NATIONAL RESOURCES NEW MEXICO RESOURCES This Fact Sheet contains selected contact information for organizations providing HIV/AIDS services and information, both within the United States and in New Mexico. For more information, contact your closest Health Management Alliance (listed below), or the New Mexico HIV/AIDS/STD/Hepatitis Hotline at (800) 545-2437. NATIONAL RESOURCES AIDS Info (US Department of Health and Human Services): (800) 448-0440 https://www.aidsinfo.nih.gov/ Centers for Disease Control (CDC) Health Information Hotline: (800) CDC-INFO or (800) 232-4636; cdcinfo@cdc.gov. National Association of People With AIDS (NAPWA), Silver Spring, MD: (240) 247-0880; https://www.napwa.org/ National Minority AIDS Council, Washington DC: (202) 483-6622; https://www.nmac.org/ National Native American AIDS Prevention Center (NNAAPC): (510) 444-2051, https://www.nnaapc.org/ Project Inform: https://www.projinf.org/ National HIV/AIDS Treatment Infoline: (800) 822-7422 or (415) 558-9051 in the San Francisco Bay Area or internationally Social Security Administration – Benefits for People living with HIV/AIDS: https://www.ssa.gov/pubs/10019.html Women Responding to Life-Threatening Diseases (WORLD), Oakland, CA: (510) 986-0340; https://www.womenhiv.org/ The web site The Body also has an AIDS Service Organization (ASO) Finder that you can find in the "Connect" section of their web site at https://www.thebody.com/connect.html The Centers for Disease Control maintains a database of over 19,000 service organizations in the United States dealing with HIV/AIDS, tuberculosis, and sexually transmitted diseases. You can search this database on the Internet at https://www.cdcnpin.org/scripts/locates/LocateOrg.asp NEW MEXICO RESOURCES Albuquerque Area Indian Health Board: (505) 764-0036, (800) 658-6717; https://www.aaihb.org/ Albuquerque Health Care for the Homeless: (505) 766-5197, https://www.abqhch.org/ All Indian Pueblo Council, Albuquerque: (505) 883-7682 Health Management Alliances: District I: New Mexico AIDS Services, Truman Street Health Services. 625 Truman Street., NE Albuquerque, NM 87110 Executive Director: Kathleen Kelley (888) 882-2437, (505)938-7100 District II: Southwest Care Center 649 Harkle Rd., Suite E Santa Fe, NM 87505 Executive Director: David Barrett, LISW (888) 320-8200 or (505) 989-8200 Fax 505 989-8131 e-mail: Swcares@ix.netcom.com https://www.southwestcare.org/ District III: Camino de Vida Center for HIV Services P.O.Drawer 2827 Las Cruces, NM 88004-0130 Executive Director: Audrey Hartley (800) 687-0850 or (505) 527-9860 Fax (505) 525-2341 https://www.caminodevida.org/home.htm District IV: Alianza of New Mexico 200 W. Hobbs Street Roswell, NM 88203 Executive Director: Debi Peterman, MSN, RN (800) 957-1995 or (505) 623-1995 Fax (505) 623-1998 e-mail: debi@alianzanm.org https://alianzanm.org/ Native American HMA: First Nations Community HealthSource 5608 Zuni Rd. SE Albuquerque, NM 87108 (505) 262-2481 Indian Health Service, Albuquerque (505) 248-4000 HIV Center of Excellence (Indian Health Service) Indian Medical Center Phoenix; https://www.ihs.gov/MedicalPrograms/aids/index.asp; (602)263-1502, (602) 263-1200 x1835 Navajo AIDS Network Inc., Chinle, AZ (928) 674-5676 Gallup, NM (505) 863-9929 New Mexico AIDS Education and Training Center, Albuquerque: (505) 272-8443;https://hsc.unm.edu/som/medicine/ID/info_AIDS_HIV.shtml New Mexico HIV/AIDS/STD/Hepatitis Hotline: (800) 545-2437 Social Security Administration, Albuquerque: (800) 772-1213; 4300 Cutler NE; (Monday – Friday 9:00 am – 4:00 pm) This Fact Sheet is sponsored by the US Food and Drug Administration (FDA)

WHY ARE THERE SO MANY AIDS MYTHS? TRANSMISSION MYTHS MYTHS ABOUT A CURE AIDS IS A DEATH SENTENCE THE GOVERNMENT DEVELOPED AIDS TO REDUCE MINORITY POPULATIONS MYTHS ABOUT MEDICATIONS WHY ARE THERE SO MANY AIDS MYTHS? When AIDS first became known, it was a very mysterious disease. It caused the death of many people. There are still many unanswered questions about the disease. Many people reacted with fear and came up with stories to back up their fear. Most of these had to do with how easy it was to become infected with HIV. Most of these are not true. TRANSMISSION MYTHS Many people believed that HIV and AIDS could be transmitted by a mosquito bite, by sharing a drinking glass with someone with AIDS, by being around someone with AIDS who was coughing, by hugging or kissing someone with AIDS, and so on. See fact sheet 150 for current information on how HIV is transmitted. Transmission can only occur if someone is exposed to blood, semen, vaginal fluid or mother’s milk (see fact Sheet 611 from an infected person. There is no documentation of transmission from the tears or saliva of an infected person. Myth: A woman with HIV infection can?t have children without infecting them. Reality: Without any treatment, HIV-infected mothers pass HIV to their newborns about 25% of the time. However, with modern treatments, this rate has dropped to only about 2%. See fact sheet 611 for more information about HIV and pregnancy. Myth: HIV is being spread by needles left in theater seats or vending machine coin returns. Reality: There is no documented case of this type of transmission. MYTHS ABOUT A CURE It can be very scary to have HIV infection or AIDS. The course of the disease is not very predictable. Some people get very sick in just a few months. Others live healthy lives for 20 years or more. The treatments can be difficult to take, with serious side effects. Not everyone can afford the medications. It?s not surprising that scam artists have come up with several ?cures? for AIDS that involve a variety of substances. Unfortunately, none of these ?cures? work. See fact sheet 206 for more information on frauds related to AIDS. A very unfortunate myth in some parts of the world is that having sex with a virgin will cure AIDS. As a result, many young girls have been exposed to HIV and have developed AIDS. There is no evidence to support this belief. Myth: Current medications can cure AIDS. It?s no big deal if you get infected. Reality: today?s medications have cut the death rate from AIDS by about 80%. They are also easier to take than they used to be. However, they still have side effects, are very expensive, and have to be taken every day for the rest of your life. If you miss too many doses, HIV can develop resistance (see fact sheet 126) to the drugs you are taking and they?ll stop working. AIDS IS A DEATH SENTENCE In the 1980s, there was a very high death rate from AIDS. However, medications have improved dramatically and so has the life span of people with HIV infection. If you have access to antiretroviral drugs (ARVs) and to medical monitoring, there?s no reason you can?t live a long life even with