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@ItsOfficialNemo: Valuing oneself more while getting a clearer understanding of life

@ItsOfficialNemo, who was diagnosed to be HIV-positive in March 2012, believes in looking forward. “There’s no point in pointing who’s to blame now because it’s clear to me that it was also my fault,” he said. And to others on the same boat as he is, “life goes on. Let’s continue to love and live responsibly this time. Our status does not define who we are, and we should not feel any less just because (of it). In the end, it’s not our status that will (define) us but how well we live our lives.”

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

In March 2012, @ItsOfficialNemo was diagnosed to be HIV-positive. “Prior to discovering my status, I was already (going) in and out of the hospital because of my pertinent fever at the time. I started getting sick frequently sometime around October 2011, but private hospitals won’t allow me to check in because they thought it was just a simple fever,” he recalled. “However, in February 2012 I collapsed in my own apartment and I was rushed to the hospital in Makati to be examined. At that point, I requested the doctor (to allow me to) stay for further examinations because I was really getting scared and I was losing weight abruptly.”

Because of his health condition at that time, the personal and professional aspects of @ItsOfficialNemo’s life were already affected. His boss, in particular, was already very concerned about his health. “So there I was, admitted in one of the private hospitals in Makati, doctors examining my condition because – aside from my fever – I had some rashes in some parts of my body. I went through a couple of tests at that time (and) it was during my ultrasound schedule that the doctor noticed some oversize nodules/lymph nodes situated at the left side of my neck. After further tests, the doctor recommended that I go through a major operation to take out those lymph nodes for them to be examined.”

And so from a couple of days in the hospital, @ItsOfficialNemo’s stay stretched to more than a week. At that time, he already asked his mother to fly into Manila to be with him before his operation.

Before the operation, no explanation was given to him about his health condition. Instead, the doctors just told him to wait after the operation so they can validate his test results.

When @ItsOfficialNemo returned to the hospital, the document with the test result indicated that he had TB of the lympnodes as the diagnosis. He recalled that “I proceed to my doctor on that same day with a sigh of relief that it’s not the diagnosis I was expecting.” But his doctor started to ask him questions related to his sexual practices. The doctor also asked him if he ever had HIV Ab test – which he never had until then – and eventually recommending it.

@ItsOfficialNemo admitted that “I didn’t submit myself for testing right away.” Instead, he only religiously took the medicines prescribed by the doctor for TB. It took him seven months before he considered getting tested.

“While I was browsing my Facebook account, I saw one posting of my friend who is a member of an organization promoting HIV awareness. At that time, he posted an invitation for (people to avail of) free HIV testing.” To make the story short, it was then that @ItsOfficialNemo found out about his HIV-positive status.

At the time of him getting tested, @ItsOfficialNemo recalled that “when I opened the envelope (containing the result), I was not hoping anymore that it would be negative because I had a very strong feeling beforehand that something was very wrong about my health and the possibility of me being infected is something I (could not avoid). And there, under my name, it stated positive. There was this long silence. It’s like the doctor and the counselor were waiting for me to break down or to react before they did or said something, but I could not find any word to say at that moment.”

In hindsight, “counting back (when) I got terribly sick to the time I was diagnosed, I just got out from a relationship that went bad. After that traumatic break-up, that’s when I lost myself and experimented with different kinds of illegal drugs (and had sexual contacts with) strangers I met mostly online,” @ItsOfficialNemo. While he has a gut feeling he knows who, specifically, infected him, @ItsOfficialNemo said that “there’s no point in pointing who’s to blame now because it’s clear to me that it was also my fault. All I can think of at that time is how am I going to get through this by myself.”

@ItsOfficialNemo decided to inform his two close friends first about his status. “It started as an obligation for me to tell someone because it was required for my counseling session before I could start taking ARV,” he said. But having disclosed, “I realized it gave me a sense of relief and comfort exposing my status to my two friends and how they reacted without judgment but love and understanding to me.”

@ItsOfficialNemo found people from Twitter he considers as “friends of the same status like mine”. “At first, I didn’t know that a certain community like ours existed. I discovered this channel when I saw a blog one time that led me to create an account in Twitter, and that blogger who is now a good friend of mine introduced me to my fellow ‘pozzies’. We keep in touch and meet once in a while to show support to each other, and it really feels good a having people with you who understand your new journey and are with you in this new life.”

