POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: LordBerners on August 31, 2008, 05:36:46 pm
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I've gotten little herpes outbreaks for years, and can't really say their frequency or severity has been related to being positive. One would assume it makes them worse, but they haven't really been that bad lately.
I'm a month into ARV and certain signs suggest I may be experiencing good effects, but my most recent herpes outbreak isn't the usual small and quick one. Its like one whole side of the penis!
Anyway, I'm just wondering if anyone knows or has experience with this - any relationship with immune reconsitution and herpes outbreaks? I would take the Valcyclovir or whatever it is but I believe it is expensive.
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Untreated HSV has been demonstrated to cause a higher HIV viral load (when not on HAART, of course). I don't know if the interaction also works the other way, i.e. causes more activation of HSV. Don't know either about immune reconstitution but my doc was fairly clear that I ought to continue acyclovir for at least a few months after initiation of HAART, so I suppose it is fair assumption.
Acyclovir is out of patent so it should be possible to find cheaper generics. You can be on a long-term suppressive regime but you can also choose to just take it to lessen outbreaks, i.e. start to take it when tingling starts and stop again when it feels like the outbreak has been averted.
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, but my most recent herpes outbreak isn't the usual small and quick one. Its like one whole side of the penis!
Its a wonder it has not fallen off. Fungi in the pee hole and herpes down the side...
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Hey Lord,
Sometimes when people start HIV meds their immune system starts responding to infections that may have been lying low for a while. This set of symptoms is often called immune reconstitution syndrome.
You should find that the outbreak settles down, and you could speak to your doc about treating the outbreak and associated pain. Also, some people take meds ongoingly to keep herpes at bay.
take care.
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Thank you keyright and tempeboy, for your helpful comments. Not so much thanks to Roie for making fun of my poor weiner. :) Considering many of us on this forum acquired hiv through a sexual mode of transmission, one would expect a degree of tolerance and understanding regarding other stds as well!
I did find some acyclovir cream and having been applying that mornings, and at night I've been applying Betadine (I read online that this has been effective in shortening herpes outbreaks and preventing secondary infection of lesions).
I'll look into the prophylaxis by acyclovir tablets, though I kind of hate to take something like that 365 days a year for a four times per year ailment.
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My Lord,
Once the HIV meds do their thing and your immune system returns to optimal functioning you might find that you breakout less often - or even not at all. Can complimentary therapies help?
And remember - clean underwear twice a day and a good airing in the sun for the little Lord. ; )
cheers
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::) Is this guy for real??????????
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::) Is this guy for real??????????
In the sense that he posts here, yes....
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Considering many of us on this forum acquired hiv through a sexual mode of transmission, one would expect a degree of tolerance and understanding regarding other stds as well!
We are; mostly when people take care of their "STD's" and don't let them seethe for eons.
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::) Is this guy for real??????????
malheureusement
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::) Is this guy for real??????????
You scoff at the possibility that a person might have herpes, Desertguy? I can assure you it is quite a common ailment.
As for 'taking care' of herpes, there is little that can be done. The available treatments are really not very effective, and as we know there is no cure.
The difference between the length of a specific outbreak, or the frequency of outbreaks is not that significant whether one uses acyclovir or not. It so happens that I am using the acyclovir cream. I don't want to commit to taking the pills 365 days a year as a prophylactic, partly because of cost, but also because of possible effects on liver, etc. As for taking pills as a treatment for this particular outbreak, it is too late as one is directed to take the pills at the first inkling of that unique herpes 'itch'.
Really I do find the attitude of many on this forum regarding the more workaday stds surprisingly judgmental.
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As for 'taking care' of herpes, there is little that can be done. The available treatments are really not very effective, and as we know there is no cure.
This just proves how shockingly little you know. Herpes is one of the most treatable illnesses there are. You can completely prevent outbreaks by popping one or two generic, cheap acyclovir pills a day.
I've been doing so myself since the pills came out in the mid 1980's. I haven't had an outbreak in over 20 years. Everyone HIV person I know that has herpes takes acyclovir or vancyclovir, and NONE of them EVER gets an outbreak. The only folks this doesn't work in are typically severely immune deficient, or in rare cases, their herpes virus has developed resistance to the meds (unlike the HIV drugs, this happens very rarely with the herpes drugs).
