“Have Sex, Save Lives!”

Uplifting Individuals, Families and Communities Affected by HIV/AIDS & Hep C Oct./Nov./Dec. 2018

Clinic Dates: Durex the condom maker has teamed up with (Product) RED to raise at least $10 million for The Global Fund to Fight AIDS, Lassen Clinic – December 14th Tuberculosis and Malaria. Coinciding with World AIDS Day, Contact: Helen May December 1, the (Durex) RED campaign urges folks to “Give a 530.251.2717 for further info. F**k,” or, in hashtag speak, #GAF.

Plumas Clinic – December 13th In a press release, Durex will make a minimum guaranteed Contact: Dawn Fowler donation of $5 million through 2020. What’s more, the Bill & Melinda Gates Foundation will match Durex’s $5 million. 530.283.6584 for further info. 100% of the money raised will go to HIV efforts on the ground, with a portion of proceeds benefiting the Keeping Girls in School th Siskiyou Clinic – December 11 HIV and pregnancy prevention program in South Africa. Durex Contact: Stan Drucker has joined forces to fight AIDS in South Africa, where it is 530.918.9007 for further info. estimated that around 7.2 million people are currently living with HIV or AIDS. Together with the Global Fund, awareness and Please e-mail your money can be raided that will empower young women and girls feedback/suggestions to to live a happy, healthy life.” For further info: https://www.red.org/durex. [email protected] Edited and compiled from an article by Trenton Straube for www.poz.com.

March 20th is an opportunity to support American Indian, Alaska Natives and Native Hawaiians in creating an affirming atmosphere in which to celebrate and to come together and take stock and recognize the advances & setbacks made in the past year.

Uplifting Individuals, Families and Communities Affected by HIV/AIDS & Hep C Oct./Nov./Dec. 2018

What Can HIV Advocates Expect With the New U.S. Congress?

leaders will be. In the Senate, Majority Leader Mitch Instead of defending HIV programs from attack, gains on issues like McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY) were re-elected to their posts along health care access and drug pricing with the vast majority of their Senate leadership reform can hopefully be made. staff colleagues. While there is still plenty that is left to be Democrats will wait until after the Thanksgiving done over the next few weeks during the break to hold their leadership elections, but most of Lame Duck session of Congress, it is hard for the major races are foregone conclusions. Rep. HIV and health care advocates not to look Nancy Pelosi (D-CA-12) seems likely to win another past the imminent back-and-forth’s over term as Speaker of the House, despite being the federal spending for the current fiscal year Republican Party’s favorite national target and being toward the new legislative opportunities that publicly disavowed by several House Democrats in may present themselves next year. The competitive races this year. However, while her composition of the 116th Congress will be popularity may be in question, Rep. Pelosi’s track considerably altered from its present form. record as Speaker is not. During her time as With Democrats flipping at least 36 seats and Speaker, Pelosi oversaw the passage of the gaining control of the House for the first time Affordable Care Act with a public option (the public since 2010, the Congressional power option was stripped in the Senate), the Lily dynamics have substantially shifted in a way Ledbetter Fair Pay Act, reauthorization of the Ryan that may enable HIV advocates to spend less White Care Act and the Children’s Health Insurance of their energy doggedly defending the Program, and the repeal of the U.S. military’s Don’t Affordable Care Act and other existing Ask, Don’t Tell policy, among others. programs that benefit people living with and On the other side of the aisle, the Republican Party affected by HIV, and spend more energy held their party leadership elections this week and pushing for much needed reforms. In the there were few surprises. As was expected, Rep. 116thCongress, it is reasonable to expect the Kevin McCarthy (R-CA-23) was named minority HIV advocacy community to galvanize around leader after fending off a challenge from the issues like health care accessibility, LGBTQ Freedom Caucus’s Rep. Jim Jordan (R-OH-4). rights, drug pricing reforms, decriminalization For more on how the shifting power dynamics in of HIV and drug use, and protections for Congress will impact people living with and affected immigrant populations, among others. by HIV and the health care landscape in Washington The fate of many of these issues will and across the country, be sure to check back invariably lie in the hands of the new regularly with AIDS United’s Policy Update. FFI: Congressional leadership for the Democratic https://www.aidsunited.org and Republican Parties and, after this week, Edited and compiled from an article by AIDS United in we have a much clearer picture of who those www.poz.com. 2 Uplifting Individuals, Families and Communities Affected by HIV/AIDS & Hep C Oct./Nov./Dec. 2018