@ItsOfficialNemo has been taking ARVs since June 2012 and “it has been pleasant for me. Though I was warned by my doctor that during the first two weeks of taking ARV, I may experience some side effects, in general, I didn’t experience any major struggle. I am thankful that my body is responding well to the ARVs.” @ItsOfficialNemo thinks his mentality contributed a lot in the whole process of taking the drugs. “I was so determined at that point that things will get better now that I am taking ARV. Setting a positive mindset and putting things in perspective helped me a lot in processing my condition with the support of my friends.”

At this point, @ItsOfficialNemo has yet to disclose his status to his family. “I am still contemplating how and when,” he said. “To be honest, the fear of losing them after I disclosed my status to them is still strong at this point.”

His friends now serve as his support system. “I still consider myself blessed to have met new friends sharing the same experience (as me, and forging) a new life with, and this opens new doors for me. They made me realize that my status will not stop me from living. Instead, they made me value myself more and gave me a clearer understanding about life.”

As an HIV-positive person, @ItsOfficialNemo has lessons he believes he can teach others.

“Be responsible, for those who are non-positive – it is still best to have yourself tested. We are so fortunate that we have NGOs that offer free HIV testing, and our community is very aggressive nowadays in promoting HIV awareness in all channels (Internet, television, broadsheet, et cetera). Do not be afraid, you owe this yourself,” @ItsOfficialNemo said.

And for “my fellow beautiful people or ‘pozzies’, life goes on. Let’s continue to love and live responsibly this time. Our status does not define who we are, and we should not feel any less just because (of it). In the end, it’s not our status that will (define) us but how well we live our lives.”

POZ

FDA approves first long-acting HIV treatment

The FDA in the US approved CABENUVA as the first once-monthly, long-acting injectable (LAI) for the treatment of HIV-1 infection in adults. CABENUVA consists of rilpivirine (Janssen) and cabotegravir (ViiV Healthcare Ltd.), for treating HIV-1 infection in adults.

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Photo by Hakan Nural from Unsplash.com

The FDA in the US approved CABENUVA as the first once-monthly, long-acting injectable (LAI) for the treatment of HIV-1 infection in adults. CABENUVA consists of rilpivirine (Janssen) and cabotegravir (ViiV Healthcare Ltd.), for treating HIV-1 infection in adults.

Before proceeding with the news (and dampening the good news), here’s an FYI: As quoted by NBC News, ViiV Healthcare Ltd. stated that the shot combo would cost $5,940 for an initial, higher dose and $3,960 per month afterward.

According to the FDA, the safety and efficacy of CABENUVA were established through two randomized, open-label, controlled clinical trials in 1,182 HIV-infected adults who were virologically suppressed (HIV-1 RNA less than 50 copies/milliliter) before initiation of treatment with CABENUVA. The patients in both trials continued to show virologic suppression at the conclusion of each study, and no clinically relevant change from baseline in CD4+ cell counts was observed (https://www.fda.gov/news-events/press-announcements/fda-approves-first-extended-release-injectable-drug-regimen-adults-living-hiv).

In first trial, the ATLAS study, CABENUVA was said to have met the primary endpoint for noninferiority (or the proportion of participants with plasma HIV-1 RNA ≥50 copies per milliliter [c/mL] at Week 48), with a comparable number of patients receiving either CABENUVA or their daily current antiretroviral regimen (CAR) having an HIV-1 RNA level ≥50 c/mL. Two percent of patients receiving the long-acting injectable and 1% of patients receiving CAR had an HIV-1 RNA level ≥50 c/mL at Week 48 (Treatment difference 0.7%; 95% CI: -1.2%, 2.5%).

In second trial, the FLAIR study, a comparable number of patients receiving either CABENUVA or daily oral dolutegravir/abacavir/lamivudine therapy had an HIV-1 RNA count ≥50 c/mL, meeting noninferiority criteria. Two percent of patients in both treatment arms had an HIV-1 RNA count ≥50 c/mL at Week 48 (Treatment difference -0.4%; 95% CI: -2.8%, 2.1%).

Rilpivirine and cabotegravir are able to act as a complete regimen for people with HIV, allowing it to replace the antiretroviral regimen for those who are virologically suppressed with HIV-1 RNA at less than 50 copies per milliliter [c/mL], have no history of treatment failure, and are not known or suspected to have any resistance to either cabotegravir or rilpivirine.

