 What I actually think is that Victoria leads people and other similar medications lead people to feel normal, but the normal in today's America, particularly during a pandemic, is to sit on your sofa and eat bonbons and watch Netflix, right? So everybody's gaining weight. Right. What's going on everyone? So I'm here for my once every six month doctor's visit. And yeah, as I always do, I like to show the course of the visit so that you get a feel for what it's like to go to see an HIV doctor and the kinds of questions they ask and the kinds of routine things we do, hopefully to kind of demystify the whole experience and take some of that fear and like worry about what that's like away. All right. Here we go. How are you today? You're just here for HIV follow up, right? What was your name? Matt. Dr. McFarland. Doesn't matter. Okay, cool. Was there anything else you wanted to talk about today other than HIV follow up, anything concerning you? And you're still taking the big tarvy? I am. Any issues with the big tarvy? No issues. I'd like to blame my weight gain on it, but I think it's just my lifestyle change more than anything. I'm probably going to blame the pandemic and that gyms aren't open and life is not that great and it's hard to motivate to work out. The studies on, you know, integrase inhibitors and weight gain aren't the greatest. So I'm inclined to trust those. And it's just so easy to kind of blame it on that and don't know what I'm finding. And big tarvy is about the easiest, best medication that we have, so I hate to change that. It's something we can keep an eye on for sure and your other markers like your marker for diabetes looked fantastic last time, which would be something to keep an eye on. We'll check that about every year unless something changes. And your cholesterol was a little bit elevated, it was 210 for total and your bad was 130, by no means anywhere where we would need to treat it with medications. But something to keep an eye on with your weight gain and making sure you're staying active, staying healthy, it will keep an eye on about every six months. I usually am like getting ready for a competition for men's physique body building. Natural. And so like the last one I did was October 2019, and I think I weighed like 160 pounds. And I did that. And then March came, 2020, and I'm pushing 200. Is that it looks like mostly muscle, but if you put like not been trying to gain muscle. No, I mean, it's fat. I appreciate it though. I'm glad. Do you use any other like supplements like workout supplements or testosterone? I haven't really been lately that much since I haven't been working out, but I just got a bench. So basically I'll take whey protein, creatine, glucosamine, I'll take vitamin D, pre-workout, post-workout. Okay. BCAA is all natural. Okay. Yeah. Do you ever do testosterone? No. Never done it. Excellent. And then just to run through your other med lists to make sure that we're up to date. So you still take the Adderall, and you take the 10 milligrams every day? No, it's just as needed. As needed. Okay. For that and the L-prosaline? And L-prosaline. Okay. Yeah. And then are you still taking mechilazine? Mechilazine. Like Antibur helps with like vertigo and dizziness and nausea. No, I only had vertigo for a few weeks and I was taking it. Okay, great. Just take that off. And then you're taking finasteride for hair. Okay. Yeah. And then are you still using the inhaler as well, the memetazone? No. No. That was a sinus urinals. Yeah. Okay. So you're done with that? Yeah. I just took over the counters or a tuck. Okay. And then your last CD4 count looked great. It was in... Double check. It was 500. Yeah. 550s. Viral lobe was still undetectable. Everything is still going well. Yeah. The pressure looks great today. Cool. The... And then with everything going on, are you still sexually active? Yeah. Yeah. I have a boyfriend. Okay. Any concern for STIs today? No. No, like sore throat, pain with swallowing, pain with pee, peeing, discharge or a penis or anal pain or discharge. No, we're symptoms. Okay. If you want, we can go ahead and skip testing today. We'll just check the syphilis titer just to have that as baseline because you've had it in the past, but otherwise we can skip the other testing if you're into that. Okay. That's fine. And then did you get the flu shot this year? I did. Thank you for doing that. Yeah. When did you get it? Do you remember? It's January now. Like November or October? Yeah. November, December probably. Okay. And then do you remember the last time you had a meningitis vaccine? I don't. Have you been seeing Jay for long enough? It's been in his old clinic. Do you know? I think it was, well, it was when they were upstairs. When they were upstairs? Yeah. Let me just see if there's some immunization records I can pull over from the last chart. Because if not, you would be due for an additional pneumonia vaccine, the pneumavax. You have Prevnar. They cover a little bit of the different strains of the pneumonia vicaria. And then a meningitis again. You just need that every five years. Gotcha. Does that get recorded on the Helio app? It does. And whatever's on the Helio app would also be in our system. And I don't see a meningitis recorded. Probably because you've had it recently enough. I think it's Helio. I don't know. Kind of awkward. Not known for pronouncing things well. My friends always make fun of me for it. So I'm sure I'm saying the app wrong. How do you spell your last name? R-R-A-Z-I. And what's your birthday? May 8th, 1985. I'm just going to throw in when you had your last tetanus so we don't bother you with that. When was that? 2015. And then we should give you, you had the other pneumonia so you'd be due for pneumavax today. And then we also should give you the menactra or the meningitis vaccine too. Fun. Probably not the vaccines you were hoping for today. No, I want the other one. Do you know if they're going to be doing vaccines through this clinic? So right now everything is being controlled by LA County Department of Public Health. So for a while we had some of the Moderna vaccine for healthcare workers in the building and around here. Because we