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D.A.P.’s nutritionist prescribes good …

The health care world, including Desert AIDS Project, looks at nutrition as a key part of good health. That’s why Gustavo Wong, registered dietitian and certified exercise physiologist, joined us about eight months ago as yet another facet of D.A.P.’s holistic approach to the care of our patients and clients.

Food is medicine for all of us, particularly for those living with HIV. “As a way of eating to live a healthier life, I recommend less processed food while choosing more natural items from a specific array of food groups,” Wong says. “Those groups are vegetables, fruits, and whole grains as good sources of carbohydrates, along with protein from meats and healthy fats.”

FoodPlate1As a primary guideline to healthier eating, Wong recommends the “plate method.” The basic idea is to have half of the plate devoted to non-starchy vegetables with a quarter for proteins and a quarter for carbs. However, Wong does tailor recommendations to the needs of individual clients. For example, some foods aggravate gastro-intestinal systems of certain patients, announcing their presence in the form of diarrhea, constipation, or nausea.

“Fats generally are the culprits,” Wong says, “so I want to make sure clients don’t have GI problems. If they do, I adjust their diet accordingly.”

The non-starchy veggies on half the plate include salads, asparagus, beets, mushrooms, broccoli, cucumber, and spinach. Denser carbs that make up a smaller part of the plate include beans, lentils, peas, winter squashes, sweet potatoes, bread, pasta, and corn. Red meat, chicken, eggs, fish, nuts and nut butters round out the plate with protein. On colder days, some people prefer to have vegetable soup, as a way of incorporating those all-important vegetables into their diet.

For breakfast, Wong recommends such items as cereal with nuts and fiber, such as flaxseed meal, or by adding some bran. Regardless of which meal, we all still need the foundation of “macronutrients” – carbs, protein, grains, and healthy fats – to help build a strong immune system. And taking a lot of supplements is no substitute for a balanced diet.

Neither is processed food. Wong insists that the nutrients that have often been removed, limited, or destroyed in food processing are essential for all of us.

Click to watch the tasty video 

HIV and its care pose special challenges …

There are some dental health issues pressing on those living with HIV and AIDS that we should illuminate in February, when National Dental Health Month is marked.

Our dentists, Dr. Ryan Yamashiro and Dr. Daniel Jo, both graduates of Loma Linda University School of Dentistry, agree that some of these concerns weigh more heavily on many of our patients than they do on those who are not HIV-positive. The doctors describe those special challenges and what they do to help.

How important is good dental hygiene for those with HIV?

Dr. Jo: In general, it’s really important for any patient to have good oral hygiene. But yes, some of the medications our patients take can create complications of the mouth.  If you don’t have good dental hygiene you can experience more problems such as gum disease and cavities than a person who isn’t HIV positive might face.

What are some of the oral challenges faced by people living with HIV?

Dr. Yamashiro: Some of the patients have candidiasis, (a fungal yeast infection also known as thrush.)  They take a lot of medications so decay can be accelerated with them. Many also suffer from dry mouth due to some of the medications they’re taking and that also can cause decay. They also have problems with dry mouth in general. They just don’t really salivate that much and it can cause a lot of problems. We try to help manage all of that with them.

How much of that do you see here at D.A.P.?

Dr. Jo: It’s a pretty common problem. It can affect their condition in terms of their HIV.  That goes back to oral hygiene. In general, it’s important to have a healthy oral environment by maintaining the teeth they have, avoiding gum disease, and trying to keep them as healthy as possible.

What do you do about dry mouth that’s a function of HIV, or the amount, or type of medications the patient is taking?

Dr. Yamashiro: Sometimes there’s not a lot you can do. We can prescribe Salagen, (which stimulates salivation), to patients. For some it works, for some it does not work. There’s also salivation replacement therapies they can buy at the store: ACT mouth wash and Biotene spray to name a couple. But they’re all quick fixes that don’t last all day. So, for a lot of patients, it’s difficult to take care of the problem 100%. Sometimes they have to work with physicians to get off those meds or change them. But for some that’s just not possible. They have to suffer with the dry mouth that leads to plaque build-up and tooth decay. It’s frustrating to them because they brush and floss and still get decay.  A lot of times it’s emotionally draining, because they say ‘why should I try when I still keep having this problem?’

Are there any changes in the dental clinic that we ought to know about?

Dr. Jo: Now that we’re a full Federally Qualified Health Center, it’s good for our patients and our workflow as well. The biggest change is we’re growing: They brought me in as the second full-time provider; we have another part-time hygienist; we have more assistance at the front desk. It’s good. We’re starting to scale up so we can provide more services to more patients. In terms of that, I think we’re on the right path.

D.A.P. tests new treatment for drug-resi …

Desert AIDS Project is studying a new treatment for a very pervasive sexually-transmitted infection (STI) that’s now become drug-resistant.

Under the direction of Dr. Steven Scheibel, D.A.P. is studying the efficacy, safety, and side effects of a drug that combats Nesseria gonorrhoeae, the bacteria that causes gonorrhea.