January through March Ø Cervical Health Awareness Month – January Ø Self-Love Month – January Ø Cervical Cancer Prevention Week – Jan 21-27 Ø Condom Month – February Ø Teen Dating Violence Awareness Month – February

Ø Body Awareness Month – February Ø International Day of Zero Tolerance to Female We can ALL help promote Genital Mutilation – Feb 6 awareness, education and Ø National Black HIV/AIDS Awareness Day – Feb 7 Ø International Day of Women’s Health – Feb 12 acceptance! Ø Sexual & Reproductive Health Day – Feb 12 You want to help, yet you don’t know how Ø National Condom Week – Feb 17-23 to help? Everyone can be an advocate, no Ø Colorectal Cancer Awareness Month – March matter whether you have been affected Ø Endometriosis Awareness Month – March Ø Vulval Health Awareness Month – March by HIV or not. Being an advocate does not Ø HPV Awareness Day – March 4th mean you have to run around shouting it Ø National Women & Girls HIV/AIDS Awareness Day from the rooftops. There are oodles of – March 10 awareness events with corresponding Ø National Native HIV/AIDS Awareness Day – March organizations looking for people willing to 20 do as little as socially share the news to as Ø LGBT Health Awareness Week – March 27-31 Ø International Transgender Day of Visibility – March much as contributing time and money. 31 Here is a list of advocacy months and days https://www.thestdproject.com to get excited about. J Cell Phone–Based HIV Test Proves Highly Precise An HIV test conducted via a cell phone was highly accurate in a recent study, raising hopes that this technology could help to less costly and easily provide screening for the virus in poorer nations. The cell phone–based test requires a single drop of blood and uses nanotechnology, a microchip and a 3-D–printed phone attachment to detect HIV. The testing mechanism accurately diagnosed HIV in 99.1 percent of cases and accurately diagnosed the lack of the virus in 94.6 percent of cases. The associated cost was less than $5 per test. “Health workers in developing countries could easily use these devices when they travel to perform HIV testing and monitoring,” said the study’s senior author, Hadi Shafiee, PhD, a principal investigator in the Division of Engineering in Medicine and Renal Division of Medicine at Brigham and Women’s Hospital in Boston. “Because the test is so quick, critical decisions about the next medical step could be made right there. This would eliminate the burden of trips to the medical clinic and provide individuals with a more efficient means for managing their HIV.” Compiled from an article by Benjamin Ryan for www.poz.com. 3 Uplifting Individuals, Families and Communities Affected by HIV/AIDS & Hep C Oct./Nov./Dec. 2018

Remember to periodically review your Orange- treatment options with your HIV specialist! Make your regimen work for you! Glazed Brussel POSITIVELY AWARE 2018 HIV DRUG CHART Sprouts Each drug is recommended for use in combination with other antiretrovirals (except any single-tablet regimen, including Atripla, Biktarvy, Complera, Genvoya, Juluca, Odefsey, Stribild, and Triumeq). For complete description of DHHS drug recommendations, go to aidsinfo.nih.gov/guidelines. Consult with a physician about which drug therapy and dose is appropriate for you; see drug page or package insert for complete information. Drug chart information is current as of March 9, 2018. Look up your drug by adding its name after you type positivelyaware.com/ into your browser (for example, positivelyaware.com/triumeq). For the complete POSITIVELY AWARE 2018 HIV Drug Guide, go to positivelyaware.com. POSITIVELY AWARE For a list of Walgreens pharmacies that specialize in HIV/AIDS care and other resources, go to HIV.walgreens.com.

SINGLE-TABLET REGIMENS (Multiple drug classes)

RECOMMENDED INITIAL REGIMEN RECOMMENDED INITIAL REGIMEN ✔ IN CERTAIN CLINICAL SITUATIONS Atripla Biktarvy ★ F O R M O S T P E O P L E Enjoy these Brussels as a side or double the glaze efavirenz/emtricitabine/tenofovir DF (EFV/FTC/TDF) bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) One tablet (600 mg efavirenz/200 mg emtricitabine/300 mg tenofovir DF), One tablet (50 mg bictegravir/200 mg emtricitabine/ once daily. Take on an empty stomach, preferably at bedtime. 25 mg tenofovir alafenamide) once daily. Take with or without food. and toss with cooked linguini for a delicious main RECOMMENDED INITIAL REGIMEN RECOMMENDED INITIAL REGIMEN ★ F O R M O S T P E O P L E Complera ✔ IN CERTAIN CLINICAL SITUATIONS Genvoya elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide rilpivirine/emtricitabine/tenofovir DF (RPV/FTC/TDF) (EVG/COBI/FTC/TAF) One tablet (25 mg rilpivirine/200 mg emtricitabine/300 mg tenofovir DF), dish. One tablet (150 mg elvitegravir/150 mg cobicistat/200 mg emtricitabine/ once daily. Take with a meal. 10 mg tenofovir alafenamide) once daily. Take with food.