To administer the therapy, a provider would conduct a once-monthly administration that would consist of two individual intramuscular injections in the buttocks.

Added the FDA: The most common adverse reactions with CABENUVA were injection site reactions, fever (pyrexia), fatigue, headache, musculoskeletal pain, nausea, sleep disorders, dizziness and rash. Cabenuva should not be used if there is a known previous hypersensitivity reaction to cabotegravir or rilpivirine, or in patients who are not virally suppressed (HIV-1 RNA greater than 50 copies/milliliter).

In a press release, Paul Stoffels, MD, vice chairman of the executive committee and chief scientific officer at Johnson & Johnson said: “With the approval of CABENUVA, we’re proud to bring a new treatment option to people living with HIV that removes the burden of taking a daily pill… While much more remains to be done to make HIV history, today’s milestone reminds us how far medical innovation has come since the first reported cases of the virus almost 40 years ago.”

Now, and realistically, with newer HIV medicines like rilpivirine and cabotegravir not even widely offered in countries like the Philippines yet, the even newer injectables may sound promising but remain stuff of dreams…

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Op-Ed

I may be HIV+ but that still doesn’t mean I’ll sleep with you

This is something every PLHIV needs to learn. That we are still “worth it”. Forget these notions of you being a “damaged good” or a “dirty person” or banalities given us along those lines. Because my HIV status is just one facet of my outrageous (and fabulous) personality; it does not define me.

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Photo by lalesh aldarwish from Pexels.com

“I’m HIV-positive.”

That was the short sentence I remember telling this guy I used to date.

Okay – to backtrack – I met a guy while I was in Northern Mindanao. We dated for a while, and – at least I thought – things between us went smoothly for a while. I’d say he wasn’t bad-looking even if he looked somewhat common. He had one of those “if you stay long enough, I can teach myself to maybe even like you” face.

And then one night, we became more intimate than the usual. So I had to stop what we were doing (before we progressed further). And then – after prepping him up by first discussing with him his views about HIV and people living with HIV – I told him I had something important to tell him (if we were to advance what we had).

Thus that short sentence.

His face immediately changed; from what I saw was longing to… shocked. He couldn’t even say a word. And when he was finally able to utter a word, it was just to tell me that “I forgot I had to be elsewhere.”

The alibi was lame. But what made it more insulting was that I wasn’t even that into him to begin with; he was just a possible lay (if it came to that).

But that moment taught me two important things.

On one hand, how the sexuality of so many PLHIVs are tempered by their status.

I have frequently heard of medical practitioners who tell PLHIVs to “already stop having sex now that you’re HIV-positive; dadami pa kayo (you’d abet in increasing the number of PLHIVs)” – all too obviously unaware of safer sexual practices and U=U, among others. Worse, this sentiment is shared by a lot of PLHIVs themselves, who see their status as a “punishment”, and the only “cure” is to stop having sex altogether. Oh, please!

On the other hand, recognizing that being sexual doesn’t disappear (and doesn’t need to vanish) with being HIV-positive, there seems to be this supposition of PLHIVs being “desperate”.

That guy I dated, for instance, had every right NOT to have sex with me (it’s called power over one’s body); but that he had to lie just to get away from me was – to admit the truth – not only discourteous but even insulting. I suppose particularly because… I wasn’t even that into him.

Here’s the thing: Me living with HIV means just that – that I have HIV. But it doesn’t mean that I’ve lost my (yes!) sexual appetite and (for that matter) taste/preferences/standards on who to do it with.

And I believe this is something every PLHIV needs to learn. That we are still “worth it”. Forget these notions of you being a “damaged good” or a “dirty person” or banalities given us along those lines. Because my HIV status is just one facet of my outrageous (and fabulous) personality; it does not define me. And if (some) guys can’t see that, well…

Because remember dearie, just because I am HIV-positive still doesn’t mean I’ll sleep with you.

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POZ

CDC in the US releases recommendations for Covid-19 vaccine for PLHIVs

According to the CDC, “adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes Covid-19.” It added that “mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine.”

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Photo by Towfiqu barbhuiya from Canva.com

With the Department of Health (DOH) still not releasing guidelines re vaccinations in the Philippines including of Filipinos living with HIV, eyes are turning – instead – to international bodies that already released recommendations for the same. One such body, the Center for Disease Control and Prevention (CDC) – released in end-2020 its “Vaccination Considerations for Persons with Underlying Medical Conditions”.