HIV infection or AIDS. THE GOVERNMENT DEVELOPED AIDS TO REDUCE MINORITY POPULATIONS The world?s best researchers in government and in private pharmaceutical companies are working hard to try to stop AIDS. The government doesn?t have the capability to create a virus. Many minorities do not trust the government, especially regarding health care. A recent study in Texas found that as many as 30% of Latinos and African Americans believed that HIV is a government conspiracy to kill minorities. However, it seems that minorities receive a lower level of health care due to the same factors as anyone else: low income, inconvenient health care offices, and so on. Attitudes about health care and health care providers were much less important. MYTHS ABOUT MEDICATIONS It has been very challenging for doctors to choose the best anti-HIV medications (ARVs) for their patients. When the first drugs were developed, they had to be taken as many as three times a day. Some drugs had complicated requirements about storage, or what kind of food they had to be taken with (or how long you had to wait after eating before taking a dose). The reality of ARVs has changed dramatically. However, there are still some myths: Myth: You have to take your doses exactly 12 (or 8, or 24) hours apart. Reality: Medications today are fairly forgiving. Although you will have the most consistent blood levels of your drugs if they are taken at even intervals through the day, they won?t stop working if you?re off by an hour or two. However, people taking Crixivan® (indinavir) without ritonavir need to be very careful about timing. Myth: You have to take 100% of your doses on time or else they?ll stop working. Reality: It?s very important to take AIDS medications correctly. In fact, if you miss more than about 5% of your doses, HIV has an easier time developing resistance (see fact sheet 126) and possibly being able to multiply even when you?re taking ARVs. However, 100% adherence is not realistic for just about anyone. Do the best you can and be sure to let your health care provider what?s going on. Myth: Current drugs are so strong that you can stop taking them (take a drug holiday) with no problem. Reality:Ever since the first AIDS drugs were developed, patients have wanted to stop taking them due to side effects or just being reminded that they had AIDS. There have been many studies of ?treatment interruptions? and all of them have shown that stopping your ARVs is very likely to cause problems. You could give the virus a chance to multiply (see fact sheet 125 on the viral load) or your

WHY DOES IT TAKE SO LONG TO APPROVE NEW DRUGS? WHAT ARE THE "PHASES" OF CLINICAL TRIALS? HOW DO WE KNOW IF A DRUG WORKS? USING UNAPPROVED DRUGS FOR MORE INFORMATION WHY DOES IT TAKE SO LONG TO APPROVE NEW DRUGS? Developing a new drug can take 10 years or more. First, drug companies must find substances that are active against HIV. Most HIV drugs are identified by testing existing drugs for anti-HIV activity (screening). A newer method is rational drug design. In this process, scientists "build" drug molecules to fight HIV in specific ways. When a promising drug is identified, it goes through pre-clinical testing. This involves test-tube and animal studies. These show whether the drug works against HIV and how it works. They also show how it can be manufactured, and make sure it is not too toxic (poisonous). If pre-clinical results are good enough, the drug company files an Investigational New Drug (IND) application. Then it starts testing the drug in humans (clinical trials). Only about 1 candidate drug in 1,000 makes it into clinical trials. When enough clinical trials are completed, the manufacturer submits an NDA, or New Drug Application. If the FDA approves the NDA, the drug can be sold to treat specific medical conditions. WHAT ARE THE "PHASES" OF CLINICAL TRIALS? There are four phases of human clinical trials. These apply to all drugs, not just drugs for HIV/AIDS. If the results from any phase of testing are not good enough, the company will stop developing the drug. Phase I trials test the safety of new drugs for humans. These trials record the side effects that occur at different dosages of the drug. Everyone in a Phase I trial receives the new drug, but different participants may get different dosages. The trials usually study less than 100 people, and take less than a year. In Phase I trials, new drugs are given to humans for the first time. People who participate in Phase I trials face the highest risks compared to possible benefits. Phase II trials can enroll several hundred people and take 1 to 2 years. They study how well the drug works against HIV disease. They also collect more information about side effects. Only about 1 drug candidate in 3 makes it through Phase II trials. These trials are usually randomized. This means that trial participants are divided into two groups that are similar in terms of age, sex, and health. One group receives the study drug. The other group is the reference or control group. People in the control group get standard treatment (called "standard of care"). If there is no standard treatment, they may get a dummy medication (called a placebo). Trial participants and their health care providers usually do not know who is getting the study drug or the placebo. This is called a blinded study. Studies are blinded so that the health care providers will be totally objective when they evaluate the health of patients in the study. Phase III trials collect more data on a drug’ s effectiveness and side effects. These trials can study up to a few thousand people and often last for a year or more. Phase III trials are normally randomized and blinded. Participants might not receive the study drug. With good results in Phase III trials, a manufacturer can apply for FDA approval to sell the new drug. Phase IV trials are called "post-marketing studies." The regulations for Phase IV trials are not very clear, and they are not conducted very often. Phase IV trials can monitor a new drug’ s long-term effectiveness and side effects, or how cost-effective it is. They can also compare the new drug to other drugs approved for the same condition. HOW DO WE KNOW IF A DRUG WORKS? The FDA used to require trials that measured clinical endpoints before approving a new HIV drug. These trials analyze how many people get sicker, develop opportunistic infections, or die. However, these trials take a long time and are very expensive. A faster, cheaper way to test new drugs is by using indirect measures of patient health. These surrogate markers are laboratory values such as viral load or CD4 cell counts. In 1997, the FDA approved the use of surrogate markers for full approval of new HIV drugs. Clinical