CAN BE A REASONABLE OPTION WHEN SWITCHING REGIMENS AND VIRALLY SUPPRESSED, THE USE OF NRTIs IS NOT DESIRABLE ✔ AND RESISTANCE TO EITHER DTG OR RPV IS NOT EXPECTED Ingredients Juluca RECOMMENDED INITIAL REGIMEN dolutegravir/rilpivirine (DTG/RPV) Odefsey ✔ IN CERTAIN CLINICAL SITUATIONS One tablet (50 mg dolutegravir/25 mg rilpivirine) once daily. Take with a rilpivirine/emtricitabine/tenofovir alafenamide (RPV/FTC/TAF) meal. For adults who are virologically suppressed on a current ART regimen One tablet (25 mg rilpivirine/200 mg emtricitabine/25 mg TAF) once daily. for at least 6 months and who have no history of treatment failure or Take with a meal. resistance mutations associated with rilpivirine or dolutegravir. 1-pound fresh Brussels sprouts

RECOMMENDED INITIAL REGIMEN RECOMMENDED INITIAL REGIMEN ★ F O R M O S T P E O P L E Stribild ★ FOR MOST PEOPLE Triumeq dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) 1 clove garlic, minced elvitegravir/cobicistat/emtricitabine/tenofovir DF (EVG/COBI/FTC/TDF) One tablet (50 mg dolutegravir/600 mg abacavir/300 mg lamivudine) once daily for people on HIV therapy for the first time. One additional 50 mg One tablet (150 mg elvitegravir/150 mg cobicistat/200 mg emtricitabine/ tablet of Tivicay 12 hours apart in people with viral resistance to INSTIs or 300 mg tenofovir DF), once daily. Take with food. when taken with certain other medications. Take with or without food. 2 tablespoons butter darunavir/cobicistat/ DHHS RECOMMENDATION doravirine/tenofovir DF/ emtricitabine/tenofovir alafenamide ● NOT YET ESTABLISHED DHHS RECOMMENDATION (DRV/COBI/FTC/TAF) lamivudine (DOR/TDF/3TC) ● NOT YET ESTABLISHED One tablet (800 mg darunavir/50 mg cobicistat/200 mg emtricitabine/ One tablet (100 mg/doravirine/300 mg lamivudine/300 mg tenofovir DF) 10 mg tenofovir alafenamide) once daily for patients without darunavir- once daily. Take with or without food. (Dose cited from that used in DRIVE- 1/2 cup water or vegetable broth related drug resistance. Take with food. (Dose cited from that used in AHEAD registrational study.) EMERALD registrational study.) INVESTIGATIONAL DRUG AT PRESS TIME. PHOTO UNAVAILABLE. NOT YET APPROVED AT PRESS TIME. PHOTO UNAVAILABLE. 2 tablespoons apple cider vinegar INTEGRASE INHIBITORS

RECOMMENDED AS COMPONENT OF RECOMMENDED AS COMPONENT Isentress HD ★ INITIAL REGIMEN FOR MOST PEOPLE Tivicay ★ OF INITIAL REGIMEN FOR MOST PEOPLE dolutegravir (DTG) and Isentress 1 tablespoon brown sugar raltegravir (RAL) One 50 mg tablet once daily for people on HIV therapy for the first time or treatment-experienced without previous INSTI resistance. Twice-daily Two 600 mg film-coated tablets once daily; twice daily Isentress available. dosing for people who have viral resistance to INSTIs or when taken with See HIV Drug Guide for details. Take with or without food. certain other medications. Take with or without food. 2 tablespoons orange juice PROTEASE INHIBITORS (Boosted and unboosted)

