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Author Topic: LOOSING ALOT OF HAIR =[  (Read 14072 times)

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Offline Rockit

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  • i want it all - i will shine
LOOSING ALOT OF HAIR =[
« on: February 11, 2010, 04:44:24 am »
hey im back after a long time of not being on here. im 28, diagnosed about 3yrs ago and probably poz a year or so before that. i am constantly loosing alot of hair.
when i run my hands trough my hair i take off 1-2 hairs and im so sad cuz i have a full head of thick hair and i think at this rait i will look bald/ish??
im not sure what to do? or why? is it the meds im on? is it the virus? can i switch a med? or add a med to help it stay on my head? can it be my shampoo? or an oil i put to soften it after i iron it VITAMINE E OIL???  should i use rogaine>? whats good?

help me plz im scared?
...after the storm, the calm......

Offline Hellraiser

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Re: LOOSING ALOT OF HAIR =[
« Reply #1 on: February 11, 2010, 06:38:40 am »
Hair loss can be due to a number of factors but honestly it's most likely just genetic, wouldn't you think?

Offline RapidRod

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Re: LOOSING ALOT OF HAIR =[
« Reply #2 on: February 11, 2010, 08:10:19 am »
Yes some HIV meds do cause some hair loss in some people. Usually it is temporary.

Offline Rockit

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  • i want it all - i will shine
Re: LOOSING ALOT OF HAIR =[
« Reply #3 on: February 11, 2010, 05:59:03 pm »
i dont think its genetic cuz we dont have that issue in our family. were known to have thick hair but im loosing so much so suddenly i feel like its thining.

i wonder if its because im showering with warm/hot water?
is my scalp tooooo dry?
is it the VITAMINE E oil thats meant for the skin i guess and not the hair?
did someone do VOoDoo on me??     :o
...after the storm, the calm......

Offline tokyodecadence

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Re: LOOSING ALOT OF HAIR =[
« Reply #4 on: February 11, 2010, 06:44:43 pm »
It's actually normal to loose about 70-100 strands of hair a day, a little more if you have thicker hair, or longer hair.
[.Fodão.]

Offline Brooke P.

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Re: LOOSING ALOT OF HAIR =[
« Reply #5 on: February 11, 2010, 07:48:06 pm »
I had the same problem when I started taking Kaletra and Combivir.  I have very fine hair but I have a ton of it and nobody has ever noticed the hair loss.  I thought that when I stopped my meds for 4 years that maybe the hair loss would stop too but it didn't.  However it did ease up a little.  Now that I'm on Atripla it seems to be falling out a little more than when I wasn't on meds!
Feb. 2003 -tested positive
Started Kaletra and Combivir
2/26/03  CD4=1080   VL=218,333
3/3/03    CD4=1072   VL=546,010
4/10/03  CD4=1886   VL=1901
12/23/03 CD4=1711   VL=<50
STOPPED MEDS IN JUNE 2004
STARTED BACK WHEN I GOT PREGNANT
9/2009  CD4=274    VL=199,420
WENT 4 YEARS WITHOUT MEDS NOW I'M BACK ON MEDS, ATRIPLA
11/2009 CD4=574    VL=350
2/24/2010 CD4=851 VL=48

Offline clsoca

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Re: LOOSING ALOT OF HAIR =[
« Reply #6 on: February 14, 2010, 01:24:26 pm »
I also experienced some hair color and growth issues while taking atripla. My ID Doc advised me in an email that  Sustiva decreases something he wrote called the 3A4 enzyme. This enzyme has alot to do with hair including growth. He did say do not take propecia if atipla has caused hair issues. He said propecia and atripla utilize this enzyme. Both of these medications if used together decreases the potency of both drugs he wrote. Also I once had curly hair it is now rather straight
10/07 Infected
11/07 Seroconversion
07/08 Tested Poz
07/08 VL 487  CD4 658  (No Meds)
10/08 VL 286  CD4 724  (No Meds)
01/24/09 VL 30,100   CD4 329 CD4 30% (No Meds)
02/06/09 VL 44,000   CD4 367 CD4 36%  Blood Work @ UCLA (No Meds)
02/06/09 VL 44,000   CD4 317 CD4 35% Blood Work @ USC (No Meds)
02/12/09 VL 52,000   CD4 297 CD4 29%
02/12/09  Started Atripla
04/01/09 VL 60  CD4 667   CD4 48%
06-05-09  VL UD CD4 427   CD4 39%

Offline Rockit

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  • i want it all - i will shine
Re: LOOSING ALOT OF HAIR =[
« Reply #7 on: February 15, 2010, 04:53:50 am »
im kinda more confused :(  so am i screwed? can i take a drug out ? is there anything i can do or take so i wont loose hair? COULD IT BE THAT ANTIBIOTIC IM TAKING? TOO MUCH OF IT??

im taking:
ZIAGEN (ABACAVIR SULFATE)
LEXIVA (FOSAMPRENAVIR CALCIUM)
EPIVIR  (GLAXOSMITHKLINE)/ LAMIVUDINE
NORVIR
SULFAMETHOXAZOLE (BACTRIM)
...after the storm, the calm......