trials should include people like those who will use the drug. But manufacturers sometimes prefer to test their products in people who are as healthy as possible. For example, sometimes they exclude people infected with hepatitis B or C because of their liver problems, although many people with HIV also are infected with hepatitis. USING UNAPPROVED DRUGS There are three legal ways to use drugs that the FDA has not approved to treat a specific health problem: 1. Expanded Access is a program where manufacturers provide unapproved drugs to people who cannot take part in a clinical trial. Patients must meet conditions set by the drug manufacturer. The drugs are usually offered at no charge, but participating health care providers have to collect information on how patients respond to the drug. 2. Treatment IND Protocol or Compassionate Use. The FDA can allow drug companies to provide new drugs to people who are very ill and who have no other treatment options. A related type of access is called Parallel Track. This policy was developed to provide investigational drugs to people with AIDS who are unable to participate in clinical trials of those drugs. 3. Off-label Use. Health care providers can write a prescription for any FDA-approved drug, even to use it for some medical condition it was not approved for. This is called off-label use. There may be no information about how often medications are used off-label, or how well they work. For example, interleukin-2 (see fact sheet 482) has been approved to treat cancer, so health care providers can prescribe it for people with AIDS. It has not yet been approved to treat AIDS. FOR MORE INFORMATION The

WHAT ARE MICROBICIDES? MICROBICIDES AND VACCINES HOW DO MICROBICIDES WORK? HOW MANY MICROBICIDES ARE NEAR APPROVAL? WHAT ARE THE SIDE EFFECTS? THE BOTTOM LINE FOR MORE INFORMATION WHAT ARE MICROBICIDES? Microbicides are anti-HIV substances. They could reduce the risk of HIV infection during vaginal or rectal intercourse. No microbicides are available yet. However, with sufficient funding and demand, microbicides could be available by 2010. They could be a very important part of global HIV prevention efforts. Currently, male and female condoms are the only tools we have for HIV prevention. However, many men object to wearing condoms. Many women do not feel they can demand, or even ask their male partners to use a condom. Currently, over 50% of new HIV infections worldwide occur in women. The use of microbicides could be controlled by women. They could be applied before sex. They won?t require male cooperation to use, the way male and female condoms do. Some might be products women can use without their partners? knowledge. They will come in gels, foams, and creams. Some may take the form of a sponge or thin film that can be inserted with the fingers. Rings or diaphragms may also be inserted into the vagina to deliver microbicides. Microbicides can also be put in suppositories, small plugs of medication designed to melt at body temperature when placed in the vagina or rectum. One study estimated that microbicide use could prevent about 2.5 million HIV infections within 3 years. This is based on a microbicide that only worked 60% of the time and was used by only 20% of women, in 73 low income countries. Microbicides may also protect women against some other sexually transmitted diseases, in addition to HIV. Condoms are still the most effective method of preventing infection. Ideally, microbicides would be used along with condoms for added protection. But, for people whose partners won?t use condoms, microbicides could offer a way of reducing HIV risk that can be used without a partner?s participation. MICROBICIDES AND VACCINES Vaccines against HIV have gotten much more attention than microbicides in recent years. An effective vaccine would offer important advantages: It could be given to a large segment of the population at risk It would be effective for several years It would not depend on people remembering to use it Microbicides, on the other hand, depend on people remembering to use them correctly each time they have sex. Once developed, microbicides and vaccines would work together. Microbicides will put the power of prevention directly in women’s hands. After a period of optimism about the development of an HIV vaccine, research has slowed. The virus presents several obstacles to vaccine development. At this point it is not clear when a vaccine might become available. However, it is unlikely to be within the next 10 years. Microbicide research is further along. But microbicide research has also encountered setbacks. Nonoxynol-9 (N-9) is a spermicide that was tested as a microbicide. Research showed that frequent use of N-9 may actually increase the risk of HIV infection. It can damage the lining of the vagina or rectum, making it easier for HIV to get past the body?s defenses. N-9 had to be discarded from the list of potential microbicides. HOW DO MICROBICIDES WORK? Microbicides could work in various ways: They could immobilize the virus They could create a barrier between the virus and the cells of the vagina or rectum to block infection They could prevent HIV from reproducing and establishing an infection after it has entered the body Some potential microbicides work in just one of the ways above and some combine two or more methods, to increase effectiveness. HOW MANY MICROBICIDES ARE NEAR APPROVAL? No anti-HIV microbicides are currently approved as safe and effective. However, many are being tested. These tests are going on around the world. Large-scale tests are going on mainly in Africa where the HIV rates are highest. Four microbicides are in Phase III (final) testing. See Fact Sheet 105 for more information on the clinical testing process. The microbicides closest to approval are Carraguard, PRO 2000 Gel, BufferGel and Savvy. Cellulose sulfate gel is also being studied as a contraceptive. However, studies of cellulose sulfate gel (Ushercell) were stopped in 2007. THE BOTTOM LINE Microbicides are anti-HIV substances designed in various forms to provide additional protection against HIV. They are intended to be used as an additional prevention measure or in cases where a partner is not using condoms. Dozens of potential microbicides are in various stages of research. Once available, they could help women and men protect themselves. Microbicides may be especially important for women in developing nations who are not always empowered to require partners to wear condoms. FOR MORE INFORMATION The Alliance for Microbicide Development (www.microbicide.org) keeps updated listings on microbicides in various stages of development and information on global clinical trials. The Global Campaign for Microbicides (www.global-campaign.org) provides information about global microbicide advocacy efforts. It explains how people can become involved in making microbicides a reality as soon as possible. source: The AIDS Infonet