RECOMMENDED AS COMPONENT OF INITIAL RECOMMENDED AS COMPONENT OF INITIAL Zest of one orange Evotaz ✔ REGIMEN IN CERTAIN CLINICAL SITUATIONS Prezcobix ✔ REGIMEN IN CERTAIN CLINICAL SITUATIONS atazanavir/cobicistat (ATV/COBI) darunavir/cobicistat (DRV/COBI) One tablet (300 mg atazanavir/150 mg cobicistat) once daily. One tablet (800 mg darunavir/150 mg cobicistat) once daily, Take with food. in patients with no darunavir drug resistance. Take with food. Pinch of salt and ground black pepper

RECOMMENDED AS COMPONENT OF INITIAL RECOMMENDED AS COMPONENT OF INITIAL Prezista ✔ REGIMEN IN CERTAIN CLINICAL SITUATIONS Reyataz ✔ REGIMEN IN CERTAIN CLINICAL SITUATIONS darunavir (DRV) atazanavir sulfate (ATV) One 800 mg tablet with 100 mg Norvir or 150 mg Tybost, once daily for 2 tablespoons toasted pine nuts first-time therapy and treatment-experienced adults without Prezista- One 300 mg capsule plus 100 mg Norvir or 150 mg Tybost, once daily; or related resistance; or one 600 mg tablet plus 100 mg Norvir, twice daily for two 200 mg capsules (without boosting), once daily for treatment-naïve treatment-experienced people with Prezista-related resistance. Prezista adults (see the POSITIVELY AWARE HIV Drug Guide for details). must be taken with Norvir or Tybost. Take with food. Take with food. GENERIC IS AVAILABLE. Preparation PK ENHANCERS (Boosters)

USED ONLY AS A BOOSTER FOR OTHER DRUGS; RECOMMENDED AS COMPONENT OF INITIAL REGIMEN FOR USED ONLY AS A BOOSTER FOR OTHER DRUGS; ✔ MOST PEOPLE AS WELL AS IN CERTAIN CLINICAL SITUATIONS RECOMMENDED AS COMPONENT OF INITIAL Tybost Norvir ✔ REGIMEN IN CERTAIN CLINICAL SITUATIONS To prepare the Brussels sprouts, rinse them in cold cobicistat (COBI) ritonavir (RTV) Used only for boosting—not an antiretroviral. 150 mg once daily Used only for boosting, also an antiretroviral. 100–200 mg, dosed with food taken at the same time with either Prezista 800 mg or once or twice daily with another PI. Must be taken with food. Reyataz 300 mg. Take with food. GENERIC IS AVAILABLE. water, trim the stems, remove the outer leaves, NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (“Nukes”) and cut them in half from top to bottom. RECOMMENDED AS A COMPONENT OF ★ INITIAL REGIMEN FOR MOST PEOPLE RECOMMENDED AS COMPONENT OF Descovy Emtriva ★ INITIAL REGIMEN FOR MOST PEOPLE emtricitabine/tenofovir alafenamide (FTC/TAF) emtricitabine (FTC) One tablet (200 mg emtricitabine/25 mg tenofovir alafenamide) One 200 mg capsule, once daily. Take with or without food. once daily. Take with or without food. In a large skillet, melt the butter over medium-high

RECOMMENDED AS COMPONENT OF INITIAL REGIMEN RECOMMENDED AS COMPONENT OF INITIAL REGIMEN FOR MOST PEOPLE WHEN USED IN COMBINATION FOR MOST PEOPLE WHEN USED IN COMBINATION Epivir ★ WITH DOLUTEGRAVIR AND ABACAVIR (AS TRIUMEQ) Epzicom ★ WITH DOLUTEGRAVIR (AS TRIUMEQ) heat. Add the halved Brussels sprouts and sauté for lamivudine (3TC) abacavir/lamivudine (ABC/3TC) One 300 mg tablet, once daily; or one 150 mg tablet, twice daily. One tablet (600 mg abacavir/300 mg lamivudine), once daily. Take with or without food. Take with or without food. GENERIC IS AVAILABLE. GENERIC IS AVAILABLE. about 4 minutes, then add the garlic and sauté 1