This is what happens when folks make a habit of self-diagnosing everything, and rarely if ever using or seeking professional advice.
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This is what happens when folks make a habit of self-diagnosing everything, and rarely if ever using or seeking professional advice.
Budgetary constraints place me in this disadvantageous postion, Peter, but I do appreciate the anecdote you share here regarding the Acyclovir.
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Just to update: Though it really wasn't my intention in this thread to just chat about my herpes (I had hoped to find out if immune reconstitution has any effect on herpes), I feel I should update as to my condition, in case some have become concerned.
Though my outbreak finally cleared and healed up as of yesterday (just a few vestiges of discoloration left), I totay went to the pharmacy and bought 400 miligram tablets of generic 'acyclovir'. The pharmacist told me I shoudl take 3(!) of these per day as a prophylactic.. I must confess that sounds an awful lot. They aren't too expensive though at about 30 cents per tablet..
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So you've not been treating this for "years" as stated in your OP, and the reasoning was "budgetary constraints" as described yesterday, when in fact you didn't even have any clue how much it cost? So how much have you spread this around Bangkok for absolutely no reason then?
I'm sorry, but you make no sense.
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So you've not been treating this for "years" as stated in your OP, and the reasoning was "budgetary constraints" as described yesterday, when in fact you didn't even have any clue how much it cost? So how much have you spread this around Bangkok for absolutely no reason then?
No, I stated that my reason for not 'seeing the doctor' about such complaints, and thusly dispelling the ignorance Peter decried in his post, was impecuniousness. I didn't refer to the price of the medicament. However let me state that much of time I have suffered from genital herpes I did live in the US of A, where medicines are much more expensive.
But please, why the attacks, philly? What's past is past, and I'm trying to deal with this as best I can now in the present.
Can anyone comment on whether it is really necessary, as the pharmacist claims, to take 1.2 grams of this stuff (3 tablets) daily 365 days per year? Or is a lesser dose possibly effective? I think Peter mentioned above that some people take just 'one or two' tablets daily. (I'm more concerned about side effects or long term detriment to liver etc, than about the possible $1/day cost, though $1 a day is a lot when you only make a thousand bucks a month).
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No, I stated that my reason for not 'seeing the doctor' about such complaints was impecuniousness. I didn't refer to the price of the medicament.
so what did you mean in this post? (http://forums.poz.com/index.php?topic=22864.msg291660#msg291660)
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so what did you mean in this post? (http://forums.poz.com/index.php?topic=22864.msg291660#msg291660)
Explained in this post (http://forums.poz.com/index.php?topic=22864.msg291914#msg291914)
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Explained in this post (http://forums.poz.com/index.php?topic=22864.msg291914#msg291914)
riiiiiight... which you claim you didn't say
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I shall resist my natural impulse to work towards clarity and understanding, and drop this endless loop with our worthy Philly267.
But back to the question I posed:
Can anyone comment on whether it is really necessary, as the pharmacist claims, to take 1.2 grams of the acyclovir (3 tablets) daily 365 days per year? Or is a lesser dose possibly effective? I think Peter mentioned above that some people take just 'one or two' tablets daily.
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Jeez, you'd think the guy was an axemurderer and not simply infected with one of the most prevalent viruses around..
My long-term suppressive regime of acyclovir was 2 x 400mg / day - it even came in a blister pack already printed with Mon AM, Mon PM, Tues AM, etc.
To treat an active outbreak I seem to recall you can do 5 x 200 mg / day - I'm not aware of prescribing that exceeds that but I don't think 3 x 400mg will do any harm as such.
In weighing up whether or not to go back on a suppressive regime I discussed the impact on the liver only yesterday with my doc. She was very clear that acyclovir has a very low impact on the liver.
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if you having recurrent episodes throughout the year, then i think mos thiv clinicians would say longer term suppressive treatment is appropriate. i will also say that i do not agree with people self diagnosing/treating somethign like this on either a short or long term basis.