WHAT IS HARM REDUCTION? HARM REDUCTION IN ACTION HARM REDUCTION AND HIV CHALLENGES TO HARM REDUCTION IS HARM REDUCTION LEGAL? HARM REDUCTION IN NEW MEXICO THE BOTTOM LINE WHAT IS HARM REDUCTION? Harm reduction is a way of dealing with behavior that damages the health of the person involved and of their community. Harm reduction tries to improve individual and community health. Much of the work on harm reduction has been in connection with drug use. This fact sheet focuses on harm reduction applied to drug use and HIV. Some key points of harm reduction: Drug use won’t disappear but its harmful effects can be reduced. Harm reduction should be a goal for service organizations and governments. Some drugs are safer than others. Some ways of using drugs are less harmful than others. Drug users can best reduce the harm of their own drug use. Abstinence is the ultimate goal. However, it is also good to reduce drug use and drug-related deaths, disease and crime. The criminal justice approach should not be the only method for dealing with drug use. Combining it with a public health approach is more productive. Services for drug users should be non-judgmental. They should not force people to receive services. HARM REDUCTION IN ACTION Harm reduction related to drug use includes: Teaching drug users about the risks of different drugs and their use. Information on using drugs more safely, and reducing the harm of overdoses. Provide methadone as a substitute for heroin. Offer medication to counteract a drug overdose. Education and referral to drug treatment opportunities. Permit drug users to exchange used syringes for new ones, or buy new syringes. Outreach services in areas where drug sales occur. There is research to support several harm reduction approaches, including methadone maintenance for heroin users and needle exchange for injection drug users. HARM REDUCTION AND HIV Some harm caused by drug use is related to HIV. Fact Sheet 154 has more information on drug use and HIV. Sharing equipment for drug use can spread HIV infection if it contains even a tiny amount of infected blood. Drug use is linked to unsafe sexual activity. This increases the spread of HIV infection. It is also related to missing doses of HIV medications (poor adherence.) This can make HIV disease get worse. Harm reduction can include education about the HIV-related risks of drug use and of unsafe sexual activity. Fact Sheet 151 has information on safer sexual activity. CHALLENGES TO HARM REDUCTION Drug use and its effects are huge challenges. They require the coordinated efforts of treatment specialists, law enforcement agents, public health professionals, corrections experts, and drug users themselves. Harm reduction suggests that drug treatment is usually more effective than arrest and imprisonment. It also s working with drug users. It also says that the best approach to drug use problems involves public health providers working with drug users rather than imposing legal punishment. Exceptions would be where drug use results in criminal activity that harms others, such as theft, violence, and driving under the influence of drugs. Many communities combine harm reduction and law enforcement approaches to drug use. Unfortunately, many debates about drug policy put public health arguments on one side against morality and law enforcement on the other. IS HARM REDUCTION LEGAL? Some aspects of harm reduction are legal. Drug users can get information on methadone, on using drugs more safely, or referrals to drug treatment programs. People can get information on reducing the risk of HIV infection through sexual activity. Many other aspects of harm reduction require changes in laws or in law enforcement procedures. For example, syringe exchange programs operate under specific exemptions to existing laws or local "emergency" legislation. They require cooperation from local law enforcement officials. HARM REDUCTION IN NEW MEXICO In 1997, the legislature passed the Harm Reduction Act. It legalized needle exchange statewide. A bill passed in 2001 permits pharmacists to sell syringes to drug users. These actions put New Mexico among the few states that have implemented harm reduction approaches to drug use instead of relying totally on a law enforcement approach. THE BOTTOM LINE Harm reduction is a public health approach to behaviors that harm individuals and their communities. Harm reduction can be applied alongside law enforcement activities. Harm reduction focuses on improving the health of individuals and the public, more than on eliminating harmful behaviors, although that is the ultimate goal. Harm reduction principles can be applied to reducing the HIV-related risks of drug use or of unsafe sexual activity. See the Drug Policy Alliance at https://www.drugpolicy.org/ for more on drug policy. For more information on laws related to syringe access, possession and disposal, see https://www.temple.edu/lawschool/aidspolicy/. source: The AIDS Infonet

WHAT ARE BODY COMPOSITION TESTS? ANTHROPOMETRY BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) BODY MASS INDEX (BMI) COMPUTERIZED TOMOGRAPHY (CT OR CAT SCAN) DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA) SCANNING MAGNETIC RESONANCE IMAGING (MRI) UNDERWATER WEIGHING THE BOTTOM LINE WHAT ARE BODY COMPOSITION TESTS? The tests and measurements described in this fact sheet provide detailed measurements of fat and lean body mass. Repeated measurements can be helpful in monitoring body shape changes associated with lipodystrophy (see fact sheet 553) or with wasting syndrome (see fact sheet 519). Some of these measurements are used to determine if someone is overweight. Excess weight is associated with a higher risk of heart disease. Low weight, including an unintended weight loss of 5% or more, may also be a sign of health problems (see fact sheet 519). There are pluses and minuses for each method. Some have to do with cost. Also, a trained technician can often make a big difference in measurements. Try to use the same technique and technician if you are tracking changes over time. ANTHROPOMETRY This word just means measuring the body. Anthropometry is the simplest technology. It involves using a tape measure to take key readings, such as biceps, thigh, waist, and hips. A trained technician is very important for this method. Skinfold measurements Calipers (a metal tool) are used to ?pinch? body tissue in several places. The measurements are compared to standards. People doing the measurement should be trained so that the measurements are