RECOMMENDED AS COMPONENT OF ★ INITIAL REGIMEN FOR MOST PEOPLE RECOMMENDED AS COMPONENT OF Truvada Viread ★ INITIAL REGIMEN FOR MOST PEOPLE emtricitabine/tenofovir DF (FTC/TDF) tenofovir disoproxil fumarate (TDF) minute more until the Brussels sprouts start One tablet (200 mg emtricitabine/300 mg tenofovir DF), once daily. One 300 mg tablet, once daily. Take with or without food. Take with or without food. GENERIC IS AVAILABLE. APPROVED AS GENERIC; NOT YET COMMERCIALLY AVAILABLE. to brown on the edges. Add the water or broth, RECOMMENDED AS COMPONENT OF INITIAL REGIMEN FOR MOST PEOPLE WHEN USED IN COMBINATION WITH Ziagen ★ DOLUTEGRAVIR AND LAMIVUDINE (AS TRIUMEQ) abacavir sulfate (ABC) Two 300 mg tablets, once daily; or one 300 mg tablet, twice daily. cover the skillet, and let the Brussels sprouts steam Take with or without food. GENERIC IS AVAILABLE.

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (“Non-nukes”) for 5 minutes.

RECOMMENDED AS COMPONENT OF INITIAL REGIMEN DHHS RECOMMENDATION IN CERTAIN CLINICAL SITUATIONS IN COMBINATION doravirine (DOR) ● NOT YET ESTABLISHED Edurant ✔ WITH DESCOVY OR TRUVADA (AS ODEFSEY OR COMPLERA) One tablet (100 mg of doravirine) once daily. Take with or without food. rilpivirine (RPV) While the sprouts are steaming, prepare the glaze (Dose cited from that used in DRIVE-FORWARD registrational study.) INVESTIGATIONAL DRUG AT PRESS TIME. PHOTO UNAVAILABLE. One 25 mg tablet, once daily. Take with a meal.

RECOMMENDED AS COMPONENT OF INITIAL REGIMEN by stirring together the apple cider vinegar, brown FOR TREATMENT-EXPERIENCED PATIENTS IN CERTAIN CLINICAL SITUATIONS (AS A COMPONENT WITH VIRAL STRAINS RESISTANT TO AN NNRTI Sustiva ✔ OF ATRIPLA, OR WITH DESCOVY OR TRUVADA) ✔ AND OTHER ANTIRETROVIRAL DRUGS ONLY Intelence efavirenz (EFV) etravirine (ETR) One 600 mg tablet, once daily. Take on an empty stomach, preferably One 200 mg tablet, twice daily. Take with food. at bedtime. sugar, orange juice, orange zest, salt and pepper in GENERIC IS AVAILABLE.

ENTRY INHIBITOR CD4 POST-ATTACHMENT INHIBITOR Long-acting monoclonal antibody (mAb) a small mixing bowl. Remove lid from the Brussels

NOT RECOMMENDED AS DHHS RECOMMENDATION Selzentry ▼ COMPONENT OF AN INITIAL REGIMEN Trogarzo ● NOT YET ESTABLISHED maraviroc (MVC) ibalizumab-uiyk (IBA) sprouts and add the glaze ingredients. Cook on 150, 300, or 600 mg (available in 150 and 300 mg tablets), twice daily, Administered once every two weeks via intravenous infusion. Treatment depends on other medications used (see the POSITIVELY AWARE HIV begins with an IV loading (starting) dose of 2,000 mg, followed by an Drug Guide for details). Take with or without food. 800 mg IV infusion maintenance dose given every two weeks thereafter. high for about two minutes or until the glaze LEGACY DRUGS The following drugs are no longer or rarely prescribed: becomes syrupy, stirring or tossing the Brussels

Aptivus Combivir Crixivan Fuzeon Invirase Kaletra Lexiva tipranavir (TPV) lamivudine/zidovudine indinavir (IDV) enfuvirtide (T-20, or ENF) saquinavir (SQV) lopinavir/ritonavir fosamprenavir calcium sprouts until well coated. Sprinkle the Brussels (3TC/AZT) (LPV/r) (FPV) sprouts with the toasted pine nuts and serve Rescriptor Retrovir Trizivir Videx EC Viracept Viramune XR Zerit delavirdine (DLV) zidovudine (AZT, or ZDV) abacavir/lamivudine/ didanosine (ddI) nelfinavir (NFV) nevirapine (NVP) stavudine (d4T) zidovudine (ABC/3TC/AZT) warm.

144 calories, 9 g. fat, 15 mg. cholesterol, 94 mg. Open Enrollment for Affordable Care Act sodium, 15 g. carbohydrate, 5 g. fiber, 5 g. protein. Health Insurance Ends December 15, 2018! https://www.strongertogether.coop 4