Offline clsoca

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Re: LOOSING ALOT OF HAIR =[
« Reply #8 on: February 15, 2010, 02:09:21 pm »
Oh I forgot to mention, the hair growth issues for me were temporary only lasting for 3 months.
10/07 Infected
11/07 Seroconversion
07/08 Tested Poz
07/08 VL 487  CD4 658  (No Meds)
10/08 VL 286  CD4 724  (No Meds)
01/24/09 VL 30,100   CD4 329 CD4 30% (No Meds)
02/06/09 VL 44,000   CD4 367 CD4 36%  Blood Work @ UCLA (No Meds)
02/06/09 VL 44,000   CD4 317 CD4 35% Blood Work @ USC (No Meds)
02/12/09 VL 52,000   CD4 297 CD4 29%
02/12/09  Started Atripla
04/01/09 VL 60  CD4 667   CD4 48%
06-05-09  VL UD CD4 427   CD4 39%

Offline WillyWump

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Re: LOOSING ALOT OF HAIR =[
« Reply #9 on: February 15, 2010, 09:08:31 pm »
i wonder if its because I'm showering with warm/hot water? -- NO

is my scalp tooooo dry? -- Prob has nothing to do with hairloss.

is it the VITAMINE E oil thats meant for the skin i guess and not the hair? --- No. Matter of fact this is a type of "remedy" that is used to prevent thinning hair.

It could be the meds. But also realize that you are 28 and as you age your hair will start doing things out of the norm. I went to the Dermatologist in my 30's because I sporadically started losing alot of hair. She explained to me that it's not unusual to go through a period of losing more hair then normal and that it would stop, then the hair would regenerate, and then I might go awhile before I experienced noticeable hair loss again. She was spot on. For me, this went on for years, and is still occurring. For about a month I will notice alot of hair in my brush, then it subsides for a few months. This may be whats happening to you.

I Definitely wouldn't try any Propecia or Rogaine until you confer with your Doc. Also, I used Rogaine for many years and the results were Ho-hum.

If it's really freaking you out (which it sounds like it is) get in touch with a dermatologist and see what they say.

-Will
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline Rockit

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  • i want it all - i will shine
Re: LOOSING ALOT OF HAIR =[
« Reply #10 on: February 15, 2010, 11:00:01 pm »
oh gosh! i wish you guys would say its one of the meds so i can stop taking it it but i guess not  :-\


 :'(


 :'(


 :'(


 :'(
...after the storm, the calm......

Offline aztecan

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  • 36 years positive, 64 years a pain in the butt
Re: LOOSING ALOT OF HAIR =[
« Reply #11 on: February 16, 2010, 11:01:16 pm »
Hey Rockit,

Its not one of the meds. If it is, your hair will grow back. A friend just had this happen and she was a bit freaked.

But now her hair is growing back thick and lush as it was before - and she didn't stop her meds!

I note you are on Bactrim,  which is usual if your immune system is substantially compromised, and Ziagen, Epivir and boosted Lexiva.

I have not heard of any of these being singled out for hair loss.

For the record, I started losing my hair when I was 18. Now, all I can say is Bald is Beautiful! ;)

HUGS.

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Rockit

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Re: LOOSING ALOT OF HAIR =[
« Reply #12 on: June 17, 2010, 03:13:35 am »
so no one has ever heard of HAIR LOSS and HAIR THINNING due to HIV, and or HIV MEDS?   
...after the storm, the calm......

Offline Rockit

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  • i want it all - i will shine
Re: LOOSING ALOT OF HAIR =[
« Reply #13 on: June 17, 2010, 03:16:36 am »
so is ATRIPLA the only drug related to possible HAIR GROWTH ISSUES? and is that the only name they use for it?
...after the storm, the calm......

Offline Matty the Damned

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  • Antipodean in every sense of the word
Re: LOOSING ALOT OF HAIR =[
« Reply #14 on: June 17, 2010, 03:16:49 am »
so no one has ever heard of HAIR LOSS and HAIR THINNING due to HIV, and or HIV MEDS?   