standardized. Waist to hip ratio Divide your hip measurement (at the widest point) by your waist measurement (at the narrowest point). In general, a healthy waist to hip ratio is below 0.9 for men and below 0.8 for women. These may not hold true for people with HIV who have fat accumulation around the waist. In general, a waist size over 40? for men or over 35? for women is associated with greater health risk. BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) In BIA, a person is weighed. Age, height, gender and weight or other physical characteristics such as body type, physical activity level, ethnicity, etc. are entered in a computer. While the person is lying down, electrodes are attached to various parts of the body and a small electric signal is circulated. This signal cannot be felt. BIA measures the resistance (impedance) to the signal as it travels through the body muscle and fat. The more muscle a person has, the more water their body can hold. The greater the amount of water in a person’s body, the easier it is for the current to pass through it. Higher fat levels result in more resistance to the current. Fat tissue is about 10% – 20% water, while fat-free mass (which includes muscle, bone, and water outside muscles) averages 70% – 75% water. BIA values depend on a person?s age. Normally you can get an analysis of your results when the test is done. BODY MASS INDEX (BMI) This is a calculation based on your weight and height. The formula is: (weight in kilograms) divided by (height in meters squared; or multiplied by itself). To convert pounds to kilograms, divide by 2.2. To convert height to meters, first convert height to inches (12 x feet, plus extra inches). Then divide by 39.4. For example, let?s say that someone weighing 165 pounds is 5? 8? tall. To convert 165 pounds to kilograms, 165/2.2 = 75 kg. 5? 8? = 68?/39.4 = 1.73 meters. 1.73 squared is 1.73 x 1.73 = 2.99 BMI = 75/2.99 = 25.1 BMI result categories are: Less than 18.5: underweight Between 18.5 and 24.9: normal weight 25 to 29.9: overweight 30 or over: obesity For more information and a convenient BMI calculator that uses pounds and inches, see the web site ?Calculate your BMI? at https://nhlbisupport.com/bmi/ COMPUTERIZED TOMOGRAPHY (CT OR CAT SCAN) Tomography means looking at slices of the body. CAT scanning uses x-rays to do this. It is helpful in calculating the ratio of fat within the abdomen compared to fat under the skin. The equipment is expensive. DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA) SCANNING This x-ray technique divides the body into fat-free (lean) mass, bone mineral content, and fat. Different amounts of the x-ray energy are absorbed by different types of tissue. DEXA scans are very accurate but are also expensive due to the cost of the machine. MAGNETIC RESONANCE IMAGING (MRI) This technique uses a magnetic field to create an image of the body. The image shows the location and amount of fat. This is very expensive due to the cost of the machine and reading the scans. UNDERWATER WEIGHING This method determines body volume. First the person is weighed dry. Then they are immersed in water in a tank and weighed again. Bone and muscle are more dense than water, and fat is less dense than water. A person with more bone and muscle will weigh more in water than a person with less bone and muscle. The volume of the body is calculated and body density and body fat percentage are calculated. This technique may underestimate the body fat percentage of athletes, and overestimate body fat in elderly people. THE BOTTOM LINE Body composition measurements can be helpful, over time, in tracking changes due to HIV or its treatments. The different techniques have pluses and minuses in terms of reliability, cost, and availability. If you are concerned about your body shape and composition, be sure to ask your health care provider to record baseline readings before you start treatment. source: The AIDS Infonet

WHAT IS DRUG LEVEL TESTING? HOW CAN TDM HELP? DOES TDM WORK FOR ALL HIV DRUGS? DIFFICULTIES WITH TDM WHEN CAN TDM HELP? FUTURE DIRECTIONS WHAT IS THERAPEUTIC DRUG MONITORING? It can be helpful to test a patient’s blood to check the levels of a medication they are taking. Drug levels that are too high sometimes cause serious side effects. Levels that are too low might allow HIV to multiply and develop resistance. Testing drug levels is also called therapeutic drug monitoring, or TDM. TDM is not generally used or available yet in the United States. Doctors do not agree on its benefits. HOW CAN TDM HELP? Even when people take the same dose of a drug, blood levels can be very different. If the viral load isn’t going down far enough, it might be because drug levels are too low. A doctor might be able to increase the dose and bring HIV under control. If a patient is having serious side effects, it might be because drug levels are too high. If they are, a smaller dose might still control HIV but relieve some side effects. Several factors can affect drug levels: Food effects: more or less drug can be absorbed depending on how the amount and kind of food in the stomach. Body weight: very low weight can increase drug levels. Very high body weight may reduce drug levels. Metabolism: different people break drugs down faster or slower. This is partly due to genetic factors. Age: children and adolescents process drugs differently than adults. Drug interactions: some drugs affect the metabolism of other drugs, and can raise or lower their levels. Smoking and drinking habits Herbal and other supplements. For example, St. John?s Wort reduces blood levels of protease inhibitors. Kidney or liver problems, including hepatitis, can cause higher drug levels. Pregnancy: as body size changes, drug levels can also change. Women nearing menopause go through changes in body chemistry that can affect drug levels. If the viral load isn’t going down far enough, it might be because drug levels are too low. A doctor might be able to increase the dose and bring HIV under control. If a patient is having serious side effects, it might be because drug levels are too high. If they are, a smaller dose might still control HIV but relieve some side effects. DOES TDM WORK FOR ALL HIV DRUGS? TDM might work well for protease inhibitors and for non-nucleoside reverse transcriptase inhibitors (non-nukes.) Research shows that blood levels of these types of drugs affect their ability to control HIV and to cause side effects. The nucleoside analog reverse transcriptase inhibitors (nukes) are a different case. They must be processed inside individual cells before they’re active against HIV. The blood level of these drugs is less important than the amount inside cells. Researchers are working on ways to measure the