have the freezer capabilities but everything was being done through the county. So you still have to sign up through the county to then get it here. So that's still the case right now. Unfortunately it seems like now that we're opening who can get the vaccine supply is becoming more of an issue. So I heard today that some of the vaccine sites in LA County are shutting down temporarily because we just don't have the supply. Okay. And thankfully HIV does not seem to predispose you to getting it or worse outcomes. So it doesn't bump you up in the list but it's good for if you get exposed to it. I'm assuming if you have like a really low CD4 then that's a slightly different story. Potentially. We just definitely for well controlled like you are. It's not a worry or a risk. Was there anything else you wanted to talk about today? I don't think so. Talk with Jay and then we'll come back shortly. Otherwise we'll just grab some labs today. Grab some urine and then we'll give you the two vaccines. You're good to go. Cool. Hello. Hey. Well good morning. Good morning. I'm good. How are you doing? I'm good. You look great. Thank you. I'm pushing 200 now. Get out. I didn't look at your weight. Yeah. How did you do that? I mean crunch has been closed for a year and I was working full-time bartending on my feet six, seven years a day and now I'm sedentary most of the day. So I just got a pellet on them and I got a bench and some weights. Yeah. So what have you been doing exercise? I tried to run for a while and then I got shin splints. I tried to do just various things and now I'm working like 60, 70 hours a week. What are you doing for work? I struggle a lot of things. I'm working for my parent's manufacturing plant. Polyethylene plastic bags tubing sheeting in Orange County. So I'm commuting and that's 40 hours a week. I'm assisting Miss Peppermint. She's a trans drag queen. She was on RuPaul's Drag Race and we've become friends. So now we're also co-producing some things together and fantastic. You know, working on that and getting that cash flow coming in. And then I'm also working with Carl Schmidt on Plus Life. So we have ongoing relationship there and then I'm doing my own social media stuff as well. Terrific. Excellent. It's been busy. Tell me more about Plus Life. Oh, yeah. So that's, it was originally just internet based platform with videos talking about HIV and then just like living your best life in general. So it appeals to everyone. But we kind of like sneak that in. And then Localish picked it up for their new digital cable channel. So now we have like a 30 minute show that airs once a week. And then on that I'll do like a five minute fitness segment. And I'll talk to other fitness gurus and share their modalities. Excellent. Excellent. Yeah. So when you said you're pushing 200, is that, that's 200 pounds of muscle or 200 pounds of other stuff? Okay. That's 200 pounds of being a sedentary. Yeah. And I did, it wasn't until like maybe two weeks ago that I finally got a weight bench and some 100 pound dumbbells. Yeah, weight, weight benches are not very expensive. No, it's not bad. We got on a couple. The bike was expensive. It just takes up space is the only thing. Yeah. Mars folds up. Although we leave it. Yeah. So they went propped up on the wall. And I got to pull it up too. So with that and the bike. Just over a month ago. Yeah. If I get a routine going, then I should be fine. Yeah. When did you get the Peloton? I got it in December. And have you been using it? I have. It started but not consistently. Okay. So you're not hooked on it yet? It's just me, I gotta figure out how to manage my time better. From Monday through Thursday I slept eight hours because I was just working. Oh. Got it. So. Not eight hours a night, but eight hours. Total. Yeah. So I'm trying to figure everything out. Okay. Yeah. We're good? Yeah. Yeah, it'll be kind of interesting to see what happens to like what we choose to do when the gym's open back up again. Yeah. Because now I've got all this stuff at home. Exactly. What do you call it? A power tower. Oh. Which is also pretty inexpensive. So you can do like pull ups and stuff on it? Yeah. And you can do some other stuff. You can do like, you know, the little things when you're at it. Yeah. This thing. And like you can do these things, dips. That's great. You can use it for cable-y stuff, but I haven't really done that yet. Yeah. Yeah. But it's really. That saves me 30, 40 minutes. Exactly. Going straight from and I'm working from home anyway. I really like having that stuff at home. Me too. You know, you don't have obviously as much. Yeah. But it saves the time and I've been using it. I'm on the Peloton every other day. Yeah. I had knee surgery a couple months ago. So I have to, I can't run right now. I will be able to run again, but not yet. Did you have an injury or just? I had a chronic injury that finally needed some attention. So I had a partial knee replacement. Wow. Makes me feel old. Not a full knee replacement. So I'm not quite that old. But so the bike is okay on it. Yeah. Good. So that's all good. So yeah, have fun with Peloton. Yeah. What else can we do for you young man? I would love for you to talk about the FDA approval of the long. Wow. I'd love to. So last week, the FDA approved a medication with the brand name Kabanuva. And the generic name is Cavitegravereal Pimerine Long Acting. Okay. Kind of a mouthful. It is the first FDA approved injectable HIV medication. It is, so there's kind of a two trends going on in HIV therapy. But before I talk about HIV therapy, let me take a step back and talk about what we would ultimately love to do in terms of development of medication and therapies. And that is cure. So there is ongoing work on cure until we have a cure. We're just working on better and better therapy. So you're on a really, really good therapy. You're on one pill once a day. It has, you tell me what it has for side effects. Nothing. Nothing. So, and it doesn't have any measurable impact on kidney health, on bone health, on cholesterol. There's, you know, people are constantly drilling down and finding, trying to find out if there's a downside to medication, but they're