No honey. It's not about HIV or Atripla or anything like that.

You're just going bald. It's a natural thing. :)

MtD

Offline Hellraiser

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Re: LOOSING ALOT OF HAIR =[
« Reply #15 on: June 17, 2010, 10:34:25 am »
Embrace the new improved shiny topped you.  You can tell people the hair was just creating unnecessary drag and reducing your aerodynamic qualities.

Offline WillyWump

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Re: LOOSING ALOT OF HAIR =[
« Reply #16 on: June 17, 2010, 07:52:44 pm »
Wash the head with a dogs urine and you shall not be bald! - 16th century Scottish Remedy.

-W
POZ since '08

Last Labs-
11-6-14 CD4- 871, UD
6/3/14 CD4- 736, UD 34%
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline phildinftlaudy

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  • sweet Ann what you think babe...
Re: LOOSING ALOT OF HAIR =[
« Reply #17 on: June 17, 2010, 11:00:46 pm »
I choose to take control of my hair loss and do the bald thing when the iimpulse catches me....
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #18 on: August 12, 2010, 03:36:48 pm »
so is ATRIPLA the only drug related to possible HAIR GROWTH ISSUES? and is that the only name they use for it?

Don't listen to those genetically bald bitches ; )  YES- ATRIPLA (the Sustiva) DOES cause hair loss or Propecia...  It was confirmed by a DR I saw on Tuesday.  I just need to know it the hair will eventually grow back.
Papillion_44

Offline metekrop

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  • Is time running fast for you.
Re: LOOSING ALOT OF HAIR =[
« Reply #19 on: August 12, 2010, 03:50:49 pm »
so no one has ever heard of HAIR LOSS and HAIR THINNING due to HIV, and or HIV MEDS?   


Meeeeeeee
Diag.on 12/8, 2000, CD 440 VL 44K, No Meds
12/08 - 2/09 CD< 50 & VL >500k hosp'z.
St. Atripla - 7/09 CD 179, VL 197k
10/09 CD 300 VL U
3/10 468 U
8/10 460 U
12/10 492 U
3/11 636 U
8/11 530 U
1/12  616 U
7/12 640 U
12/12 669 U
5/13 711 U
11/13 663 U
4/14  797 U
10/14 810 U
4/15 671 U
10/15 694 U
3/16 768 U
8/16 459 U
2/22 780 U
8/31 940 U
2/26 809 U
8/18 882 U
3/28 718 U
8/15 778 U
2/25 920 70
8/11 793 U
2/22 690 U
6/8 834 U

Offline phildinftlaudy

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Re: LOOSING ALOT OF HAIR =[
« Reply #20 on: August 12, 2010, 03:51:18 pm »
Don't listen to those genetically bald bitches ; )  YES- ATRIPLA (the Sustiva) DOES cause hair loss or Propecia...  It was confirmed by a DR I saw on Tuesday.  I just need to know it the hair will eventually grow back.
Okay - I'm confused - Propecia is the name of a drug that is taken to manage hair loss.  It is not the name of hair loss....
There is an interaction that can occur between Propecia and Sustiva because they both use the same enzyme.  Sustiva can cause the blood level of Propecia to drop, thereby making it less effective in managing hair loss.

So, a person would have to be on Propecia to manage hair loss in order for there to be an interaction between it and Sustiva.  

My recollection of your history is that you did not have hair loss problems and I don't recall you saying you were on Propecia.  If you were on Propecia, then there could be an interaction issue making it less effective.  If you weren't on Propecia then I don't know why it was mentioned in your response.

The other med you have stated you are on for acne has been known to cause hair loss.

By the way, all these things are searchable on the web - below is link to Sustiva and Propecia (medication) interaction info:
http://www.thebody.com/Forums/AIDS/Meds/Current/Q202875.html
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Hellraiser

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Re: LOOSING ALOT OF HAIR =[
« Reply #21 on: August 12, 2010, 10:58:50 pm »
Because he meant Alopecia

Offline phildinftlaudy

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Re: LOOSING ALOT OF HAIR =[
« Reply #22 on: August 12, 2010, 11:02:14 pm »
Because he meant Alopecia
ahhh ok - thanks for the clarification   duly noted.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline HippieLady

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Re: LOOSING ALOT OF HAIR =[
« Reply #23 on: August 13, 2010, 01:08:16 pm »
I am losing tons of hair. It's not noticeable on my head yet but when I shower I lose about 50-100 strands of hair and then again when I comb my hair I lose about as much.  I have to clean my shower drain frequently or it clogs.  I have spoken to my ID doc about it and she's not worried yet.  She wants me to give it a little more time as she thinks it's either hormonal or antibiotic related.  I sure hope she's right and it tapers off soon.