According to the CDC, “adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes Covid-19.” It added that “mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine.”

The CDC noted that PLHIVs were actually included in clinical trials, but “safety data specific to this group are not yet available at this time.” It saw fit to stress this point: “Information about the safety of mRNA COVID-19 vaccines for people who have weakened immune systems in this group is not yet available.”

Nonetheless – and this is worth stressing – because “PLHIVs and those with weakened immune systems due to other illnesses or medication might be at increased risk for severe Covid-19… they may receive a Covid-19 vaccine.”

Aside from v=being aware of the potential for reduced immune responses to the vaccine, those with weakened immune systems (including PLHIVs) should continue following all current guidance to protect themselves against Covid-19.

  • Wearing a mask
  • Staying at least six feet away from others
  • Avoiding crowds
  • Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
  • Following (CDC) travel guidance
  • Following quarantine guidance after exposure to Covid-19
  • Following any applicable workplace guidance
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POZ

Risk of developing cervical cancer is six times higher in women with HIV

Cervical carcinomas are usually caused by infections with Human papillomavirus (HPV), which are sexually transmitted just as HIV is. Based on the results of a new study, it can be assumed that an infection with HIV represents a risk factor for an infection with HPV.

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Photo by Lucian Dachman from Unsplash.com

The risk of developing cervical cancer is six times higher in women who are infected with HIV.

This is according to a study from the TUM School of Medicine’s Center for Global Health and the chair of Epidemiology at the TUM Department of Sport and Health Sciences – “Estimates of the Global Burden of Cervical Cancer Associated with HIV” – that was published in the The Lancet Global Health.

According to WHO statistics, cervical cancer is the fourth most common type of cancer for women. In 2018 an estimated 570,000 women worldwide were diagnosed with cervical carcinoma, with approximately 311,000 of these women dying.

On the other hand cervical cancer, usually caused by Human Papillomavirus (HPV), is also one of the most successfully preventable and treatable types of cancer, as long as it is detected at an early stage and treated effectively.

Cervical cancer is at the same time the most frequently detected cancer for women who live with HIV, since their immune systems are weakened by the HIV infection.

Systematic review and meta-analysis of 24 studies

The lead authors Dr. Dominik Stelzle (Center for Global Health and Chair of Epidemiology) and Dr. Luana Tanaka (Chair of Epidemiology) conducted a systematic review as well as a meta-analysis of a total of 24 studies from the years 1981 to 2016, in which 236,127 women with HIV from four continents (Africa, North America, Asia and Europe) participated.

These studies covered a total of 2,138 cervical carcinoma cases. The results were linked with data from UNAIDS on worldwide HIV infection and with data on cervical carcinoma from the International Agency for Research on Cancer (IARC), the WHO’s Cancer Research Center, and then evaluated.

“Until now there have only been estimates from countries with high net income levels,” says Dr. Stelzle. “That’s why we looked at the figures on global incidence of cervical carcinoma in connection with an HIV infection and included estimates for countries with low net incomes. In most parts of the world the numbers are under five percent. In some countries however we’re talking about well over 40 percent of cases.”

Risk is six times higher for women with HIV

The objective of the study was to calculate the share of women living with HIV among the number of women with cervical cancer. The authors found that 5.8 percent of all new cervical cancer cases worldwide in the year 2018 were diagnosed for women with an HIV infection. This is equivalent to 33,000 cases a year, 85 percent of which occurred in Sub-Saharan Africa.

Furthermore, based on their results the team was able to show that women with HIV have a sixfold higher risk of developing cervical cancer than women without HIV infection.

“The association between cervical carcinoma and HIV is plausible,” says Prof. Andrea S. Winkler, co-director of the Center for Global Health. “Cervical carcinomas are usually caused by infections with Human papillomavirus (HPV), which are sexually transmitted just as HIV is. Based on our results it can be assumed that an infection with HIV represents a risk factor for an infection with HPV.”

Based on the results, the TUM authors determined that women with an HIV infection have a significantly higher risk of developing cervical cancer. They also pointed out that this means that HPV vaccinations and early-stage cervical carcinoma screenings are of particular importance.

