Covid-19; New HIV treatments; Single and Starting PrEP?
GGN had some burning questions and took them to the long-time trusted pharmacist in the heart of Toronto’s Village, Zahid Somani, who just opened his second Village Pharmacy location serving Toronto’s LGBTQ+ community.
GGN: There’s so much pandemic talk out there – give us the real deal about COVID19 and HIV. Are HIV-positive people more at risk?
Zahid Somani: This is absolutely a question that’s top of mind for everyone. If you’re HIV-positive and on effective treatment, you are not at any greater risk than anyone else for COVID19, according to The World Health Organization, the CDC (US Centers for Disease Control), UNAIDS, and Canada’s own CATIE, to name a few. It’s still vitally important that you take your meds regularly, have good hygiene (wash your hands often / don’t touch your face), practice physical distancing, and contact your doctor or pharmacist if you have questions about your meds, or think you might have COVID19.
For people whose CD4 count is on the low side or who are not on treatment for HIV for any reason, and for those over the age of 60 for whom there may also be underlying health issues (like heart disease, diabetes, etc), there is a greater risk for serious illness from COVID19 infection. If any of these scenarios apply to you, please start/resume HIV treatment right away. I’d also say it’s a good idea to take extra precautions – stay at home and arrange deliveries for food and meds. And, if you feel unwell, contact your doctor as soon as possible.
GGN: What’s new with HIV treatment – it feels like there’s always something.
Somani: The amazing thing about HIV treatment is that it’s always evolving. There’s so much research going on around the world, and exciting new developments that are helping people live long and healthy lives. We’ve come a long way from the days of AZT & HIV cocktails, and in a relatively short amount of time too.
There’s a couple of things that are exciting about the latest HIV treatments:
The first is ‘Dual Drug Therapy,’ that is, 2-in-one single-tablet treatments that maintain viral suppression and overall good health, with lower cost and fewer side-effects. I’ve found that my clients appreciate that the single-pill regimens are convenient and well-tolerated, which makes taking meds regularly that much easier.
Dovato is the latest single-tablet regimen available for the treatment of HIV and is now covered by the Ontario Drug Benefit program (ODB) as well as most insurance companies. Dovato is approved for those who are newly diagnosed with HIV and just starting anti-retroviral therapy, or for those with high viral loads. Trials are currently underway to assess the effectiveness of Dovato when switching from more complicated regimens. Initial results are promising.
Juluca is also a new 2-in-one that is approved for use in Canada, and it is covered by ODB. Doctors prescribe Juluca as maintenance therapy, that is, once the virus has been suppressed for some time, and is a good option to consider if you want to simplify your drug regimen.
Injectables are another new development in HIV treatment. Cabenuva is the first long-acting HIV injection to be approved in Canada and the first anywhere in the world. The drug, by Glaxo-Smith Kline, is administered once a month. It’s still early days, and details are limited right now about costs and insurance coverage, but we’re certainly keeping tabs on how this will roll out as a treatment option in Ontario.
GGN: It’s amazing how many MSM are unaware of what “undetectable” means. The U=U campaign is helping with education around that.
Somani: Yes! U=U stands for Undetectable = Untransmissible, and that is absolutely true. Based on much research around the world, U=U means that if HIV is suppressed in your body, and your viral load is undetectable on a blood test, you cannot transmit HIV to a sexual partner, period. The Government of Canada has officially endorsed U=U and provides guidance to medical professionals.
GGN: A 40+ friend who is HIV-negative is just coming out of a long-term monogamous relationship. Is PrEP right for someone like them?
Somani: Over 40% of new HIV infections in Canada are among those over 40. That’s sobering. Thinking about PrEP means you’re taking control of your health. And, at the same time, you’re helping to reduce the spread of HIV in the community. No matter your age, if you have multiple sexual partners and want peace-of-mind protection from HIV infection, PrEP is an option that provides 95%+ protection against HIV infection when taken as directed.
PrEP is just one pill once a day and is generally very well-tolerated. Both generic Truvada and the newer Descovy are used for PrEP and are equally effective. However, Truvada is much cheaper and is covered by insurance plans and the Ontario Drug Benefit program.
GGN: You’ve been on Church Street in Toronto for a long time and now you’ve just opened up a second location on Yonge Street. What drove that decision?
Somani: You’re right! I’ve been around since the early days of HIV, and I’ve seen both HIV treatment and the Village evolve during that time. The Church Street location will always be our hub. Unfortunately, the HIV-infection rate in Toronto and across Ontario continues to go up each year, so the need to reach more people with front-line HIV expertise remains higher than ever.
The 535 Yonge Street location has given us extra space to offer more in-depth HIV services including HIV-testing, HIV medication consultations for both existing and New-to-HIV clients, and PrEP consultations in a safe, welcoming and confidential space. Providing access to care is something we’ve worked hard on, and will continue to do moving forward. This means helping with insurance and trillium applications, co-pay support, connecting them to doctors/clinics, HIV-services and mental health organizations and more.
I’m so blessed to have great staff who are friendly and knowledgeable in HIV, understand the importance of confidentiality, and have a good, solid, no-nonsense work ethic. They’ve been amazing, especially during this crisis.
Both our locations are open regular hours and provide phone/text consultations and free-delivery as always. Clients can also find info about our services on our website, along with COVID19 updates, and a trove of HIV & PrEP resources plus my HIV blog.
GGN: Final thoughts?
Somani: Just a couple: In these crazy pandemic times, for those of you who are HIV-positive or think you might be positive, getting on and staying on HIV treatment is the number one thing you can do for your health. And for everyone, physical distancing, washing your hands, not touching your face, and getting in touch with your doctor as soon as you’re feeling unwell, can go a long way to staying healthy at this time.