~Katie~
Diagnosed HIV+ April 30, 2010

Current CD4-638  VL-UD  11/2013

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #24 on: August 16, 2010, 02:58:31 pm »
Okay - I'm confused - Propecia is the name of a drug that is taken to manage hair loss.  It is not the name of hair loss....

I meant to say ALOPECIA.

Atripla causes AOLPECIA...
Papillion_44

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #25 on: August 16, 2010, 02:59:24 pm »
I am losing tons of hair. It's not noticeable on my head yet but when I shower I lose about 50-100 strands of hair and then again when I comb my hair I lose about as much.  I have to clean my shower drain frequently or it clogs.  I have spoken to my ID doc about it and she's not worried yet.  She wants me to give it a little more time as she thinks it's either hormonal or antibiotic related.  I sure hope she's right and it tapers off soon.



Are you taking any medication?
Papillion_44

Offline HippieLady

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Re: LOOSING ALOT OF HAIR =[
« Reply #26 on: August 16, 2010, 04:13:52 pm »
Are you taking any medication?

Truvada, Reyataz and Norvair

No other meds or supplements
~Katie~
Diagnosed HIV+ April 30, 2010

Current CD4-638  VL-UD  11/2013

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #27 on: August 16, 2010, 04:29:05 pm »
I'm going through the same thing you are in regards to the hair loss  >:( and it is very frustrating because that is the only real side effect of the drug I'm taking (Atripla).  It is interesting that a component of Atripla is also Truvada- but my DR said that the ALOPECIA was probably caused by the Sustiva component in the Atripla. Maybe both are causing the hair loss?  I am waiting one more week to see if things change before switching to another drug (or drugs). 

How long have you experienced the hair loss?  I have noticed for about a month now. 

Also, someone on this Forum mentioned a condition called Telogen Effluvium- which is rapid hair loss due to a shock to your system (sometimes brought on by medications).  Perhaps what we are going through is a shock reaction to the new medications we are taking? 

Everything would be OK if the hair would eventually grow back!  So far no one has assured me that the hair will grow back once i adjust to the initial shock of the medications.  I also read that with TE if it's medication causing the hair loss you should stop taking the drug(s). 

I'm between a rock and a hard place here in making the choice to continue the medication, find something else or abandon medications altogether.  Let me know how things go for you!

 ;)

~M

Papillion_44

Offline Tempeboy

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Re: LOOSING ALOT OF HAIR =[
« Reply #28 on: August 17, 2010, 10:21:27 pm »
All NNRTI's (especially Efavirenz) and many PI's are the meds most associated with hair loss for people living with HIV - http://www.medscape.com/viewarticle/561173_3

HIV replication itself can also contribute to hair loss as well as genetics etc.
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #29 on: August 18, 2010, 02:14:36 pm »
Thanks Tempeboy!  That was a great and informative article.  I'm going to wave it under my Dr.'s nose to see what he might have to say about it  ;)
Papillion_44

Offline loop78

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Re: LOOSING ALOT OF HAIR =[
« Reply #30 on: August 18, 2010, 03:31:07 pm »
All NNRTI's (especially Efavirenz) and many PI's are the meds most associated with hair loss for people living with HIV - http://www.medscape.com/viewarticle/561173_3

HIV replication itself can also contribute to hair loss as well as genetics etc.

I might be reading this wrong, but what I get from that article is that there may be a link between some PI's (Kaletra, most of all) and hair loss, but not with NNRTI's. In fact, according to it, the patients condition improved after they were switched to an efavirenz based regimen:

Quote
After this drug was switched to efavirenz, the patient's general condition improved, and her hair loss resolved, with substantial hair growth localized to the scalp.

Quote
In 10 patients with indinavir-induced alopecia, progressive hair regrowth occurred within 4 months after indinavir was replaced with nelfinavir, ritonavir plus saquinavir, nevirapine, and/or efavirenz.

Going back to the OP, my opinion is that any hair loss you are experiencing is more likely to be some mild form of IRIS than something specifically related to efavirenz.

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #31 on: August 18, 2010, 03:51:47 pm »
Hi Tempeboy- could you remind me again what PI's and NNRTI's are?

The description in that article about how the hair fell out- with very little trauma and within weeks of taking the drug is exactly like how it was for me.