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POZ

How the vaginal microbiome may affect HIV prevention

With no effective vaccine for HIV, alternative strategies such as pre-exposure prophylactic (PrEP) drugs are necessary to prevent transmission. PrEP drugs are highly effective in preventing the acquisition of HIV infection in men, but they are much less effective at preventing HIV infection in women.

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Photo by Timothy Meinberg from Unsplash.com

Healthy Lactobacillus bacteria in the vagina are critical for women’s health, but the accumulation of additional bacterial genera can imbalance the vaginal ecosystem. Such an imbalance may result in bacterial metabolism of drugs designed to prevent HIV infection, thereby decreasing their effectiveness and enhancing risks to women.

This is according to a study published in the open-access journal PLOS Pathogens by Dr. Nichole Klatt of the University of Minnesota Medical School, and colleagues.

With no effective vaccine for HIV, alternative strategies such as pre-exposure prophylactic (PrEP) drugs are necessary to prevent transmission. PrEP drugs are highly effective in preventing the acquisition of HIV infection in men, but they are much less effective at preventing HIV infection in women.

Recent evidence demonstrates that vaginal microbial communities are associated with increased HIV acquisition risk and may impact PrEP efficacy. To better design and conduct clinical studies assessing HIV prevention in women, it is essential to understand how microbes in the female reproductive tract affect therapeutic drug levels.

In the new study, Klatt and her colleagues investigated how vaginal bacteria alter PrEP drug levels and impact HIV infection rates using cervicovaginal lavage samples from women with and without bacterial vaginosis (BV) – a highly common syndrome in women that is caused by bacteria that can induce itching, discharge and discomfort, and has been associated with increased sexually transmitted infections and negative reproductive tract outcomes in women.

However, current treatments for BV frequently fail and recurrence is common. The researchers found that bacteria associated with BV – but not healthy Lactobacillus bacteria – can metabolize PrEP drugs and may potentially reduce PrEP efficacy due to reduced levels of available preventative drug. According to the authors, better measurements and interventions for bacterial vaginosis will be critical for improving the efficacy of HIV prevention efforts in women.

Dr. Klatt highlights, “women’s health, and factors that contribute to health and disease prevention in women are grossly under studied. This study demonstrates the critical need to develop better treatments for bacterial vaginosis, and in general, to promote more studies of women’s health.”

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POZ

Dep’t of Health dispenses newer HIV drug in the Phl

The Department of Health (DOH) is introducing LTD (lamivudine, tenofovir, dolutegravir) in the country.

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Took them long enough…

Xander (not his real name) has been HIV-positive since December 2012; and from the very first time he took his antiretroviral (ARV) medicines, “it has always been LTE (for lamivudine, tenofovir, efavirenz),” he said.

There have been adverse side effects – e.g. “At night, my dreams are so vivid I am unable to distinguish what’s real or what’s not,” Xander said, adding with sadness that “the doctor just told me to ‘Drink more water!’ as if that’d solve my problem.”

Those like Xander may now have their ARVs changed, with the Department of Health (DOH) introducing LTD (for lamivudine, tenofovir, dolutegravir) in the country.

This December, the Global Fund for treatment of people living with HIV (PLHIV) donated 197,260 bottles of LTD. The stock is being managed by the DOH’s Disease Prevention and Control Bureau – National HIV, AIDS and STI Prevention and Control Program.

The first tranche of 98,630 bottles were already allocated to various Centers for Health Development, while the last tranche (98,630 bottles) are expected to arrive in the country before the end of the year.

In an advisory signed by Undersecretary of Health Dr. Myrna Cabotaje, the DOH stated that based on the National Plan for LTD Introduction, the new ARV will be introduced from now until December 2021. These sub-populations of PLHIVs can benefit from LTD:

  • ART-naive adults, adolescents and children (30 kg and above), excluding TB patients on rifampicin-based regimen
  • PLHIVs on LTE with severe adverse events (dizziness, insomnia, abnormal dreams, anxiety, depression, mental confusion, convulsions, hepatoxicity, severe skin and hypersensitivity reactions and gynecomastia)
  • Patients with treatment failure to zidovudine (AZT) and abacavir (ABC)-based regimens

Xander knows he has to broach his concerns to the doctor in his treatment hub again to ascertain if he can shift from LTE to LTD. And “the DOH really took its time,” he mused, adding that hopefully, “this is just one of the steps wherein Filipino PLHIVs actually already start being able to access life-saving HIV meds already widely available in more developed countries.”

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