level of drug inside cells. Then they will have to show that these drug levels affect how well the nukes work, or the side effects they cause. TDM is not yet being used with the nukes. DIFFICULTIES WITH TDM TDM is not ready for use with the "nuke" drugs. As noted above, blood levels of the nukes aren’t as important as the levels inside HIV-infected cells. The technology for measuring these levels is not very good yet. There isn’t just one target blood level for each drug. The "best" amount of drug for a patient depends on how resistant their virus is to that drug. The more resistant the virus, the higher the blood level of drug needed to control it. It’s difficult to measure drug levels accurately. With the current technology, repeated tests can give very different results. Adherence is very important. Missing doses of a drug can make more of a difference than any other factor in how well HIV is controlled, and can throw off the results of TDM. TDM might not make any difference. Many doctors use a dose of ritonavir to boost blood levels. It might not be possible to increase the blood levels any further, even with an increased dose. Lowering blood levels won’t decrease all side effects. Some side effects aren’t linked to the amount of drug in the body. Higher doses probably cause more stomach problems with the protease inhibitors, or kidney stones with indinavir. However, the hypersensitivity reaction to abacavir is unrelated to the dose of the drug. TDM won’t reduce this side effect. TDM is expensive. Because it’s still experimental, it’s difficult to get reimbursement for TDM. WHEN CAN TDM HELP? TDM could provide useful information in several situations: For patients with high levels of side effects When treatments fail to control HIV even though patients are taking all their doses For patients with very high or very low body weight For children and teen-aged patients To assess interactions between HIV medications To assess interactions with non-HIV medications such as birth control pills, methadone, or TB medications For patients with kidney or liver problems, including hepatitis For pregnant patients For women nearing menopause FUTURE DIRECTIONS Research will continue on several key questions related to TDM: For each drug, what is the relationship between drug levels and viral control? How sensitive is it? For each drug side effect, how do drug levels affect the amount or severity of side effects? How can drug levels of the nukes, inside the cells, be measured more accurately? source: The AIDS Infonet

Over 750 listings of web sites related to HIV and AIDS are organized in the categories below. See also the general NOTES WEB SITES IN SPANISH ADVOCACY ALTERNATIVE THERAPIES BASIC SCIENCE CHILDREN, YOUTH AND AIDS CLINICAL TRIALS CONFERENCE REPORTS DISSIDENTS (AIDS Doesn’t Exist or HIV Isn’t the Cause) DRUGS AND DRUG INTERACTIONS EDUCATION AND PREVENTION GLOSSARIES AND DICTIONARIES GOVERNMENT (UNITED STATES) AGENCIES AND PROGRAMS INTERNATIONAL (Based outside the USA) LINKS TO OTHER AIDS SITES & RESOURCE GUIDES MANUFACTURERS MISCELLANEOUS NEWS SERVICES NEWSLETTERS & MAGAZINES NUTRITION PEER-REVIEWED JOURNALS PROFESSIONAL ASSOCIATIONS SEARCH TOOLS SOCIAL CONTACT STATISTICS ON HIV/AIDS SUPPORT SERVICES TREATMENT – General Sites TREATMENT – Specialized Sites VACCINES AGAINST HIV WOMEN AND AIDS NOTES: Addresses for internet web pages (URLs, or Uniform Record Locators) must be entered exactly. Some web sites require that you register before you can obtain information, especially news services and on-line journals. There can be several reasons for getting a "File Not Found" error message. Verify the address, and try again later. The problem might be with the web server (computer) where the web pages are stored. To find a web site if you don’t have the address, use a search engine to look for the organization or web page name. Consider the source when you get information off the Internet. Just because it’s on a web page doesn’t mean it’s accurate! A few websites that are particularly useful are indicated by an asterisk (*) and Bold Type. 1. WEB SITES IN SPANISH Acción Ciudadana Contra el SIDA (Venezuela) https://www.internet.ve/accsi/ Acción SIDA ? Recursos e iniciativas de comunicación en América Latina y El Caribe https://www.accionensida.org.pe/ Acción Solidaria (Venezuela) https://www.acsol.org Actua, la asociación de personas que vivimos con VIH/SIDA (Spain) https://www.actua.org.es/ Agua Buena (La Asociación Aguabuena Prodefensa de los Derechos Humanos) https://www.aguabuena.org Amigos Contra el SIDA (México) https://www.aids-sida.org/ Asociación Redes Nueva Frontera (Argentina) https://www.redesnuevafrontera.org.ar/ APLA en Español ? Impacto! https://www.apla.org/espanol/publicaciones.html Asociación Vía Libre (Peru) https://www.vialibre.org.pe/ BETA en español (San Francisco AIDS Foundation) https://www.sfaf.org/betaespanol/ Campaña de lucha contra el SIDA. Colombia – 2001 https://www.sidacolombia2001.es.vg/ CanalSIDA (Reino Unido) https://www.aidschannel.org/es/ Consejo Nacional para la Prevención y Control del SIDA (México) https://www.salud.gob.mx/conasida/ Corporación de Lucha contra el Sida (Colombia) https://www.clsida.org.co/ El SIDA y el VIH (de NOAH) https://www.noah-health.org/es/infectious/aids/ Foro Español de Activistas en Tratamientos del VIH (FEAT) https://www.feat-vih.org/ Fundación Descida https://www.descida.org.ar/ Fundación Huésped (Argentina) https://www.huesped.org.ar/ Fundación Vivir Mejor (Colombia) https://www.telesat.com.co/f-vivirmejor/ Fundamind – Aprender sobre VIH/SIDA (Argentina) https://www.fundamind.org.ar/aprender/index.asp Gente Positiva (Guatemala) https://www.gentepositiva.org.gt/doc_nacionales.html Grupo de Estudio del SIDA-SEIMC (España) https://www.gesida.seimc.org/index.asp Grupo de Trabajo sobre Tratamientos del VIH https://www.gtt-vih.org/ HIV InSite (University of California, San Francisco) https://hivinsite.ucsf.edu/InSite.jsp?page=li-10-01 HIV Prevention Fact Sheets https://www.caps.ucsf.edu/espanol/ IMPACTA (Perú) https://www.impactaperu.org/ Infecto: AIDS SIDA Enfermedades Infecciosas y SIDA (Uruguay) https://www.infecto.edu.uy/ InfoRed SIDA (EE.UU.) https://www.aidsinfonet.org/?newLang=es International Community of Women With HIV/AIDS https://www.icwlatina.org/espaniol/quienes_somos.html LACCASO Consejo Latinoamericano y del Caribe de Organizaciones No Gubernamentales con Servicio en VIH/SIDA (Venezuela) https://www.laccaso.org/ Programa Nacional de lucha contra los RH-SIDA y ETS (Argentina) https://www.msal.gov.ar/htm/site/sida/site/default.asp Medscape elmundo.es https://elmundosalud.elmundo.es/elmundosalud/ PASCA Proyecto Acción SIDA de Centroamérica (Guatemala) https://www.pasca.org Pastoral del SIDA (Argentina) https://www.pastoralsida.com.ar/ Project Inform Información en español https://www.projinf.org/spanish/ RED 2002 https://www.red2002.org.es Red Latinoamericana de Personas Viviendo con VIH/SIDA https://www.redla.org/ Red SIDA Perú (Peru) https://www.accionensida.org.pe/p01.htm Un Rincón de Esperanza (Argentina) https://www.fundamind.org.ar/aprender/index.asp San Francisco AIDS Foundation en español https://www.sfaf.org/espanol.html SIDA (Página de GayMéxico) https://www.geocities.com/WestHollywood/5144/sida.htm SIDACCION (Chile) https://www.sidaccion.cl/ Sida-Studi (España) https://www.sidastudi.org/ Todosida Portal ? Revista SIDA-VIH-Hepatitis https://www.todosida.org/ VIH y SIDA (España) https://www.ctv.es/USERS/fpardo/home.html vihsida en Chile https://www.vihsida.cl/ VIH/SIDA, Ministerio de Sanidad y Consumo, España https://www.msc.es/ciudadanos/enfLesiones/enfTransmisibles/sida/home.htm VIH-SIDA.org.ar (Argentina) https://www.adusalud.org.ar/ Vivo Positivo (Chile) https://www.vivopositivo.cl/portal/ 2. ADVOCACY Access to Essential Medicines https://www.accessmed-msf.org ACT UP-New York https://www.actupny.org/ ACT UP Philadelphia https://www.critpath.org/actup/ African American AIDS Policy and Training Institute https://www.BlackAIDS.org Agua Buena (La Asociación Aguabuena Prodefensa de los Derechos Humanos) https://www.aguabuena.org AIDS Action Committee of Boston https://www.aac.org/ AIDS Action Council https://www.aidsaction.org/ AIDS Action Europe https://www.aidsactioneurope.org/ AIDSChannel.org (United Kingdom) https://www.aidschannel.org/ AIDS Drug Assistance Program (ADAP) Working Group https://www.osborneny.org/health_services.htm AIDS Empowerment and Treatment International https://www.aidseti.org/default.htm AIDS and the Law https://www.aidsandthelaw.com/ AIDS in Prison Project https://www.osborneny.org/health_services.htm AIDS Treatment Activists Coalition https://www.atac-usa.org AIDS Vaccine Advocacy Coalition https://www.avac.org Campaign to End AIDS https://www.endaidsnow.org/ Canadian HIV/AIDS Legal Network https://www.aidslaw.ca/EN/index.htm Canadian Treatment Action Council (CTAC) https://www.ctac.ca/en/news Global Business Council on HIV/AIDS https://www.gbcaids.com Global Treatment Access Campaign https://www.globaltreatmentaccess.org Health Gap Global Access Project https://www.healthgap.org Hepatitis C Advocacy https://www.hepcadvocacy.org/ Hepatitis C Project https://www.hepcproject.org JurisAIDS https://www.jurisaids.org/ Latino Commission on AIDS https://www.latinoaids.org National Association of People With AIDS https://www.napwa.org/ National Association on HIV Over Fifty https://www.hivoverfifty.org National Minority AIDS Council https://www.nmac.org National Native American AIDS Prevention Center https://www.nnaapc.org/ National Working Positive Coalition https://www.workingpositive.net/nwpchome.html New York HIV/AIDS SNP Site (Re: Managed Care) https://www.generes.net/hivsnp/hivsnp.htm TAG: Treatment Action Group https://www.aidsinfonyc.org/tag/ T2CANN ? A Voice for Our Community https://www.tiicann.org UNIFEM Gender and HIV/AIDS Portal https://www.genderandaids.org/ 3. ALTERNATIVE THERAPIES AIDS and dehydroepiandrosterone https://www.anthropogeny.com/AIDS%20and%20DHEA.htm Alternative Medicine Homepage https://www.pitt.edu/~cbw/altm.html Alternative Medicine Review https://www.thorne.com/alternative_medicine_review.wss Armenicum AIDS Drug Information Page https://www-personal.umich.edu/~kpearce/armenicum.htm Bastyr University https://www.bastyr.edu/ Being Alive San Diego https://www.beingalive.org/ Being Alive Website https://www.beingalive.org/aboutus/newsletter.shtml Boston Buyers Club https://www.bostonbuyersclub.com/ Chinese Medicine Directory https://www.Chinese-Medicine-Directory.com/ Database on Dietary Supplements https://ods.od.nih.gov/Health_Information/IBIDs.aspx Doc Misha’s HIV Wellness Center https://www.docmisha.com/applying/hiv_wellness/index.html Facts About Dietary Supplements (National Institutes of Health) https://ods.od.nih.gov/Health_Information/Vitamin_and_Mineral_Supplement_Fact_Sheets.aspx Foundation for Integrative AIDS Research https://www.aidsinfonyc.org/fiar/ Houston Buyers Club https://www.houstonbuyersclub.com/ Institute for Traditional Medicine-HIV https://www.itmonline.org/disorder.htm International Bibliographic Information on Dietary Supplements Database https://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=1 International Treatment Access Coalition https://www.who.int/hiv/itac/en/ Jon D. Kaiser, MD, Wellness Center https://www.jonkaiser.com/ Keep Hope Alive Home Page https://www.keephopealive.org/ Marijuana as a Medicine https://www.druglibrary.org/olsen/MEDICAL/media.html Medibolics https://www.medibolics.com/ National Institutes of Health, National Center for Complementary and Alternative Therapies https://nccam.nih.gov Rene Caisse, Canad’s Cancer Nurse & the History of Essiac https://www.essiacinfo.org/ A Practical Guide to Complementary Therapies for People Living with HIV https://www.catie.ca/pdf/PG_CAM/CAM_rvsd_05_ENG_web.pdf Sloan-Kettering – About Herbs, Botanicals and Other Products https://www.mskcc.org/mskcc/html/11570.cfm 4. BASIC SCIENCE AIDS Pathology https://library.med.utah.edu/WebPath/TUTORIAL/AIDS/AIDS.html Glossary of HIV/AIDS Related Terms https://www.sfaf.org/glossary/ HIV Medicine: Free Medical Textbook https://www.hivmedicine.com/ HIV Molecular Immunology Database (Los Alamos Laboratories) https://www.hiv.lanl.gov/content/immunology/index.html HIV Resistance Database (Los Alamos Laboratories) https://resdb.lanl.gov/Resist_DB/default.htm HIV ResistanceWeb.com (Free registration required) https://www.hivresistanceweb.com/ HIV Resistance Response Database Initiative https://www.hivrdi.org/ HIV Sequence Database (Los Alamos Laboratories) https://www.hiv.lanl.gov/content/hiv-db/mainpage.html *Immunology bookcase https://pim.medicine.dal.ca/home.htm *Merck Manual (Home Edition) https://www.merck.com/mmhe/index.html NOVA Online – Surviving AIDS https://www.pbs.org/wgbh/nova/aids/ Ohio State Microbiology 521 https://www.biosci.ohio-state.edu/~mgonzalez/Micro521.html Stanford HIV RT and Protease Gene Database https://hivdb.stanford.edu/ Understanding Cancer Series: The Immune