When you say IRIS- does this mean that my reaction to the drug will pass?  Or that I should discontinue the ATRIPLA? 

A Dr. I saw last week suggested I start taking Fosamprenavir, Ritonavir and Truvada.  It all sounds very scary to me...
Papillion_44

Offline denoirby

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Re: LOOSING ALOT OF HAIR =[
« Reply #32 on: August 18, 2010, 08:50:42 pm »
I used to have a lot of hair loss unti I started taking Biotin. I the highest mg capsule they make a day. I was getting so thin I thought about shaving my head & I would not look good bald.... Also a low testosterone level I was told by HIV doc may have contributed as well. I am much thicker now.. I believe I am thicker than I was before I was diagnosed almost 20 years ago.. Good luck..

Offline Tempeboy

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Re: LOOSING ALOT OF HAIR =[
« Reply #33 on: August 19, 2010, 01:05:39 am »
Hi Tempeboy- could you remind me again what PI's and NNRTI's are?

The description in that article about how the hair fell out- with very little trauma and within weeks of taking the drug is exactly like how it was for me.

When you say IRIS- does this mean that my reaction to the drug will pass?  Or that I should discontinue the ATRIPLA? 

A Dr. I saw last week suggested I start taking Fosamprenavir, Ritonavir and Truvada.  It all sounds very scary to me...

Hi Papillion,

The article was more intended to give an outline of how the meds can effect hair growth/loss etc.  Indiviiduals respond differently to different meds, so one may cause a side effect for one person, but not another.

I can't say what you should and shouldn't take, however if you are concerned that Efavirenz might be the culprit - you could ask your doc if you can switch your combo and see if it makes a difference.  Efavirenz has also been related to birth defects, so that's something else to think about.

I would be reluctant to take fosamprenavir - http://www.aidsmap.com/page/1437030/

You might like to ask about Isentress or Maraviroc?  They have great side effect profiles.

In terms of what drugs belong to which groups, here is a link to the aidsmap drug chart ( very good ) - http://www.aidsmeds.com/list.shtml
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline Hellraiser

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Re: LOOSING ALOT OF HAIR =[
« Reply #34 on: August 19, 2010, 01:08:52 am »
could you remind me again what PI's and NNRTI's are?

PI = Protease Inhibitor
NNRTI = Non-nucleoside Reverse Transcriptase Inhibitor

Offline Tempeboy

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Re: LOOSING ALOT OF HAIR =[
« Reply #35 on: August 19, 2010, 01:15:44 am »
I might be reading this wrong, but what I get from that article is that there may be a link between some PI's (Kaletra, most of all) and hair loss, but not with NNRTI's. In fact, according to it, the patients condition improved after they were switched to an efavirenz based regimen:

Going back to the OP, my opinion is that any hair loss you are experiencing is more likely to be some mild form of IRIS than something specifically related to efavirenz.

Good point loop, sorry for any confusion, the article was more intended to give an overall explanation - I should have clarified.

The NNRTI's as a group are associated with hair loss in some people- depending on how the mechanism of the drug impacts on the various stages of hair growth - if at all - so individual responses will vary. 

Having said that NNRTI's are a great group of drugs, as are any HIV treatments when they work and don't cause nasties.

cheers

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline loop78

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Re: LOOSING ALOT OF HAIR =[
« Reply #36 on: August 19, 2010, 04:07:36 am »
Efavirenz has also been related to birth defects, so that's something else to think about.

Which would be a problem if papillon were a woman  ;)

You might like to ask about Isentress or Maraviroc?  They have great side effect profiles.

I agree Isentress' side effect profile so far is fantastic, Papillon. If whatever the reason, you end up wanting to switch from atripla, you may ask about Isentress+Truvada. The only drawback I can think of that combo, is that right now it's still a twice daily one, but regarding side effects is clearly one of the tops.

Good point loop, sorry for any confusion, the article was more intended to give an overall explanation - I should have clarified.

No problem, tempeboy, that clears everything up. Thanks! :)

Offline Papillon_44

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Re: LOOSING ALOT OF HAIR =[
« Reply #37 on: August 19, 2010, 02:31:21 pm »
Thank you so much- you have all been so extremely helpful.  Poring through some of the medical information on some of the websites (that sometimes read like 12th C. laws written in Latin) can be intimidating.  I prefer the straight forward talking from people with insight and experience- expressed in a way for people to understand clearly. 

You have all been very helpful and I appreciate it very much.  Please continue to provide feedback!

 ;D
Papillion_44

 


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