Uk BASHH guidelines for hiv+ people recommend oral acyclovir 400-800mg twice to three times a day for suppressive therapy. active infection, 400 mg three times daily for 5-10 days
re hsv and immune reconstitution, yes, there is a link. if that is indeed what you are dealing with, controlling hiv replication with combo/strengthening yr immune system shoud reduce frequency and severity of hsv episodes. on its own thuogh, combo ( as i understand it) don't have such a pronounced effect on hsv "shedding" even when you not having noticeable symptoms.
kate
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You know Berners, I believe you can be really funny sometimes and I think your heart is in the right place but sometimes I have the impression that you don't really understand the concerns that people are expressing here.
On the one hand, in various posts you have expressed some sort of sense of solidarity with other folks (even to the extent of referring to class struggle in an approving way here
http://forums.poz.com/index.php?topic=8506.msg215503#msg215503)
On the other hand, when people suggest that you should see a doctor regarding your various STD's you react solely based on your own personal situation -- "Budgetary constraints place me in this disadvantageous situation..." and you don't seem to acknowledge that you have any interest or obligation to also protect other people from the diseases you are carrying. No doubt deep down you feel that goes without saying, and you are just trying to be funny, but at this point I think you risk coming across as not caring about or feeling any solidarity with the people (primarily women) you are having sex with. Its almost objectification rather than solidarity.
Furthermore, while we "get" the idea that you believe the medical care you receive in Thailand is not up to Western standards, you don't appear to "get" the idea that by self diagnosing you put both yourself and others at risk of disease and death -- and that often the bar appears to be effort on your part rather than cost to you (i.e., that you assume diagnosis and treatment will be costly and so don't even try).
This is no doubt unduly blunt -- sorry I can't figure out any other way to say it. I hope you can find treatment for your various ailments.
Assurbanipal
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Thanks, keyrite and penguin, for your helpful information. I think I will take the 400 twice a day and see how it goes, and then mention it to my hiv docs when I see them in a few weeks.
Assurbanipal, thank you also for your kind attention and particularly for remembering a political post of which I was rather proud. I do like to chat about issues and ideas. But regarding your concern that I am somehow wronging other people, I think you will find that nothing in my posts suggest I am having sex with others.. and I don't think my left hand is particularly at risk ;)
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That's what I'd recommend. I take 400mg, twice a day.
See dosage recommendations here:
http://www.rxlist.com/cgi/generic/acyclo_ids.htm
"Chronic Suppressive Therapy for Recurrent Disease: 400 mg 2 times daily for up to 12 months, followed by re-evaluation. Alternative regimens have included doses ranging from 200 mg 3 times daily to 200 mg 5 times daily."
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Hey Lord,
Where in Thailand are you living - I have a couple of friends working in HIV there that I could put you in touch with that may be able to help.
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Lord, I know this doesn't help you because of your budget, but I just wanted to share my experience. I am newly diagnosed with both HSV and HIV. I am not on medication yet for the HIV but will probably start soon. For the herpes, I tried acyclovir but found that if I took less than 3 a day, I still had an outbreak. I have since started taking Valtrex and only need one a day to remain symptom free.
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Thanks for the comment, PositivelySOuthern. I have often heard that Acyclovir is not really all that effective at preventing herpes outbreaks, at least for a large percentage of people. This was one reason I never bothered to pursue treatment.
But I understand that Valtrex is much more expensive? Probably impossible for me.
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I have often heard that Acyclovir is not really all that effective at preventing herpes outbreaks, at least for a large percentage of people.
I am really surprised at this. As Peter Staley, an expert in the field and a herpes sufferer himself, said:
Herpes is one of the most treatable illnesses there are. You can completely prevent outbreaks by popping one or two generic, cheap acyclovir pills a day.
I've been doing so myself since the pills came out in the mid 1980's. I haven't had an outbreak in over 20 years. Everyone HIV person I know that has herpes takes acyclovir or vancyclovir, and NONE of them EVER gets an outbreak. The only folks this doesn't work in are typically severely immune deficient, or in rare cases, their herpes virus has developed resistance to the meds (unlike the HIV drugs, this happens very rarely with the herpes drugs).
Perhaps you missed this post, but I for one would weigh an expert opinion based in quantifiable data over heresay any day of the week. And seeing as how Acyclovir is generic and fairly inexpensive, it could never, ever hurt to try.