having a really hard time with BigTarvy. Yeah. And you may know what some of the, and I'm getting to your question, by the way, but you may know what some of the current kind of controversy is around BigTarvy and similar medications as we drill down and try to find. Is that the weight thing? Weight. So that's all kind of. But I'm also kind of like, is that. That's a very. Is that chicken or egg? Like exactly. That's a very, very nebulous question. Yeah. And what we can't tease out is, does some HIV medications cause weight loss because they make people feel nauseated? We also can't tease out, you know, America in general is gaining weight in case you haven't noticed. People are big. And what I actually think is that BigTarvy leads people and other similar medications lead people to feel normal. But the normal in today's America, particularly during a pandemic is to sit on your sofa and eat bonbons and watch Netflix. Right. So everybody's gaining weight. Right. And I find some people on BigTarvy gain weight. Some people on BigTarvy lose weight, get fit, feel great. Yeah. Anyway, what I'm getting at is you're on a really, really good combination. And when it comes to therapies, the current trend in research is to find things that are as good and then maybe that have some advantage, not really in safety because you can't get safer than something that's already incredibly safe. Yeah. Or find things that have an advantage in terms of different ways of getting the same medication into people's bodies. And the two areas that are getting developed are two drug therapies instead of three. There's three active meds in BigTarvy. That's traditionally what we've done since we've had effective therapy is use three meds to shut the virus down. So we're now finding that in some combinations you can use just two. And then the other area that's getting developed is long-term injectables. So this is the first long-term injectable. It happens to be a two-drug therapy. It's exciting to have a new delivery system, so injections instead of pills. It's not new in the sense that these are new classes of medications. These are the same medications just delivered by a different mechanism, different route. And that may be appealing to some people. There's more work going on to develop other long-term injectables. I don't think we'll have anything available for several years. So this is the first one. When it was approved last week, it was approved to be given once a month. There's also research going on right now, looking at giving it once every two months. Same medication. It's given as a deep muscle injection into the gluteus medius. So that goes deep in here. And it's actually two injections. Capitagovir, real pivoting. One on each side once a month. There is some discomfort with the injection. The discomfort tends to get less and less with time as people get, you know, know what to expect. I don't remember if you've ever had a deep injection in your butt. What's that? Yeah, exactly. So it's kind of like that, maybe not quite as bad. That's what people tend to say. Okay. And for some people it's appealing. They would prefer not to take pills every day and they would rather just get a shot every month. Again, hopefully within the year we'll have approval to give it every two months instead of every month. It is given in the office. So it does require an office visit. Is that a logistical concern about having more and more people coming in and out on a regular basis? Yes. It's a logistical concern particularly during COVID. It's also a logistical concern in the sense of, so what we do now is we see you like twice a year, right? Yeah. And we draw some blood and we give it to you. And then you go home and who's responsible for you taking the Victoria? I am. You are? Yeah. So we see you later and hopefully everything is good. You're taking your Victoria, all your labs are great. It's a little different though now that it's this injection that we're now somewhat responsible because what do we do if you've got an appointment to come back in a month for your injection and someone doesn't show up? Yeah. Then we have to chase them down otherwise there's issues of having drug levels that are not ideal. Yeah. So it's exciting that we've got new regimens available, new modalities. It can appeal to some people. And the real hope is that the real goal I think as you know with HIV is to get everybody to undetectable. And what's the name of the show that you're doing again? Plus Life? Yeah. So you probably talk about that with Plus Life that essentially you get to undetectable, all of life is open to you in all of its fullness, right? But not everybody with HIV is able to get there as easily as others. So we give you your Victoria prescription, you take it every day. Not everybody's going to do that. So people that don't have a place, a secure place to live, they find it hard to keep their meds. Women in particular who live with HIV may not find it, they may not feel safe to have their medication in their cabinet where somebody else may see it. Or people that have more shame around HIV may not want to look at their meds every day. And that can get in the way of people taking their meds and then getting to undetectable. And if they're not going to get undetectable, they're not going to have their full range of a healthy life. So it's nice to have other options and it's a good sign that we're going to have other options yet in the future that maybe every three months or every six months, they're even looking at things that are given by a little injection or a little incision with an implant once a year. So that's what's going on research-wise. Was that a long-winded answer to your question? Thank you for joining this interview. Yeah. I hope you didn't mind me talking for about a half an hour now and stop. Okay, Kato? Yep. Okay. Let's get you out here and get some blood out of you. Okay? You probably see my shoes like doing this while she's getting ready to give me these shots because that's my nerves. As much as I get picked and prodded with needles, I still get nervous. Okay. I'm going to do this year in and then that's it. We're good to go. Bye, guys.