Gonorrhea is the second most common STI and a major source of morbidity worldwide. Without treatment, it can cause infertility, cervicitis, proctitis, urethritis, pelvic inflammatory disease, and pharyngitis. Babies grow outside the womb in some women and the infection makes both genders more susceptible to HIV, according to GlaxoSmithKline, sponsor of the study. They go on to say:

“The ability of Neisseria gonorrhoeae to develop resistance to antimicrobials has complicated the management of the disease, leading to an urgent need for new treatment options.”

D.A.P. is one of eight medical centers testing the new drug, called GSK2140944. The study invites 60 adults with gonorrhea infection to take a single dose of either 1,500-mg or 3,000-mg of GSK2140944. The study wants to know if the smaller or the larger dose works best. The study last about a week with two scheduled visits. On the first visit, doctors will dispense the drug and gather baseline information from the study subject. A follow-up visit, called the Test-of-Cure visit, occurs between day 4 and 8 and determines the subject’s response to the drug. That includes success, failure, and adverse effects. Although there are two scheduled visits, bad reactions to the new drug will be monitored until they are resolved.

So far, D.A.P. has enrolled three subjects in the study, to meet the six-subject goal for each site. Our clinical administrators are working on identifying additional subjects. “Right now, though, we have more subjects than any other site and we’ve enrolled them quickly,” says Rod Hagan, D.A.P.’s Clinical Research Coordinator. D.A.P. began accepting subjects about six weeks ago, while other sites have been at it since January. “We have a concentration of people in the Coachella Valley, who need support in fighting gonorrhea infection, so our services have to be cutting edge and we must be fast out of the blocks,” Dr. Scheibel states.

Although the name of the drug sounds like a chemical weapon from an action hero comic strip, the problem and the need for an immediate answer is very real.

According to the study protocol, a variety of antimicrobial agents have been used over the years for the treatment of gonorrhea. Effective treatment options for gonorrhea have diminished rapidly because of the emergence and worldwide spread of antimicrobial resistance to many drugs previously used or considered the first line. The study goes on to list six drugs that patients are taking to almost no effect.

“Azithromycin was the big tah-dah,” Rod says. “But N. gonorrhoeae has become resistant to it and there’s nothing else in the pipeline. Without a new treatment, it could be like it was at the turn of the century again and it could be fatal.”

D.A.P. is trying to keep that from happening. We’re participating in this study and several other clinical trials that aim to improve the lives of patients and clients living with HIV. The search for a new antimicrobial is one of five that D.A.P. has conducted in the past 12 months. Those studies include Medication Therapy Management, a study on HIV, aging, and the brain, a study that searches for a milder antiretroviral that we’ve called Switch, and a new treatment for anal dysplasia. These studies represent a new function we’ll perform for the HIV community here and abroad. Beyond those in disadvantaged communities in the Coachella Valley, many others — nationally and globally — will benefit from our findings.

“Our search for a new treatment for this drug-resistant strain of gonorrhea is one of the most important things we can do,” Dr. Scheibel says. “We have to get out in front of this challenge because it threatens us locally and globally.”

 

In the Coachella Valley… “throw a ro …

That’s how clients of Desert AIDS Project describe the prevalence of crystal methamphetamine –commonly referred to as meth, crystal, Tina, ice, or glass, among other street names – in the Coachella Valley. Just as crystal meth has become a social problem on a global scale, our clients insist it plagues many of the people D.A.P. seek to provide medical care and social services.

Ray Robertson, Client Wellness Services Center Manager, knows this all too well. He was already a certified recovery counselor with about 20 years of experience leading a local, residential treatment facility before coming to D.A.P. more than five years ago. Having earned 29 years of sobriety himself, Ray sensed that addiction is an issue among many of our patients and clients living with HIV, who need a way back to a safer, saner life.

So he established the “Crystal Meth Action Team,” which held its first meeting this summer. Ray knew that D.A.P. had previously organized the “Crystal Meth Task Force” some years ago, to take on its use valley-wide. However, the task force dissolved in part because its mission was too broad and because it actually scared off some of the people it wanted to attract. When people encountered the Crystal Meth Task Force at the popular Thursday evening street fair in downtown Palm Springs, they thought they were being targeted by the police.

“We’re not going to ferret out users and bring them to judgment day,” Ray told team members at an initial brainstorming session. “What we’re going to be doing is opening doors to recovery.”

The Action Team’s primary goal is to develop strategies for creating a compassionate, nonjudgmental space where clients will feel welcomed and safe in sharing. No matter whether they use crystal meth themselves or have someone in their life who does, the Action Team members want to see that clients receive the help they ask for … whether that is simply more information, a chance to talk with someone who understands, or to actively engage in care. At the first gathering, members shared their experiences with meth and other substance use. Some are in recovery while others haven’t “used” but have watched friends and loved ones wrestle with substance abuse challenges.

Team members also discussed why they joined and what they believe should be done for those in the grips of this powerful habit. Many spoke from experience:

“I got HIV from sharing a needle I used to shoot crystal.”

“When you’re ‘slamming’ meth, it takes over and you forget everything else.”

“When you use meth, there are three possible endings: dead, in jail, or in recovery.”