WHAT ARE SIDE EFFECTS? WHO GETS SIDE EFFECTS? HOW TO DEAL WITH SIDE EFFECTS WHICH SIDE EFFECTS ARE THE MOST COMMON? THE BOTTOM LINE WHAT ARE SIDE EFFECTS? Side effects are what a drug does to you that you don’t want it to do. Medications are prescribed for a specific purpose, such as to control HIV. Anything else the drug does is a side effect. Some side effects are mild, like a slight headache. Others, like liver damage, can be severe and, in rare cases, fatal. Some go on for just a few days or weeks, but others might continue as long as you take a medication, or even after you stop. Some conditions are called side effects even though we don’t know what causes them. In some cases, HIV disease itself might be as much of the cause as true drug side effects. WHO GETS SIDE EFFECTS? Most people taking antiretroviral medications (ARVs) have some side effects. In general, higher amounts of drugs cause more side effects. If you are smaller than average, you might experience more side effects. Also, if your body processes drugs more slowly than normal, you could have higher blood levels and maybe more side effects. Each medication comes with information on its most common side effects. Don’t assume that you will get every side effect that’s listed! Some people have only minor side effects when they take their ARVs. HOW TO DEAL WITH SIDE EFFECTS There are several steps you can take to prepare yourself to deal with side effects. Learn about the normal side effects for the medications you’re taking. The InfoNet fact sheets list common side effects for each drug. Talk to your health care provider about what side effects to expect. Ask when you should get medical attention because a side effect goes on too long, or has gotten severe. Find out if you can treat mild side effects with home remedies or over-the-counter medications. In some cases, your health care provider can write you a prescription for something you can take to deal with a side effect if it gets severe. Stock up! If you’re having stomach problems, make sure you have plenty of food that you like to eat and that’s easy on your stomach. Don’t run out of toilet paper! Do not stop taking any of your medications, or skip or reduce your dose, without talking to your health care provider! Doing so can allow the virus to develop resistance (see fact sheet 126), and you might not be able to use some ARVs. BEFORE side effects make you skip or reduce doses, talk to your health care provider about changing drugs! WHICH SIDE EFFECTS ARE THE MOST COMMON? When you start antiretroviral therapy (ART), you may get headaches, hypertension, or a general sense of feeling ill. These usually improve or disappear over time. Fatigue (fact sheet 551): Most people with HIV feel tired at least part of the time. It’s important to find the cause of fatigue and deal with it. Anemia (fact sheet 552) can cause fatigue. Anemia increases your risk of getting sicker with HIV infection. Routine blood tests can detect anemia, and it can be treated. Digestive Problems: Many drugs can make you feel sick to your stomach. They can cause nausea, vomiting, gas, or diarrhea. Home remedies include: Instead of three big meals, eat small amounts, more often. Eat mild foods and soups, not spicy. Ginger ale or ginger tea might settle your stomach. So can the smell of fresh lemon. Exercise regularly. Don’t skip meals or to lose too much weight! Marijuana (see Fact Sheet 731) can reduce nausea. Be careful with over-the-counter or prescription nausea drugs. They can interact with ARVs. Gas and bloating can be reduced by avoiding foods like beans, some raw vegetables, and vegetable skins. Diarrhea (fact sheet 554) can range from a small hassle to a serious condition. Tell your health care provider if diarrhea goes on too long or if it’s serious. Lipodystrophy (fact sheet 553) includes fat loss in arms, legs and face; fat gain in the stomach or behind the neck; and increases in fats (cholesterol) and sugar (glucose) in the blood. These changes may increase the risk of heart attack or stroke. Skin Problems: Some medications cause rashes. Most are temporary, but in rare cases they indicate a serious reaction. Talk to your health care provider if you have a rash. Other skin problems include dry skin or hair loss. Moisturizers help some skin problems. Neuropathy (fact sheet 555) is a painful condition caused by nerve damage. It normally starts in the feet or hands. Mitochondrial Toxicity (fact sheet 556) is damage to structures inside the cells. It might cause neuropathy or kidney damage, and can cause a buildup of lactic acid in the body. Bone Problems (fact sheet 557) have recently been identified in people with HIV. Bones can lose their mineral content and become brittle. A loss of blood supply can cause hip problems. Get enough calcium from food and supplements. Weight-bearing exercise like walking or weight lifting can be helpful. THE BOTTOM LINE Most people who take ARVs have some side effects. However, don’t assume you will get every side effect you hear about! Get information on the most common side effects and how to treat them. Read the InfoNet fact sheets on individual drugs and their side effects. Stock up on home remedies and other items that can help you deal with side effects. Be sure you know when to go back to your doctor because a side effect may have gone on too long or gotten severe. Don’t let side effects keep you from taking your medications! If you can’t deal with them, talk to your doctor about changing your drugs. source: The AIDS Infonet

For confidential HIV/AIDS counseling and information, call your state’s toll-free AIDS Hotline. Most hotlines operate 24 hours a day, 7 days a week, and can answer your questions and offer free educational materials to the public. State Phone Number Alabama (800) 228-0469 Alaska (800) 478-AIDS Arizona (602) 402-9396 Arkansas (800) 364-2437 California (North) (800) 367-AIDS California (South) (800) 992-AIDS Colorado (800) 252-AIDS Connecticut (800) 342-AIDS Delaware (202) 422-0429 District of Columbia (800) 332-AIDS Florida (800) 352-AIDS Georgia (800) 551-2728 Hawaii (800) 321-1555 Idaho (800) 677-AIDS Illinois (800) 243-AIDS Indiana (800) 232-4636 Iowa (800) 445-AIDS Kansas (800) 232-0040 Kentucky (800) 654-AIDS Louisiana (800) 992-4379 Maine (800) 851-AIDS Maryland (800) 638-6252 Massachusetts (800) 235-2331 Michigan (800) 827-AIDS Minnesota (800) 248-AIDS Mississippi (800) 826-2961 Missouri (800) 533-AIDS Montana (800) 233-6668 Nebraska (800) 782-AIDS Nevada (800) 842-AIDS New Hampshire (800) 752-AIDS New Jersey (800) 624-2377 New Mexico (800) 545-AIDS New York (718) 638-2074 North Carolina (800) 342-AIDS North Dakota (800) 472-2108 Ohio (800) 332-AIDS Oklahoma (800) 535-AIDS Oregon (800) 777-AIDS Pennsylvania (800) 662-6080 Puerto Rico (800) 981-5721 Rhode Island (800) 726-3010 South Carolina (800) 342-AIDS South Dakota (800) 592-1861 Tennessee (800) 342-AIDS Texas (800) 299-AIDS Utah (800) 366-AIDS Vermont (800) 882-AIDS Virginia (800) 533-4148 Virgin Islands (800) 773-AIDS Washington (800) 272-AIDS West Virginia (800) 642-8244 Wisconsin (800) 334-AIDS Wyoming (800) 327-3577 Spanish-speaking Reference Specialists  (800) 344-SIDA. TTY / Deaf Specialists  (800) 243-7889 (TTY).