • Download a free app from the Internet to your computer or on your smartphone that can help remind you when it’s time to take your HIV medication. Search for “reminder apps,” and you will find many choices.
  • Set up automatic refills at your pharmacy. Your medicine will be ready when you need it, and you won’t run out.
  • Ask a family member or friend to encourage you and give you a daily phone call, text, or email to remind to take your HIV medication.
  • Continue to see your health care provider regularly. Regular medical visits are important to monitor the amount of virus in your blood to make sure it stays undetectable, and to receive other medical support. Use these visits to talk openly to your provider about any help you might need sticking to your treatment plan..

You can also visit HIV.gov’s Positive Spin or CDC’s HIV Treatment Works campaign to view stories of how people living with HIV are taking their HIV medication every day.

What Are Some Challenges I Might Face Taking My HIV Medication Every Day?

Taking medication every day can be difficult. That is why it is important to understand some of the challenges you may face and to think through how you might address them before they happen. For example, remembering when to take your medication can be complicated. Some medication regimens involve taking several pills every day—with or without food—or before or after other medications. Making a schedule of when and how to take your medicines can be helpful. Or ask your health care provider about the availability of multiple drugs combined into one pill.

Other factors can make it difficult to take your HIV medications every day, including:

  • Problems taking medications, such as trouble swallowing pills, can make staying on treatment challenging. Your health care provider can offer tips and ideas for addressing these problems.
  • Side effects from medications, for example, nausea or diarrhea, can make a person not want to take them. Talk to your health care provider. There are medicines or other support, like nutritional counseling to make sure you are getting important nutrients, which can help with the most common side effects. But don’t give up. Work with your health care provider to find a treatment that works for you.
  • A busy schedule. Work or travel away from home can make it easy to forget to take pills. Planning ahead can help. Or, it may be possible to keep extra medicines at work or in your car for the times that you forget to take them at home. But make sure you talk to your health care provider—some medications are affected by extreme temperatures, and it is not always possible to keep medications at work.
  • Being sick or depressed. How you feel mentally and physically can affect your willingness to stick to your HIV medications. Again, your health care provider is an important source of information to help with your mental health needs.
  • Alcohol or drug use. If substance use is interfering with your ability to keep yourself healthy, it may be time to seek help to quit or better manage it.
  • Treatment fatigue. Some people find that taking their HIV medications becomes harder over time. Every time you see your health care provider, make it a point to talk about staying adherent to your medications.

Your health care provider will help you identify barriers to keeping up with your HIV medication regimen and ways to address those barriers. Understanding issues that can make keeping up with your HIV medication regimen difficult will help you and your health care provider select the best treatment for you.

Tell your health care provider right away if you’re having taking your HIV medication every day. Together you can identify the reasons why you’re skipping medications and make a plan to address those reasons. Joining a peer support group of others taking HIV medication, or enlisting the support of family and friends, can also help you.

[Note from TheBody: This article was created by HIV.gov, which last updated it on Jan. 9, 2019.]