You seem way too intelligent to remain in the grips of a painful malady unnecessarily, when an inexpensive and effective remedy has been shown.
But it's your call. Perhaps your friends are a stronger influence. At the end of the day, it is your body, your penis, your pain.
Me, I'm all about less pain more happy - with enough money to spare to eat something nice for lunch.
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Please understand that I, by no means, meant to discourage anyone from using Acyclovir. It definitely works. It is just that everyone is different and responds differently to different medications. I was only sharing my personal experience with it.
Lord, I have a medical plan and make co-payments on my meds. I'm not sure what the actual cost of Valtrex is but I pay $40 for a month's supply, which is definitely more expensive than the acyclovir.
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To my last post, I would like to add that, as long as I took 3 acyclovir a day, I had no outbreaks. I did remain symptom free.
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See my latest blog posting on this fascinating new study about acyclovir:
Acyclovir -- One Reason Why I'm Still Alive?
http://blogs.poz.com/peter/archives/2008/09/acyclovir_one_r.html
If you comment here, please cut & paste your comment below my blog posting as well.
Thanks for reading!
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Thank you Peter for this very encouraging information, and for remembering this thread.
Perhaps this news suggests it could be worthwhile to keep one's acyclovir dose at three 400 milligram tablets per day (a treatment dose) rather than two (the prophylactic dose).. I shall continue with the more frequent option and ask my doctors about it soon.
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My doctor recently discouraged me from taking acyclovir as a prophylaxis unless it was very necessary, as they said it has a deleterious effect on the kidneys, and one of the drugs in my Sustiva/Truvada combo is also bad for the kidneys. (my bloodwork shows totally normal kidney function so far). Can anyone comment if this is an opinion I should lend full credence or should I inquire elsewhere?
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Hmm, don't know for sure, but I can say I discussed the potential impact of a long-term acyclovir regime with my HIV consultant very recently, because I was worried it might be too high a load on the liver, when combined with Sustiva/Truvada.
She was very clear that the impact was negligible and that she would have no reservations whatsoever. We didn't, though, discuss the kidneys.
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Practically every drug a person with HIV takes can cause renal failure, especially in patients with current renal impairment. This isn't a unique situation to acyclovir. That's why we all have our blood tested every 3 to 6 months to see how our liver and kidneys are doing.
Unless you have prior evidence of renal impairment, I find it weird that your doc would warn you off a drug that might help you. That's what the drug's label says (just like most of the antivirals we're on).
Whatever.
Sorry, Lord, but I won't be posting to this thread again. I'm convinced you only want to find info that justifies a decision you've already made. I feel jerked around, frankly.
Adios.
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My doctor recently discouraged me from taking acyclovir as a prophylaxis unless it was very necessary, as they said it has a deleterious effect on the kidneys, and one of the drugs in my Sustiva/Truvada combo is also bad for the kidneys.
Valcyclovir (which is a pro-drug version of acyclovir) was the drug you mentioned in the OP. Are you really sure your doctor wasn't talking about Valcyclovir, rather than acyclovir? The fact that you mention the expense of the drug (acyclovir certainly isn't expensive and is available as a generic) would also tend to support the idea that your doctor was talking about Valcyclovir.
Also, is this the same doctor who you claim never impressed on you the importance of taking your drugs on time?
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Sorry, Lord, but I won't be posting to this thread again. I'm convinced you only want to find info that justifies a decision you've already made. I feel jerked around, frankly.
I realize you don't wish to respond, Peter, but I wanted to assure you I had no intention of jerking anyone around. I'm only passing along what my doctor told me.
Valcyclovir (which is a pro-drug version of acyclovir) was the drug you mentioned in the OP. Are you really sure your doctor wasn't talking about Valcyclovir, rather than acyclovir? The fact that you mention the expense of the drug (acyclovir certainly isn't expensive and is available as a generic) would also tend to support the idea that your doctor was talking about Valcyclovir.
No, we were discussing acyclovir.
Also, is this the same doctor who you claim never impressed on you the importance of taking your drugs on time?
One of them.
