Ask the Doc: Being Truly Thankful at Thanksgiving

In this installment of Ask the Doc, Dr. Howard Scheiner tackles some important issues around dealing with HIV around the holidays.

With Thanksgiving approaching, many people are spending more time with their families. This can be stressful for anyone, but especially if you are not out to them about your sexual orientation or serostatus.

In addition, the holidays are often a time for excessive eating and drinking. With the many holiday parties, it's easy to overindulge in booze and even sex. Dr. Scheiner suggests that some people might benefit from 'seasonal PrEP.'

Are We Close to a Cure for HIV?

Q: Dear Doc, I lost my partner to HIV/AIDS 10 years ago on Thanksgiving. Although Thanksgiving can be a difficult holiday for me, I am particularly thankful that I have the option of PrEP as prevention in my life. But I still wish for a cure. Are we any closer?

A: There is progress on many fronts. One new and exciting area has been called "Kick and Kill." The key to eradication of HIV rests on the ability to rid the body of the so-called latent HIV reservoirs. These reservoirs are established early on during HIV infection. It is where cells, such as resting CD4 cells, remain infected but not actively producing HIV.

So, while treatment with antiretroviral therapy reduces the level of HIV in blood to undetectable levels, these latent reservoirs of HIV survive. If a latently infected cell is reactivated the cell begins to produce HIV again allowing treatment to work. A cure can only be possible being able to attack and eradicate these sanctuary sites.

Reversing HIV latency so infected cells can be killed is the "kick." HDAC (histone deacetylase) inhibitors are drugs that can do this and recently a potent such drug called romidepsin, was shown to activate the virus from the latent reservoir.

This alone doesn't reduce the reservoir so a "kill" strategy for the cells that have been harboring the latent virus is needed. That is where vaccines are being looked at to improve the "kill."

Stay tuned!

Ask Your Doc About Seasonal PrEP

Q: Dear Doc, I'm single and don't see my family over the holidays. Although I'm not usually sexually active, I did have to take PEP (post-exposure prophylaxis) last year during the holidays. I'm not complaining, as I had a blast. I have been invited to a lot of holiday parties already, but I'm afraid that all this extra eating, drinking and partying will wreak havoc on my system. Got any tips to survive the holidays?

A: Alcohol and drugs are known to impair judgment and can lead you to have riskier sex than you might otherwise. It might be time for "seasonal PrEP (pre-exposure prophylaxis)," after discussion with your physician to see if this is right for you.

PrEP is even better than initially thought in "real-world" settings. Most recently in September of this year, Kaiser Permanente reported in the Journal Clinical Infectious Diseases seeing no new HIV infections after more than 2.5 years of providing PrEP.

Your physician will test you for HIV and other STI's, along with liver and kidney function tests. It is also important to have hepatitis B testing as well before initiating treatment. Periodic HIV testing every three months is also necessary. You can then decide if you wish to continue, extending your preventive treatment beyond the holidays or simply stop if you don't require it, (if you are not sexually active during the rest of the year).

Also, while eating a healthy diet is always a wise choice, you might want to schedule some extra gym workouts so that you don't have the guilt of indulging in that extra eating and drinking.

Called "more than a doctor, a trusted friend" by his patients, Dr. Howard Scheiner is a true native New Yorker. He was born in the Bronx, he attended the esteemed Bronx High School of Science and City University of New York before receiving his medical education at The Mount Sinai School of Medicine. Truly a Renaissance man, in addition to his lifelong service to the medical profession, Dr. Scheiner is a published author, playwright and musical composer. Combining all his loves, he is perhaps most proud of founding "The Brent Varner Project, Inc." a charity that provides free HIV services to those in need through the Actors Fund of America.

This story is part of our special report: "Ask the Doc". Want to read more? Here's the full list.

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