This issue’s specialist:
Dennis Myers MSN, FNP, AAHIVS
Dear HIV Specialist,
I am a 49-year-old female and have been positive since 1995. I am currently on meds. My T-cell count is currently 700. It was 1,100 a year ago, but I am still undetectable. Should I consider a different med regimen? My doctor says there is no concern unless my virus becomes detectable.
Signed, Worried
Dear Worried,
There is always room for healthy, knowledgeable concern. HAART (highly active antiviral therapy) failure is multi-factorial. T-cell counts fluctuate. Adherence is always the first thing to check if you suspect a problem. Are you 100% faithful to your regimen? Do you take your HAART at the same time every day? Drug blood levels will drop if med routines are inconsistent over time. A viral load breakthrough or a drop in your T-cells can result. I watch count “trends” and correlate them with how my client is “feeling.” If your T-cells continue to drop over time, your adherence is back to 100%, and you remain undetectable, you may be experiencing “immunological failure.” A genotype test can’t be used to check for HAART failure until your viral load is greater than 1,000 copies. Any regimen may begin to lose its potency over time. A complete HAART review is in order for you. Your counts are still excellent. At what CD4 count level your regimen should be changed is a purely clinical decision at this time. I would repeat your counts every three months to follow this trending. Monitor your physical signs and symptoms. Correlate these with your counts. Given your concern, if your T-cell count drops to 500, suggest to your provider a HAART change may be needed. If either of you are unsure as to what to switch to, consult with an HIV specialist. Take heart and keep taking your HAART. Congratulations on being undetectable and surviving this long.
Dear HIV Specialist,
I am a 24-year survivor and am 64 years old. During the 80s or early 90s I read an article in some gay publication that explained that if one’s mouth was healthy (no bleeding gums, no ulcers) one could swallow cum and not be concerned about contracting HIV because the natural stomach acid destroyed the virus. Am I delusional?
Signed, Swallow or Spit
Dear SOS,
Swallowing sperm is not the real issue. Any type of oral sex can be potentially hazardous. Your body’s first line of defense is intact skin and mucous membranes. I view the mouth as “the mirror of the HIV soul.” Signs of illness and a depressed immune system can show up first in the oral spaces. Your gums, mouth, and esophagus are fragile, subjected to daily hazards such as toothpicks, toothbrushes, pencils, fingers, foods, and chemicals. You may not always be aware of breaks in the oral membranes. There is a slight potential of contracting HIV by exposing your oral mucous membranes to HIV-infected sperm. The level of HIV virions is greater in sperm and vaginal secretions than in blood. But I would be more worried about syphilis, gonorrhea, herpes, warts, and just plain bacterial infections from lack of basic oral hygiene. The effects of these would appear sooner. Inspect your partner’s lips and genitalia before engaging. “Turn the lights on” if you must. The use of dental dams and condoms should be the rule not the exception. Congratulations on your surviving this long. Take heart and keep taking your HAART.
Dennis Myers, MSN, FNP, AAHIVS
Clinic Director
Matthew 25 AIDS Services, Inc.
Henderson, Kentucky