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I guess the point here is, yes i hate to take lots of meds but hey for someone with Scurvy (N.Lat. scorbutus) is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. a pill of vitamin C -- 300 years ago would have been like a drug, and look how many good things that acyclovir stops, i mean i guess i am trying to say, it is hard to take meds because of the worry of what they do to the body but it helps me to know that aciclovir may actually help stop some other bad thing from coming up (who knows but hopefully something-- cancer for example see list below... Epstein-Barr virus (EBV) Nasopharynx, Hodgkin’s disease, non-Hodgkin’s lymphoma
Human herpesvirus type 8 (HHV-8) Kaposi’s sarcoma)
so acyclovir may have many added benefits -- perhaps we should all be on it, what is rate of Hodgkin’s disease, non-Hodgkin’s lymphoma among hiv poz guys??????? i think it is rather significant,
There are a number of Human Polymerase enzymes. They do things in human cells.
Reverse Transcriptase, is an HIV Polymerase enzyme used by RNA retroviruses like HIV, which is used to create a complementary strand to the preexisting strand of viral RNA before it can be integrated into the DNA of the host cell. It is also a major target for antiviral drugs.
Acyclovir/Valtrex actually suppresses one of the viral DNA polymerase enzyme strongly and the human DNA polymerase enzyme (but very weakly)
http://en.wikipedia.org/wiki/Acyclovir
Acyclovir is a very potent inhibitor of viral DNA polymerase; it has approximately 100 times greater affinity for viral than cellular polymerase. As a substrate, acyclo-GMP is incorporated into viral DNA, resulting in chain termination. It has also been shown that viral enzymes cannot remove acyclo-GMP from the chain, which results in inhibition of further activity of DNA polymerase. Acyclo-GTP is fairly rapidly metabolised within the cell, possibly by cellular phosphatases
Microbiology
Aciclovir is active against most species in the herpesvirus family. In descending order of activity:[1]
Herpes simplex virus type I (HSV-1)
Herpes simplex virus type II (HSV-2)
Varicella zoster virus (VZV)
Epstein-Barr virus (EBV) ------ doesn't this nasty thing cause chronic fatigue syndrome or who knows what
Cytomegalovirus (CMV) -- least activity
[and probably many other things yet to be discovered]
[Recently there is some studies that show it is active in some ways with hiv but this is not completely proven yet but some say it may be inexpensive part of a future cocktail. i heard,,, is this proven yet or still in study]
http://en.wikipedia.org/wiki/Polymerase
http://en.wikipedia.org/wiki/DNA_polymerase
Polymerase
From Wikipedia, the free encyclopedia
A polymerase is an enzyme whose central function is associated with polymers of nucleic acids such as RNA and DNA. The primary function of a polymerase is the polymerization of new DNA or RNA against an existing DNA or RNA template in the processes of replication and transcription. In association with a cluster of other enzymes and proteins, they take nucleotides from solution, and catalyse the synthesis of a polynucleotide sequence against a nucleotide template strand using base-pairing interactions.
Reverse Transcriptase, an enzyme used by RNA retroviruses like HIV, which is used to create a complementary strand to the preexisting strand of viral RNA before it can be integrated into the DNA of the host cell. It is also a major target for antiviral drugs.
http://www.yourdiseaserisk.harvard.edu
http://www.yourdiseaserisk.harvard.edu/hccpquiz.pl?lang=english&func=show&quiz=lung&page=table
INFECTIOUS AGENTS ASSOCIATED WITH CANCER
Agent Type of cancer
Epstein-Barr virus - a herpes virus (EBV) Nasopharynx, Hodgkin’s disease, non-Hodgkin’s lymphoma
Human herpesvirus type 8 (HHV-8) Kaposi’s sarcoma
Human immunodeficiency virus type 1 (HIV-1) Kaposi’s sarcoma, lymphoma
Human T-cell lymphotrophic virus type I (HTLV-I) Leukemia/lymphoma
Schistosomes Bladder
Liver flukes Bile duct
Human papillomavirus (HPV) Cervix, vulva, anus, penis, head and neck
Helicobacter pylori Stomach
approximately 7 percent of all cancers have been linked to infections. In developing countries, this number reaches almost 25 percent.
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Uh... what are you trying to tell us, bim?