Be they former drug abusers or “normies,” who’ve never used, team members agreed that users must be offered an avenue to recovery that’s safe, humane, and free from judgment or stigma. During the first meeting of the Crystal Meth Action Team, Ray diagrammed this concept for how recovery might begin to happen:

“Let’s open a corridor to doors – and behind each door is yet another recovery option.
Let’s make it comfortable for anyone to open those doors without fear of repercussions.”

The diagram resembled a pathway leading north with several roads intersecting it along the way. Ray labeled each of those connectors as team members suggested services: a helpline; education, outreach, and mentoring; referrals to 12-step programs such as Narcotics Anonymous; safe social connections; strategies to break the connection between sex and meth; housing options during recovery; and literature describing meth’s effect on the body, particularly when HIV-positive. Several team members were enthusiastic about the books “Chasing the Scream” and “Overcoming Crystal Meth Addiction,” the latter showing what the drug does to brain chemistry and physiology.

Team members are, understandably, concerned because of the unfortunately all-too-common link between meth and HIV. The New England Journal of Medicine calls meth an extremely strong stimulant that provides an escape from stress, depression, alienation, and loneliness. It increases sexual arousal while reducing inhibition and judgment. The drug often crosses paths with people who are under tremendous emotional duress because of their illness. Throw in homophobia and stigma attached to HIV, and you have a perfect storm touching down in the Coachella Valley.

Medical trials suggest that people living with HIV who are also using meth often have lapses in their antiretroviral treatment, which might make their infection drug resistant. It can also rearrange the brain chemistry causing psychosis and depression so that users cannot feel good without pharmaceutical help. “People struggling with addiction are in emotional pain and the remedy they turn to is as harmful as it is habit-forming,” Ray says. “As holistic healthcare providers, we want to address all parts of what is causing pain for our clients and patients, helping them back to full and healthy lives.”

Exciting breakthrough in treating dyspla …

Dr. Steven Scheibel, Medical Director at Desert AIDS Project, believes he’s found a new way to treat the conditions that can lead to anal cancer. The new therapy uses human papillomavirus (HPV) vaccines in conjunction with an immune-boosting cream to kill anal dysplasia, which is often a gateway to anal cancer. This therapy promises to be an alternative to surgery as well as a way to address soaring rates of HPV and resulting dysplasia, which weighs so heavily on gay men and those with HIV.

Dr. Scheibel, along with Dr. Praveena Yetur of LabCorp in Monrovia, wanted to treat anal dysplasia, which manifests as lesions in the anal cavity. These lesions can range from mild to severe and may morph into cancer. Working with a 55-year-old man with moderate to severe anal dysplasia, the patient was given imiquimod cream followed by injections of an HPV vaccine called Gardasil. By intervals of three to four weeks, the treatments were delivered over a two-year period. “The patient was screened for high-risk HPV on a weekly basis and had multiple biopsies to identify possible dysplasia,” Dr. Scheibel says. “The result was no virus and a normal anal Pap smear.”

Treatment for HPV and anal cancer is essential at D.A.P. because they pose growing threats to many of our patients. HPV is the most common sexually-transmitted virus circulating today, with up to 75% of sexually active people contracting it in their lifetimes, according to Boston Medical Center’s website. Medical experts agree that HPV infection is even higher in people with HIV. And, although anal cancer is still relatively rare, its prevalence is growing fast, particularly among men who have sex with men (MSM) and those who are HIV-positive, says BioMedCentral.com.  In fact, anal cancer among MSM with HIV is rising at 80 times the rate of the general population, Dr. Scheibel reports. Therefore, D.A.P. is busy searching for answers to HPV, anal cancer, and other clinical issues that challenge our patients.

HPV also is a key factor in head and neck cancer, for which we offer free screenings to clients, staff, and the general public once a year through the Annette Bloch Cancer Care Center. Dr. Scheibel leads a movement to increase clinical research performed under our roof and has made notable headway in the area of HPV and anal dysplasia. The treatment has shown so much promise that Dr. Scheibel will present his findings at “HPV 2015,” the 30th International Papillomavirus Conference in Lisbon, Portugal, held September 17-21.

Researching disease and sharing results with international colleagues, is not new to the internist, who specializes in infectious disease and is AAHIVS credentialed as an HIV Specialist. Dr. Scheibel has done clinical research on HIV and AIDS for decades and was a researcher as well as co-founder and Associate Medical Director of the Community Health Network in Rochester, N.Y., in 1989. He’s been on teams whose work is cited in books such as “Public Health Behind Bars: From Prisons to Communities.” Dr. Scheibel has presented at the Conference on Retroviruses and Opportunistic Infections, the Symposium on Cell Biology of Virus Entry, and he’s traveled to such cities as San Francisco, Casablanca, and Yokohama, Japan, to appear at the International Conference on AIDS.

Nevertheless, presentation at the HPV conference is special, says Rod Hagan, D.A.P.’s Clinical Research Coordinator: “If we could demonstrate a potential treatment for dysplasia that would prevent the need for the invasive surgical solutions that are out there, then this is huge. And getting the rate of HPV among our patients in line with that of the general population… yes, the potential of this is pretty exciting.”